Ortho

Question 1

Should cast be circumferential in OR?

Answer 1

“Posterior mold / Splint “
Never - this is reserved for doc who will be following the patient long term
- This allows for swelling
- Should follow up as o/p in a week

Question 2

Which joints should be immobilized?

Answer 2

Both above and below

Question 3

What does ER cast / posterior mold consist of?

Answer 3

1. Padding
2. Plaster
3. Ace bandage

Question 4

What to always do after casting?

Answer 4

Repeat neurovascular exam

Question 5

What does axial loading of thumb check for?

Answer 5

Snuff box injury: push thumb down towards wrist to check for pain

Question 6

Why are we worried about scaphoid injury?

Answer 6

Blood supply to scaphoid is only coming from the radial artery
- At extremely high risk for avascular necrosis from this

Question 7

What is an occult fracture?

Answer 7

So small that can not be screened on xray

- Should be visible in 7-10 days in callus formation if there was a fracture

Question 8

How to treat scaphoid injury?

Answer 8

Thumb - spica immobilization

Question 9

What does a thumb spica entail?

Answer 9

1. ABduct thumb (holding wine glass)
2. Distal to IP joint of thumb
3. Proximal along distal 2/3 radial forearm
4. Wrist at 20 degrees
5. Pad along radial aspect of arm

Question 10

What is the ulnar collateral ligament?

Answer 10

Ligament running on medial aspect of thumb

Question 11

How to check for ulnar collateral injury?

Answer 11

Flex thumb and apply radial stress to check for laxity of ulnar ligament and tenderness over ligament

Question 12

When is thumb spica used?

Answer 12

1. Ulnar collateral ligament injury
2. Scaphoid injury
3. Lunate injury
4. Quervain tenosynovitis
5. 1st Mc fracture

Question 13

What is the last joint on index finger?

Answer 13

“DIP”

Distal interphalangeal joint

Question 14

What is mallet deformity?

Answer 14

DIP droops down

• Can be from hammering it “mallet”
• Or from blunt trauma to end of finger (softball)

Question 15

How to treat mallet injury?

Answer 15

Prolonged stint with finger in extension (6-8 weeks)

- Do not take off for any reason

Question 16

What is clam digger?

Answer 16

Splint that looks like your holding a sandwich

• Fingers are flexed at MCPs so you dont limit ROM of collateral ligaments upon removal
• MCP at 90

Question 17

When is sugar tong used?

Answer 17

Distal ulnar or radius fracture

Question 18

How to place sugar tong?

Answer 18

1. Palmar MCP, Around Elbow, Dorsal MCP
2. Elbow at 90 - use sling
3. Hand in functional positioning

Question 19

When is posterior mold used?

Answer 19

1. Elbow fracture or soft tissue injury

2. Proximal radius / ulnar injury

Question 20

How to place posterior mold?

Answer 20

1. Distal hand at palmar crease
2. Along forearm proximal to humerus
3. Elbow 90
4. Wrist and hand neutral
5. Abduct thumb, Wrist at 20

Question 21

What views to get when imaging extremities?

Answer 21

1. A/P
2. Lateral
3. Oblique

Question 22

First things to do if neurovascular compromise expected?

Answer 22

Straighten out the limb!

Question 23

What caulse an avulsed fracture?

Answer 23

A ligament pulling a piece of bone off

Question 24

Leigh man term for shattered bone?

Answer 24

Comminuted

Question 25

Difference between open and closed fracture?

Answer 25

Open needs to go to OR - much higher risk of infection and complication

Question 26

What abx for open fracture?

Answer 26

Cefazolin or ancef

Question 27

What can cause compartment syndrome?

Answer 27

Anything that can restrict blood supply 1. Casts 2. Fractures 3. Swelling

Question 28

Signs of compartment syndrome?

Answer 28

If you wait till all present it is too late: 1. Pain - there is no way to control it and it gets worse 2. Paresthesias 3. Pallor 4. Pulselessness 5. Poikilothermia

Question 29

Bacteria in septic joint?

Answer 29

1. Staph | 2. Neisseria

Question 30

Diagnosis septic joint?

Answer 30

1. Lactate over 10 | 2. WBC over 50k

Question 31

When is MRI needed in back pain?

Answer 31

1. Weakness not related to pain 2. Loss of bladder function 3. No fever / suspected epidural abscess 4. Saddle anesthesia

Question 32

Who to xray in low back pain?

Answer 32

1. Over 50 2. Cancer 3. Drug use 4. Osteoporosis 5. Fever

Question 33

Bedrest or bending activity better for low back pain?

Answer 33

Activity avoiding painful activities

Question 34

Nexus criteria?

Answer 34

1. No tenderness posterior midlines 2. No neurologic deficit 3. Normal alertness 4. No intoxication 5. No distracting injury

Question 35

What can a fracture at base of fifth metatarsal mimic?

Answer 35

Ankle fracture

Question 36

Risk supracondylar fracture in peds?

Answer 36

Brachial artery and medial nerve compromise w/ posteriorly displaced fracture

Question 37

What is nursemaid's elbow?

Answer 37

Toddler with arm yanked, or fall | - Arm held at side slightly flexed at elbow, semiflexed, prone

Question 38

What does the lachmans test examen?

Answer 38

Injury to ACL