FMGE Orthopaedics Flashcards

24 sample cards from the Orthopaedics deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What is the most common elbow fracture in children and its major complication?

   Supracondylar fracture of the humerus; major complications include brachial artery and median/anterior interosseous nerve injury, and Volkmann's ischemic contracture from compartment syndrome.

2. What is the classic clinical presentation of a femoral neck (intracapsular hip) fracture?

   The affected limb is shortened and externally rotated, with hip pain and inability to bear weight, typically after a low-energy fall in an elderly osteoporotic patient.

3. Why are displaced intracapsular femoral neck fractures prone to avascular necrosis?

   The femoral head's main blood supply (medial femoral circumflex artery via retinacular vessels) runs along the femoral neck and is disrupted by displacement, leading to avascular necrosis and nonunion.

4. What is the most common direction of hip prosthesis/native posterior dislocation and the limb position seen?

   Posterior dislocation is most common; the limb is shortened, flexed, adducted, and internally rotated. The sciatic nerve is at risk.

5. What does the unhappy/terrible triad of the knee consist of?

   The combination of injuries to the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the medial meniscus, classically from a valgus force with the foot planted.

6. Which clinical tests assess anterior cruciate ligament (ACL) integrity?

   The Lachman test (most sensitive), the anterior drawer test, and the pivot-shift test - all detect excessive anterior tibial translation relative to the femur.

7. What is McMurray's test used to detect?

   Meniscal tears of the knee; pain or a palpable click on rotating and extending the flexed knee suggests a meniscal injury (external rotation for medial meniscus, internal rotation for lateral meniscus).

8. What are the components of the Ottawa Ankle Rules?

   Ankle X-ray is indicated if there is pain in the malleolar zone PLUS bony tenderness at the posterior edge/tip of either malleolus OR inability to bear weight (4 steps) both immediately and in the ED; foot films for midfoot zone pain with navicular or 5th metatarsal base tenderness.

9. Which ankle ligament is most commonly injured in an inversion sprain?

   The anterior talofibular ligament (ATFL), part of the lateral ligament complex, injured during plantarflexion-inversion injuries.

10. What is developmental dysplasia of the hip (DDH) and which two clinical tests screen for it in neonates?

    A spectrum of hip instability/dysplasia where the femoral head and acetabulum are improperly aligned; screened with the Ortolani test (relocation of a dislocated hip) and the Barlow test (provocation/dislocation of a dislocatable hip).

11. What is the first-line treatment for DDH in an infant under 6 months of age?

    A Pavlik harness, which holds the hips in flexion and abduction to maintain reduction and promote acetabular development.

12. What does the deformity in congenital talipes equinovarus (clubfoot) consist of, and what is the mnemonic?

    Cavus (high arch), Adductus (forefoot adduction), Varus (heel inversion), and Equinus (ankle plantarflexion) - mnemonic CAVE; the primary treatment is the Ponseti method of serial casting.

13. What is adolescent idiopathic scoliosis and what Cobb angle defines it?

    A lateral curvature of the spine with rotation of unknown cause in adolescents; defined as a Cobb angle greater than 10 degrees; bracing is considered for curves 25-45 degrees, surgery generally for curves >45-50 degrees.

14. What is spondylolisthesis and how is its severity graded?

    Anterior slippage of one vertebra over the one below it; graded by the Meyerding classification I-IV (and V = spondyloptosis) based on the percentage of slip in 25% increments.

15. What is the most common primary malignant bone tumor in children/adolescents and its classic radiographic sign?

    Osteosarcoma; classic signs include the 'sunburst/sunray' periosteal reaction and Codman's triangle, typically around the knee (distal femur/proximal tibia metaphysis).

16. Which primary bone tumor classically shows an 'onion-skin' periosteal reaction and a characteristic chromosomal translocation?

    Ewing sarcoma; it shows lamellated 'onion-skin' periosteal reaction and carries the t(11;22) EWS-FLI1 translocation, typically affecting the diaphysis of long bones in children.

17. What is a giant cell tumor of bone and its typical radiographic appearance/location?

    A locally aggressive, usually benign tumor of the epiphysis/metaphysis of long bones (commonly around the knee and distal radius) in young adults, showing an eccentric, lytic 'soap-bubble' appearance extending to the subchondral bone.

18. Which five primary cancers most commonly metastasize to bone (mnemonic)?

    Breast, Lung, Thyroid, Kidney (renal), and Prostate - mnemonic 'BLT with a Kosher Pickle.' Most are osteolytic, but prostate metastases are characteristically osteoblastic (sclerotic).

19. What is the most common benign soft tissue tumor in adults?

    Lipoma - a benign tumor of mature adipocytes, typically soft, mobile, painless, and subcutaneous.

20. What is the most common malignant soft tissue sarcoma in older adults, and what is a red-flag feature suggesting a soft tissue mass is malignant?

    Undifferentiated pleomorphic sarcoma (formerly malignant fibrous histiocytoma); red flags for malignancy include size >5 cm, deep to fascia, rapid growth, and being painful/fixed.

21. Differentiate a sprain, a strain, and a stress (overuse) fracture.

    A sprain is a ligament injury; a strain is a muscle or tendon injury; a stress fracture is a fatigue fracture of bone from repetitive submaximal loading (overuse), common in the tibia and metatarsals.

22. What does the RICE protocol stand for in acute soft-tissue/sports injury management?

    Rest, Ice, Compression, and Elevation - the immediate first-aid management to limit swelling and pain in acute musculoskeletal injuries.

23. What is the goal of the SAID principle in orthopaedic rehabilitation and return to play?

    SAID = Specific Adaptation to Imposed Demands; rehabilitation and progressive loading must replicate the specific functional/sport demands so tissues adapt appropriately, and return to play follows criteria-based (not purely time-based) progression once strength, ROM, and sport-specific tests are met.

24. In evidence-based orthopaedics, what type of study sits at the top of the hierarchy of evidence (Level I), and what does PICO stand for?

    A systematic review/meta-analysis of randomized controlled trials (high-quality RCTs) represents the highest level of evidence; PICO = Population, Intervention, Comparison, Outcome, a framework for forming a focused clinical question.

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