CHAPTER 28
Orthopedics

Joshua Gish and Scott Sexton

Test Taking Tip

Orthopedics is not usually a high-yield topic for the ABSITE, although they will occasionally ask a question related to trauma. Look over injury patterns and know which fractures are associated with each other (eg, calcaneal fractures and spinal compression fractures).

TYPES OF FRACTURES

Which type of fracture is characterized by sharp fragments?

Acute fractures

Which type of fracture is characterized by rounded fragments with callous formation?

Chronic fractures; callous indicates an attempt at healing.

What are “greenstick” fractures?

Incomplete disruptions of all aspects of the bony cortex in children; bone can be bent but not displaced with greenstick fractures.

Which type of fracture occurs through diseased bone (eg, a tumor or osteopenic bone)?

Pathologic fractures

What are fractures called that have a communication to the skin?

Open fractures (sometimes called “compound fractures”)

What type of fracture is caused by rotational forces?

A spiral fracture

What term is given to a fracture that breaks in multiple places?

A comminuted fracture

What is a “butterfly fragment?”

A smaller portion of bone that is separated from the larger portions by comminution; implies greater force and a bending mechanism; must be at least 3 fragments

Define a Monteggia fracture:

Fracture of the proximal one-third of the ulna with associated dislocation of the radial head

Define a Galeazzi fracture:

Fracture of the mid radius with associated dislocation of the distal radial-ulnar joint

Define a Lisfranc injury:

A disruption of the Lisfranc ligament—the ligament binding the first metatarsal to the second

Scaphoid fractures most commonly occur as a result of:

Fall on an outstretched hand

FIGURE 28-1. Scaphoid fracture: nonunion. (Reproduced from Doherty GM. Current Diagnosis and Treatment: Surgery. 13th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Where does a scaphoid (navicular) fracture of the wrist classically produce tenderness?

Pain on the radial aspect of the wrist with tenderness over the anatomic snuffbox

Define a Chance fracture:

A distraction-type injury of the spine where the anterior ligament fails under tension; often caused by a seatbelt injury. There is a high likelihood of associated abdominal injury (~60%).

Define a Jefferson fracture:

Burst fracture of C1, the atlas—actually widens the spinal canal; therefore, spinal cord injury is uncommon.

Define a Hangman fracture:

Fracture of the pars interarticularis of C2, the axis, with dissociation of the C2-C3 articulation—has a high incidence of neurologic injury.

Define a clay shoveller fracture:

Avulsion of the lower cervical spinous process—no association with the spinal canal, therefore has no association with neurologic injury

FIGURE 28-2. Salter-Harris classification of physeal injuries occurring at the zone of provisional calcification of the growth plate. (Reproduced from Doherty GM. Current Diagnosis and Treatment: Surgery. 13th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

What is the “Salter Harris” classification?

FIGURE 28-3. An anteroposterior x-ray of a spiral fracture of the distal third of the humerus. This fracture is called a Holstein-Lewis fracture. It is frequently associated with radial nerve palsy. (Reproduced from Felliciano DV, Mattox KL, Moore EE. Trauma. 6th ed. http://www.accesssurgery.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

What injuries can be associated with supracondylar humerus fractures?

What is the usual surgical treatment for type I, II, and IIIA open fractures of the tibia?

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