Orthopedics: Spondylolisthesis and Fractures

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Questions and Answers

How is hyperlordosis characterized and in which demographic is it most common?

Hyperlordosis is characterized by an excessive inward curvature of the lumbar spine and is very common among females.

What is the purpose of Lachman’s test in orthopedic assessments?

To diagnose injury of the anterior cruciate ligament (ACL).

Describe the difference between a closed fracture and an open fracture.

A closed fracture does not break through the skin, while an open fracture does, exposing the bone to the outside environment.

What are the signs that might suggest Developmental Dislocation of the Hip (DDH) in infants?

Difficulty in changing the baby's diaper and limited mobility may suggest DDH. Signup and view all the answers

What imaging approaches does the ABCS method emphasize in evaluating fractures?

It emphasizes assessing adequacy of x-ray views, alignment, bone examination, cartilage assessment, and soft tissue evaluation. Signup and view all the answers

What is scoliosis and how does it typically present in individuals?

Scoliosis is a lateral deviation of the spine from the midline, often presenting as a painless deformity. Signup and view all the answers

During which growth period does Slipped Capital Femoral Epiphysis (SCFE) typically develop?

SCFE develops during periods of accelerated growth, shortly after the onset of puberty. Signup and view all the answers

What are intra-articular fractures and what treatment is typically required if they are displaced?

Intra-articular fractures involve the joint surface and require Open Reduction and Internal Fixation (ORIF) if displaced. Signup and view all the answers

What are the common diagnostic views used in assessing a proximal humerus fracture?

The common diagnostic views are AP, lateral, and axillary views. Signup and view all the answers

What is spondylolisthesis, and which vertebral level is most commonly affected?

Spondylolisthesis is a defect in the pars interarticularis causing a forward slip of one vertebra on another, usually affecting L5-S1. Signup and view all the answers

What is the primary complication associated with a tibia shaft fracture?

The primary complication is the risk of compartment syndrome. Signup and view all the answers

Describe the difference between a Galeazzi and a Monteggia fracture.

A Galeazzi fracture is a distal radius fracture with disruption of the distal radioulnar joint, whereas a Monteggia fracture involves an ulna fracture with dislocation of the radius proximally. Signup and view all the answers

What are the two types of hip fractures, and how does their management differ?

Hip fractures can be intra-capsular or extra-capsular; management varies based on displacement, with displaced intra-capsular often requiring surgical intervention. Signup and view all the answers

What injury is commonly associated with a humerus shaft fracture?

A humerus shaft fracture is commonly associated with a radial nerve injury. Signup and view all the answers

In the context of fractures, what does ORIF stand for, and when is it indicated?

ORIF stands for Open Reduction and Internal Fixation, and it is indicated for displaced fractures. Signup and view all the answers

What is the common management strategy for a proximal humerus fracture if it is displaced?

If a proximal humerus fracture is displaced, surgical management is indicated. Signup and view all the answers

What is an open fracture and what should be considered if there is a wound close to a fracture?

An open fracture is one that has communicated with the environment, potentially exposing the bone. Any wound close to a fracture should be considered an open fracture until proven otherwise. Signup and view all the answers

How is an open fracture graded and what distinguishes Grade 3A from Grade 3B?

Open fractures are graded from 1 to 3 based on size and contamination. Grade 3A consists of any size with extensive soft tissue contamination, whereas Grade 3B requires soft tissue coverage. Signup and view all the answers

What initial antibiotic treatment is recommended for Grade 1 open fractures?

For Grade 1 open fractures, 1st generation cephalosporin, such as cefazolin, is recommended. Signup and view all the answers

What are the essential assessments to perform when managing an open fracture?

Assess soft tissue, bone, and neurovascular status of the affected limb, and check neurovascular status at various intervals. Signup and view all the answers

What should you avoid doing immediately after a wound is discovered in an open fracture?

Do not close the wound on the first look; it should be rechecked after 48-72 hours. Signup and view all the answers

What is the role of the orthopedic and vascular surgeons in managing a vascular injury associated with fractures?

The orthopedic surgeon performs quick fixation, followed by the vascular surgeon for vascular repair if needed. Signup and view all the answers

In what scenario should nerve injury associated with a closed fracture be treated with observation?

Nerve injuries that occur with closed fractures not requiring surgical fixation should be observed. Signup and view all the answers

What is a common irrigation solution used during surgical management of open fractures?

Normal saline is commonly used to irrigate the wound during the surgical management of open fractures. Signup and view all the answers

Study Notes

Limb Deformities and Dislocations

Valgus: Limb moves laterally, joint shifts medially.
Varus: Limb moves medially, joint shifts laterally.
Acute dislocations require urgent reduction to prevent neurovascular injuries.
Dislocation description starts from distal to proximal fragment—categorized as Anterior, Posterior, Inferior, or Superior.
Intra-articular fractures should be treated with Open Reduction and Internal Fixation (ORIF) to prevent loss of function and early degenerative changes.

Orthopedic Assessment

ABCS approach for X-ray assessment involves:
- A: Adequacy of views and penetration.
- B: Bone alignment and fracture lines.
- C: Cartilage spaces for widening.
- S: Soft tissue for swelling or effusions.

Fracture Classification and Types

Fractures are classified as open or closed, with specific anatomical locations (distal, mid, proximal) and fracture lines (transverse, oblique, spiral).
Spondylolisthesis involves a defect in pars interarticularis, usually affecting L5-S1.

Common Fractures

Clavicle fractures most commonly occur in the middle third and are usually managed conservatively.
Proximal humerus fractures often occur at the surgical neck and may involve axillary nerve injury.
Humerus shaft fractures are frequently associated with radial nerve injury; typically treated non-surgically.

Specific Bone Fractures

Both bone forearm fractures require ORIF; includes Monteggia and Galeazzi fractures, which involve radius dislocation.
Distal radius fractures are categorized into extra-articular (like Colle’s and Smith fractures) and intra-articular (like Barton’s fracture); intra-articular fractures typically treated with ORIF.

Hip and Femur Fractures

Hip fractures in older patients pose high mortality risk with management depending on displacement:
- Intra-capsular and Extra-capsular classifications for fractures.
Femoral neck fractures in younger patients necessitate ORIF within 6 hours.
Femur shaft fractures may lead to fat embolism and Acute Respiratory Distress Syndrome (ARDS).

Open Fractures

Defined as fractures that communicate with the external environment, with caution for wounds near fractures.
Classification:
- Grade 1: ≤1 cm wound, ≤6 hours old.
- Grade 2: Same as Grade 1 but >1 cm.
- Grade 3: Any fracture not classified as 1 or 2, further divided into 3A, 3B, and 3C based on soft tissue and vascular involvement.
Antibiotic treatment varies by grade, with specific coverage for anaerobes in higher-grade fractures.

Surgical Considerations

In the operating room:
- Irrigate the wound, remove necrotic tissue and bone fragments without soft tissue attachment.
- Wounds should not be closed initially; review after 48-72 hours.
- External fixators preferred over internal for open fractures.

Vascular and Nerve Injuries

Vascular hard signs indicate the need for realignment; observe and intervene based on persistence of symptoms.
Nerve injuries after closed fractures warrant observation unless surgery is needed for fixation.

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Description

This quiz covers key concepts in orthopedics, focusing on conditions like spondylolisthesis and clavicle fractures. Test your knowledge on the causes, locations, and implications of these orthopedic injuries. Ideal for medical students and professionals interested in musculoskeletal disorders.