What are the most common causes of pathologic changes in bones and joints?
Congenital anomalies
Trauma
Infection
Metabolic disorders
Endocrine disorders
Tumors
Circulatory disorders
Neurologic disorders
Psychologic disorders
What are the 5 major complaints in orthopedic patients?
Pain
Deformity
Paralysis
Instability
Mechanical symptoms
In the analysis of pain, what is the PQRST method?
Provocative/palliative
Quality
Radiation
Severity
Temporal
What should be determined in the analysis of deformity?
Character
When first noticed and by whom
Association with injury or disease
Increasing?
Extend of disability caused by it
What should be determined in the analysis of instability and mechanical symptoms?
Date and circumstances of initial event
Frequency and activities causing recurrence
Neurovascular symptoms associated with instability episodes
Measurement of joint range of motion is done with?
goniometer
If there is any doubt about the orthopedic diagnosis, what should be done to confirm the clinical diagnosis?
X-rays of the opposite (normal) side to detect subtle differences
A break straight across the shaft of the bone.
Transverse fracture
A break at an oblique angle to the shaft of the bone
Oblique fracture
The break twists around the shaft of the bone and the two ends of the twist are connected by a longitudinal fracture
Spiral fracture
A transverse fracture through one cortex of a bone
Greenstick fracture
A break in which the bone is fragmented into more than two pieces
Comminuted fracture
The ends of the broken bone are jabbed into each other
Impacted fracture
A fracture in which the skin is left intact
Close fracture
Fracture associated with an open wound that extends between the fracture and the skin surface so that there is a communication of the bone with the outside environment
Open fracture
In diagnosis of a fracture, what is important to remember when taking x-rays of the injury?
X-ray the joint above and below the bone involved
What is the sequence of the healing process for fractures?
Inflammatory Stage
Reparative Stage
Remodeling Stage
Which phase of the healing process? A hematoma is formed from ruptured blood vessels. Some of the injured vessels thrombose, leading to necrosis and then inflammatory cells invade the organizing hematoma.
Inflammatory phase
Which phase of the healing process? Pluripotential mesenchymal cells and new capillaries invade the organized hematoma. Mesenchymal cells differentiate to form callus.
Reparative phase
Which phase of the healing process? New bone formed by the osteoblasts predominate over the other elements of the callus and new bone is formed.
Remodeling phase
What type of pediatric fracture injuries may be more difficult to recognize on x-ray and therefore it is essential to get the normal limb for comparison?
Epiphyseal injuries
What type of fractures must be reduced anatomically if possible?
Intra-articular
How should the initial cast be applied?
So that it immobilizes the joint above and below the fracture site.
Blood in the joint cavity
hemarthrosis
What is a late finding in acute compartment syndrome that is not needed to make the diagnosis?
Loss of motor and sensory function
Infection of the bone
osteomyelitis
Infection of a joint
septic arthritis
Where the most frequently involved site for osteomyelitis?
rapidly growing metaphyseal region of the long bones
Dead bone
sequestra
Osteomyelitis causing a periosteal reaction may lead to what?
involucrum formation and eventual repair
What is a common complaint in peds patients with osteomyelitis?
pseudoparalysis in the upper extremity of older children and extremities of infants
What can be helpful in the initial exam and follow-up for patients with osteomyelitis?
circumferential measurements of involved and uninvolved extremities
Patients with lesions resembling Ewing's sarcoma or eosinophilic granuloma have proved to have indolent osteomyelitis, called?
Brodie's abscess
Typical lytic and periosteal bone changes of acute osteomyelitis do not appear for?
10-12 days
What kind of imaging can be helpful in making a diagnosis of osteomyelitis?
soft tissue radiographs of normal and involved extremities
What is the earliest x-ray finding in osteomyelitis before changes take place in the bone?
deep soft tissue swelling adjacent to the metaphysis that appears as a displacement of the deep muscle plane away from the bone
Pseudomonas osteomyelitis is not too uncommon, especially in association with what kind of wounds?
puncture wounds
What are the most important aspects of care in the first 6-12 hours of treatment of osteomyelitis?
general supportive measures
Do you need surgery for osteomyelitis?
Surgical incision and drainage is often necessary, but rarely required as an immediate procedure.
When should you take x-rays for acute cervical sprains?
ALWAYS (to r/o fracture or dislocation)
Neural arch is defective but neural contents do NOT herniate
spina bifida occulta
one or more layers of the meninges herniate through the neural arch defect
spina bifida with meningocele
hernial sac contains meninges, cerebrospinal fluid, spinal cord and/or nerve roots
spina bifida with meningomyelocele
Name this test: wrist held in neutral position and thumb flexed into the palm; the hand is then deviated toward the ulnar side
Finkelstein's test
Finkelstein's test is the most specific test to diagnose?
De Quervain's disease
What contains a clear, gelatinous substance?
cyst
In Mallet/Baseball finger, what kind of extension is retained?
Passive extension is present but active extension is lost
What are similar conditions to Dupuytren's contracture?
Plantar fascitis
Peyronie's disease
What are important parts to the stability and function of the knee?
quadriceps muscle and its tendinous expansions
How serious is a dysplastic acetabulum in a pediatric patient?
VERY serious and must be recognized ASAP or a normal hip joint will not develop
When should treatment be started for congenital dislocation of the hip?
Ideally on the first day of life
What should always be obtained in a child complaining of knee pain?
A hip film
A lesion that arises from one or more of the cellular elements in osseous tissue
Primary bone tumor
Either arises within the bone because of a previous benign condition or is metastatic from a distant source. Should be considered malignant
Secondary bone tumor
A localized mass that grows by expansion and direct extension but does not metastasize.
Benign tumor
Characterized by uncontrolled local growth as well as the potential for metastatic disease
malignant tumor
What are the 3 basic patterns of bone destruction in primary bone tumors?
geographic
moth-eaten
permeative
Slow rate of growth of destructive bone tumor
geographic
intermediate rate of growth of destructive bone tumor
moth-eaten
rapid rate of growth with little host response to destructive bone tumor
permeative
New periosteal bone which is formed as a lesion expands the bone
onion-skinning
What are the two types of matrix production?
ossification
calcification
Appears as radiodense material with internal organization. Mineralization occurs in osteoids tissue that has been manufactured by bone-forming cells
ossification
Disorganized pattern of radiodense mineral primary in cartilage tumors and usually described as stippled or punctate areas of mineralization
calcification
Ossification perpendicular to the long axis of the bone and should make the clinician think of a malignant process
sunburst appearance
What is the most common malignant lesion of bone?
metastatic disease
What is the most common primary malignancy of bone?
myeloma
What are the 5 most common metastatic bone lesions?
breast, lung, thyroid, prostate, kidney
Breast and prostate lesions can be osteo____________.
blastic
Which is benign? A soft tissue mass that is well defined or diffuse swelling?
diffuse swelling
Rank in terms of least to most aggressive patterns of destruction: moth-eaten, geographic, permeative
geographic<moth-eaten<permeative
Which is the only non-aggressive periosteal reaction? Mature (buttressing), Layered (onion skinned), Codman triangle, sunburst
Mature
What is the only non-aggressive pattern of margination? poor, sharp, sharp with sclerotic margin
sharp with sclerotic margin
How do X-rays aid in nursemaids elbow diagnosis?
They don't
T/F there is no need to immobilize the thumb when treating DeQuervain's
True. It is contraindicated bc this can aggravate the problem when motion is resumed