To demonstrate a general orthopedic screening exam.
To be able to perform a directed examination of each of the axial skeleton and be able to recognize traumatic signs and symptoms related to fracture of the upper and lower extremities.
To understand the concepts of operative management of skeletal injury, including skeletal stabilization, early motion, rehabilitation and return of limb function.
To be able to understand the difference between conservative and operative fracture management of the major long bones of the axial skeleton.
To be able to understand the pathophysiology and clinical assessment of compartment syndrome and its surgical management.
Typical Exam questions:
What are the problems associated with fractures of the femoral neck?
What are the treatment options to manage patients with fractures of the femur?
Explain the need for anatomic reduction of articular fractures and the consequences of fractures that extend into the major extremity joints.
What are the soft tissue injury levels associated with open and closed fractures?
What are the standard choices of implants for the upper and lower extremity fractures.
What is the difference between a metaphyseal-articular fracture and a diaphyseal shaft fracture and what are the differences in operative implant choices to manage these fractures?
Why are open fractures an emergent problem and describe the treatment principles of open fractures.
To be able to adequately assess a patient with isolated verses multiple injuries and to prioritize the injuries requiring operative intervention.
To describe the operative management of major long bone fractures.
To be familiar with classification of long bone and articular fractures using the AO Classification protocol and to be able to accurately describe fractures based on this classification system.
To be able to diagnose and manage compartment syndrome.
Be able to recognize and open fracture and describe the standard treatment of open fractures.
To clinically diagnose a fracture and obtain the appropriate x-rays, e.g. including a joint below and above the suspected site, deciding in the elbow whether to order the forearm, or the humerus to get a true perpendicular view of the area in question.
To apply and remove a simple cast with attention to the risks that are associated with doing so.
To be able to apply an extremity splint in the acute trauma environment.
Be able to insert skeletal traction for the femur and tibia in the emergency setting.
To be able to interpret and expand on the radiographic characteristics of the following conditions on plain x-ray films:
To examine the axial skeleton to determine areas of injury and be able to accurately order and assess appropriate radiographs
Typical Exam Questions
What are the treatment options for intra-capsular fractures of the femoral neck?
Describe what fractures of the tibial shaft can be managed conservatively?
Describe the difference between intramedullary verse plate osteosynthesis?
What are the implants available to manage fractures of the femur?
Describe surgical approaches to the femur and tibia.
Describe the classification of pelvic fractures and the associated complications and how to complete lower extremity neurologic exam in a pelvic fracture patient.
To describe the pathophysiology of the multiple trauma patient and the role of rapid stabilization of multiple skeletal injuries.
To be able to describe the classification and approaches to acetabular fracture management.
Be able to assess and classify open long bone fractures.
The adequately perform and entire trauma patient pelvic and axial skeletal exam, and manage the acute stabilization of polytraumatized patients.
To accurately interpret acute trauma radiographs and describe a prioritized plan of patient management including requesting additional studies and operative intervention.
Practice-Based Learning and Improvement
To articulate specific treatment approaches and their alternatives, based on the strength of the literature evidence and applicability to a specific patient.
To elucidate current treatment concepts of operative fracture management for the long bones of the axial skeleton.
Patient Care and Operative Procedures
To diagnose and treat the acute traumatic orthopedic emergencies of children and adults.
Be able to show competency in closed reduction and splinting of common fractures.
Describe and perform adequate treatment of open fractures and their operative stabilization options.
To effect closed reductions of the forearm, distal radius and closed tibial injuries, ankle and foot fractures conduct a pre-operative assessment of any special risk factors
Recommend the most proper anesthetic agent in coordination with the anesthesiologist
Select the appropriate position in which to align and stabilize the fracture
Educate the parent for post-operative care
To evaluate the patient for adequacy to withstand a surgical procedure,
To anticipate and deal with the potential blood loss during a surgical procedure.
To carry out the following procedures as outlined in a surgical atlas and apply such information to the case at hand:
Intramedullary nailing of a femral shaft fractrues
Open reduction and internal fixation of hip fractures
Drainage of an infected hip
Open reduction of a both bone forearm fracture.
Debridement of open fractures
Closed reduction and casting of tibial shaft fractures
Closed reduction and intramedullary nailing of tibial shaft fractures
Closed reduction and splinting of humeral shaft fractures.
Open reduction and internal fixation of metaphyseal-articular fracture about the knee.
Demonstrate sensitivity to different cultural approaches that patients may wish to employ as complimentary care
Demonstrate listening skills including projecting respect for the patient, and employing proper positioning and body language when listening and eliciting complaints.
Typical Exam Questions:
Describe the treatment of an ischemic extremity following a closed reduction of a tibial shaft fracture.
What are the vascular risks of a complete physeal disruption of the distal femur? Which procedures should be employed to assess the ischemic risk.
Describe the priority management of lower extremity long bone fractures in the polytraumatized patient?
What is the significance of fat in the urine in a multiple trauma patient with respiratory compromise? What are the confirmatory studies and subsequent treatment?
What are the signs and symptoms of compartment syndrome and describe the surgical approaches for compartment syndrome in the upper and lower extremities?
To organize and manage the clinic environment
Develop an operative schedule in consultation with the Attending Orthopedist
Assess patient load and complexity
Evaluate the specific abilities of clinic staff and junior residents
Delegate responsibilities to junior team members based on their specific abilities.
Monitor and adjust work flow
Supervise patient care including chart reviews
Organize weekly academic conference
Be able to show competence in operative fracture management
Practice-based Learning and Improvement
To participate in advanced diagnostic work ups
Perform and interpret arthrograms of the hips and other joints as required.
Interpret complex MRI and CT studies
Discuss cases in relation to recent literature on the subject.
Interpersonal and Communication Skills
To be able to interact skillfully with the community
Assess special equipment needs
Conduct equipment safety checks.
Patient Care and Operative Procedures
To be able to transcend what is published and create a surgical solution as required by specific circumstances.
To be able to perform complex emergency surgeries one after another without the need for excessive reading, reflection, or reinforcement.
To be able to perform complex procedures utilizing and directing assistants, while minimizing operative time and blood loss. Typical procedures would include:
Complex proximal femoral osteotomies with simultaneous two plane corrections.
Describe management of atrophic and hypertrophic nonunions
Arthroscopic pinning of an osteochondral fragment, meniscal repair
Show ability to correctly approach and manage long bone fractures with either plate or intramedullary nail osteosynthesis
Percutaneous reduction and stabilization of common lower extremity fractures.
Care of complex multiple orthopedic trauma including ischemia, respiratory post operative management, and blood replacement.
To work as a team member with other specialties in the management of polytrauma patients.
Ensures confidentiality of patient information, informed consent, and ethical business practices. Takes care of the patient first, then considers the financial ramifications to the providers.
Typical Exam Questions:
What are the approaches to management of acetabular fractures?
Describe the classification and surgical management of pelvic fractures?
What are the surgical options for management of proximal femur fractures?
What is the approach and surgical stabilization of comminuted fracture of the distal humerus.
What is the treatment paradigm for severe swelling in a fractured leg of a trauma patient with a head injury?
What fractures take priority when managing a polytrauma patient?
Under what circumstances is it ethical to with hold treat from a patient. Is it ethical for your employer to withhold potential treatment strictly because of cost considerations, by purposely not making it available at your institution.