Orthopedic Board cheat sheet

Salter-Harris classification: I = physis only; II = physis + metaphysis (most common); III = physis + epiphysis; IV = metaphysis, physis, epiphysis; V = physeal crush. Types III–IV cross the physis into the joint and risk articular incongruity.

Compartment syndrome: the earliest and most reliable clinical sign is pain out of proportion, especially with passive stretch; pulselessness and paralysis are late findings. Delta pressure (diastolic BP minus compartment pressure) < 30 mmHg supports fasciotomy.

Open fracture: antibiotics within 1 hour (cefazolin for type I/II; add an aminoglycoside for type III); tetanus prophylaxis per immunization status; urgent debridement and stabilization.

Garden classification of femoral neck fractures (I incomplete/valgus-impacted; II complete nondisplaced; III complete partially displaced; IV complete fully displaced) predicts risk of avascular necrosis and guides internal fixation vs arthroplasty.

Cauda equina syndrome is a surgical emergency: saddle anesthesia, bowel/bladder dysfunction, bilateral leg pain or weakness; obtain urgent MRI and decompress, ideally within 24–48 hours of symptom onset.

Osteomyelitis: Staphylococcus aureus is the most common organism in all age groups; Salmonella is classic in sickle cell disease; Pseudomonas is classic in IV drug users and diabetics.

Pediatric supracondylar humerus fracture (Gartland): type I nondisplaced (nonoperative), type II displaced with intact posterior cortex, type III completely displaced; assess for pulselessness and anterior interosseous nerve injury.

Tumor workup: obtain plain radiographs first; MRI with contrast for staging; biopsy should be performed at the definitive treatment center. Osteosarcoma peaks in the second decade; multiple myeloma peaks in the 6th–7th decades.

Structure each case answer as: diagnosis, key findings, treatment options with rationale, and complications/outcomes. State the most likely diagnosis before discussing management.

Hip fracture in the elderly: displaced intracapsular fractures are treated with arthroplasty (hemiarthroplasty or total hip arthroplasty based on pre-injury function); extracapsular fractures are treated with intramedullary nailing or dynamic hip screw.

Ankle fracture: assess the syndesmosis (tibiofibular clear space, medial clear space); unstable bimalleolar or trimalleolar fractures require open reduction and internal fixation; stress views if equivocal.

Knee dislocation: a high-energy injury with multiligamentous disruption and high risk of popliteal artery injury; perform an ankle-brachial index and CT angiography if abnormal; reduce and splint before imaging.

Pediatric forearm both-bone fracture: accept angulation within remodeling potential based on age (approximately 10 degrees per year of age in children under 10); otherwise reduce and cast or pin.

Rotator cuff tear: acute traumatic full-thickness tears in active patients are treated with early repair; chronic degenerative tears with fatty infiltration may be managed with physical therapy or reverse shoulder arthroplasty if pseudoparalysis.

Compartment syndrome of the leg: perform four-compartment fasciotomy via a two-incision technique (lateral and medial); leave wounds open and return for delayed closure or skin grafting.

Infected total joint arthroplasty: classify as acute postoperative (within 4–6 weeks), chronic, or hematogenous; chronic infection usually requires two-stage revision with an antibiotic spacer.