Your SlideShare is downloading. ×
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Ortho jeopardy
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Ortho jeopardy

2,842

Published on

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
2,842
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
128
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Ortho Jeopardy I’ve fallen and I can’t get up Those crazy kids Stupid Canadians and their rules “ I don’t know Lloyd, the French are assholes” Code brown, I mean yellow Q $100 Q $200 Q $300 Q $400 Q $500 Q $100 Q $100 Q $100 Q $100 Q $200 Q $200 Q $200 Q $200 Q $300 Q $300 Q $300 Q $300 Q $400 Q $400 Q $400 Q $400 Q $500 Q $500 Q $500 Q $500 Final Jeopardy
  • 2. 40yo M w/ shoulder pain s/p shoulder reduction following volleyball game.
  • 3. Answer: Hill-Sachs deformity
  • 4. Hill Sachs deformity -compression fx of posterolateral humeral head from anterior rim of glenoid -50% of anterior dislocations -may infer damage to cartilagenous and/or osseous portions of the glenoid but does not change mgmt -associated with recurrent dislocations -only requires repair when associated with significant shoulder instability
  • 5. 79yo F s/p fall from standing, c/o hip pain. Name fracture, be specific
  • 6. Answer: Intertrochanteric femur fracture
  • 7. Intertrochanteric hip fracture
    • results from falls, generally in elderly
    • Most common hip fx
    • leg will be shortened, externally rotated (dislocation will be shortened internally rotated)
    • Bucks traction
    • admit for ORIF/hemiarthroplasty
  • 8. 16yo M w/ Rt elbow pain s/p fall onto right arm. Name the fracture and tell-tale sign seen here.
  • 9. Answer: Supracondylar fracture w/ Posterior fat pad sign
  • 10. Supracondylar fracture -make up 60% of fx of elbow -Type I: non displaced (posterior fat pad, sail sign, radiocapitellar line) - splint, ortho f/u Type II: partial displacement but retains cortical contact; III: posteromedial or posterolateral displacement w/o cortical contact -II and III admit for closed reduction, pin fixation, possible ORIF; -Volkmann's contracture: swelling  incr’d forearm pressure  muscle necrosis, fibrosis, contracture
  • 11. 25yo M w/ hip pain s/p fall from dorm loft. Give fracture and mgmt.
  • 12. Answer: Femoral neck fracture; emergent ortho consult
  • 13. Femoral neck fracture -intracapsular meaning higher risk for vascular compromise due to tearing of vessels or compression by hemarthrosis -admit all for ORIF but need emergent orthopedic consultation if young 2/2 high risk of AVN (w/ older pt they'll just do hemiarthroplasty)
  • 14. 29 y/o M slipped while playing soccer. Name the bony abnormality. Your Text Here
  • 15. Answer: Perilunate dislocation
  • 16. Perilunate dislocation -Results from forceful dorsiflexion (FOOSH) -Midcarpal ligament disruption -With enough force the ligaments are stripped away and the capitate is displaced posterior to the lunate producing posterior dislocation -Lunate maintains contact with the radius -Emergent orthopedic consultation
  • 17. 22yo “profressional skateboarder” w/ wrist pain s/p gnarly ollie. Name the Fx.
  • 18. Answer: Colle’s fracture
  • 19. Colle’s Fracture -FOOSH  distal radius metaphyseal fracture just proximal to radiocarpal joint with dorsal angulation of fracture fragment  "dinner fork deformity” -may include fracture of ulnar styloid, disruption of DRUJ  - check median nerve on exam -if non-displaced - sugartong w/ palmar flexion/ulnar deviation -if more than moderate angulation/displacement - reduce in ED w/ finger traps - may require OR but can d/c w/ ortho f/u
  • 20. 22yo M w/ Rt hand pain s/p altercation. Lacerations over knucles. Give Fx and mgmt.
  • 21. Answer: Boxer’s fracture w/ fight bite injury; Tx w/ copious irrigation and prophylactic abx
  • 22. Boxer’s fracture -Fracture through neck of 5th metacarpal 2/2 closed fist hitting solid object; -if >40degrees of angulation, should attempt reduction in ED -ulnar gutter splint w/ wrist at 30 degree extension and MCP at 90 -early hand sx f/u -beware the fight bite – ppx antibiotics
  • 23. 25yo F c/o Rt wrist pain s/p drunken fall. Name this injury.
  • 24. Answer:Scaphoid fracture
  • 25. Scaphoid fracture -Scaphoid transmits force from hand to forearm making it most common carpal bone fx (triquetrum=2, lunate=3) -Result from FOOSH or axial load on thumb -TTP over snuffbox - examine with wrist in ulnar deviation, and check for pain w/ axial loading of thumb -negative plain films in 10% - repeat in 2 weeks and splint if high degree of suspicion -non-displaced fx = thumb spica splint and non-emergent ortho referral, if displaced may need ORIF -risk of AVN and non-union if not treated appropriately
  • 26. 20yo snowboarder c/o L wrist pain s/p fall onto clenched fist.
  • 27. Answer: Smith’s fracture
  • 28. Smith’s fracture -aka "reverse Colle’s = fracture of distal radius with VOLAR angulation of distal fragment  "garden spade deformity" -result of fall on flexed wrist -tx same as colles, although volar angulation makes reduction difficult, if angulation not severe/tenting skin, just splint.
  • 29. 55yo M w/ wrist pain s/p fall. Name the injury and tell-tale sign
  • 30. Answer: Scapholunate dissociation
  • 31. Scapholunate dissociation -Pt c/o pain on radial side of wrist and clicking sensation -PE - scaphoid shift test w/ radial deviation and examiner pressing over volar aspect of scaphoid -widening of scapholunate joint space >3mm -may also get rotation of scaphoid  "signet ring sign” -usually require surgical repair -radial gutter or short arm splint w/ early ortho f/u -complications: early severe degenerative arthritis
  • 32. Your Text Here
  • 33. Your Text Here
  • 34. 19yo F w/ ankle pain s/p trip over curb. Name the Fx.
  • 35. Answer: Trimalleolar fracture
  • 36. Trimalleolar ankle fracture -Fracture involves lateral malleolus, medial malleolus and posterior aspect of distal tibia (posterior malleolus – misnomer) -If there is asymmetry in gap between the talar dome and 2 malleoli on mortise view, the injury is presumed to be unstable -Emergent ortho consult – may d/c w/ early o/p f/u if able to tolerate crutches
  • 37. 27yo M w/ lateral foot pain s/p rolling ankle during basketball game. Name the injury.
  • 38. Answer: Jones fracture
  • 39. Jones Fracture -transverse fx through base of 5th MT 2/2 inversion injury -several definitions: -fx of 5 th MT distal to JCT of metaphysis and diaphysis -10-20mm distal to proximal part of MT -fx distal to distal edge of neighboring cuboid -complicated by nonunion/malunion -conservative mgmt: ortho surgical boot, NWB for 6 weeks
  • 40. 50yo M w/ lateral knee pain s/p jumping off top rung of ladder.
  • 41. Answer: Tibial plateau fracture
  • 42. Tibial plateau fracture -MOA: strong varus/valgus force w/ axial loading, ie fall from height -lateral = 55-70% -commonly associated with ligamentous injury -non-displaced fx of one plateau - knee immobilizer, NWB, crutches, f/u ortho w/in a few days, possible o/p MRI -if depressed articular surface - early ortho consult and ORIF;
  • 43. 20yo M w/ lateral foot pain s/p twisting ankle.
  • 44. Answer: Pseudo-Jones fracture
  • 45. Pseudo-Jones fracture -2/2 inversion injury -avulsion fx of tuberosity of base of 5th MT -proximal to articulation of 4th and 5th MT -treat w/ cast shoe - WBAT
  • 46. 13yo M w/ knee pain s/p fall off bicycle. SH classification pls.
  • 47. Answer: Salter-Harris II
  • 48. Salter-Harris II fracture -SH classication used to classify fractures involving epiphyseal (growth) plate in children -SH II is most common type (75%) w/ good prognosis -fracture involves physis and metaphysis -generally conservative management is appropriate -ORIF is often required for type III and IV
  • 49. Salter-Harris Classification S – I – Slip A – II – Above L – III – Lower T – IV – Through R – V – Rammed
  • 50. 44yo M w/ midfoot pain s/p MVA
  • 51. Answer: Lisfranc Fracture
  • 52. Lisfranc injury -6 bone tarsometatarsal complex = Lisfranc joint, separates midfoot from forefoot - 20 percent of injuries are missed in ED -Fx of base of 2nd MT is pathognomonic for disruption of Lisfranc ligamentous complex -look for loss of alignment of 2nd through 4th MT w/ associated tarsal bones; -MOA ranges from minor rotational force to high speed MVA -frequently require ORIF -May be complicated by DP damage and severe DJD
  • 53. 70yo F s/p FOOSH
  • 54. Answer: Monteggia Fracture
  • 55. $200 Answer from H4 Your Text Here
  • 56. Monteggia Fracture -ulnar shaft fracture w/ proximal radial head dislocation -easy to miss radial head dislocation so be sure to image the elbow -be sure to check posterior interosseous nerve (finger/wrist extension) fxn b/c it wraps around proximal radius; -requires ORIF - call ortho
  • 57. 22yo M c/o pain at base of Lt thumb after punching wall
  • 58. Answer: Bennet’s fracture
  • 59. Bennet’s fracture -intraarticular fx at base of thumb -MOA: axial load to flexed/adducted thumb as in punch with closed fist -unstable fx - requires thumb spica and hand sx referral -complications include malunion, severe DJD
  • 60. 70yo F s/p FOOSH
  • 61. Answer: Galeazzi fracture
  • 62. Galeazzi fracture -distal radial fracture w/ DRUJ dislocation -emergent ortho referral for ORIF -be sure to check distal neurovascular status -MUGR (Monteggia=Ulna, Galeazzi=Radius)
  • 63. 55yo M w/ RLE pain s/p FFH
  • 64. Answer: Maisonneuve Fracture
  • 65. Maisonneuve Fracture -proximal fibular fracture assoc w/ rupture of deltoid ligament or fracture of medial malleolus (disruption of tibiofibular syndesmosis) -when you get ankle fracture, especially isolated medial malleolus fx, be sure to examine knee -requires immediate ortho consultation in ED -most require surgical repair of ankle fx/syndesmotic injury but may also be tx'ed conservatively w/ cast immobilization for 6-8 wks
  • 66. 22yo F w/ foot pain s/p jump from 2 nd floor fire.
  • 67. Answer: Calcaneus fracture
  • 68. Calcaneus fracture -MOA:fall from height onto foot -if high degree of suspicion but no obvious cortical disruption, check Boehler angle: <20 suggests depressed fracture -emergent ortho consult - tx varies: orthopods usually use CT to determine plan but most non-displaced fx can be managed conservatively -high incidence of compartment syndrome w/ comminuted fractures -check lumbar spine -
  • 69. 25yo M unrestrained driver w/ wrist pain s/p MVA
  • 70. Answer: Barton’s fracture
  • 71. Barton’s fracture -Fx of distal radial metaphysis w/ either volar or dorsal angulation (Colles/Smith) and intra-articular involvement and some carpal displacement – high force mech. -minimally displaced fx tx w/ splint and o/p ortho -unstable fx involving 50% of articular surface or associated carpal subluxation require ORIF - talk to ortho prior to d/c
  • 72. 32yo M tree cutter, new onset quad s/p tree branch to head.
  • 73. Answer: Jefferson fracture
  • 74. Jefferson fracture -fracture of C1 resulting from significant axial load to top of the head -4 part fracture involving both anterior and posterior arches -associated SCI common -treatment depends on integrity of transverse ligament  intact ligament: tx w/ hard collar; disrupted ligament  halo or surgery
  • 75. 55yo M unrestrained driver w/ wrist pain
  • 76. Answer: Lunate dislocation
  • 77. Lunate dislocation -similar to perilunate dislocation radiographically -triangular shape of lunate on AP view = &quot;piece of pie&quot; sign, lateral view shows lunate displaced volarly from radius = &quot;spilled teacup&quot; sign -unstable  emergent ortho consultation, most require OR -complications = early DJD, malunion/nonunion, AVN, median nerve compression
  • 78. 45yo M high speed MVA w/ low back pain, ankle pain
  • 79. Answer: Pilon fracture
  • 80. Pilon Fracture -aka Tibial Plafond Fracture -combination of & distal tibial metaphyseal frx, usually w/ tibiotalar articular involvement -vertical loading drives talus into distal tibia -commonly associated with other high force mechanism injuries, ie VB compression fracture
  • 81. Final Jeopardy 60yo M w/ wrist pain after trying to start Ford Model T
  • 82. Final Jeopardy Answer Hutchinson fracture -fracture of radial styloid w/ intra-articular involvement -aka Chauffeur’s fracture – back-firing of hand crank on old cars -requires ORIF

×