Trauma - Orthobullets

  1. BBFF: associated injurueued
    • Montegia
    • Galeazzi
  2. Prognosis in BBFF ORIF depends on
    Restoration of radail bow
  3. Forearm interosseus membrane composition
    • Central band: key band to reconstruct
    • Accessory band
    • Distal oblique bundle
    • Proximal oblique cord
    • Dorsal oblique accessory cord
  4. BBFF indications conservative mgmt 2
    • Undisplaced BBFF
    • DIstal 1/3 ulnar shaft with: <50% displacement and  <10 degrees angulation.
  5. Approach for distal/middle 1/4 radius fracture
    Henry
  6. Approach for middle/proximal radius
    Thompson
  7. Approach to ulna
    BTW ECU/FCU
  8. BBFF ORIF plate chpice
    3.5 mm LCDP
  9. BBFF compartment syndrome increased risk
    • High energy crush
    • Open Fx
    • Low velocity GSW
    • Vascular injuries
    • COagulopathies
  10. Ulnar shaft #: immobilization type
    Long vs short arm: equivalent results
  11. Removal of HO in BBFF: timing
    6 months: in conjunction with radiotherapy
  12. Fenoral neck fracture mortality:
    -%
    -Predictors
    • -30% within 1 year
    • -Pre injury mobility

    Renal failure 45% mortality at 2 years
  13. NOrmal femoral:
    -neck shaft angle
    -Anteversion
    • -130 degrees +/- 7
    • -10 degrees +/- 7
  14. Blood supply femoral head 4
    • - Medial femoral circumflex: main > becomes lateral epiphyseal artery
    • - Lateral femoral circumflex
    • - Inferior gluteal
    • - Ligamentum teres
  15. Garden classification
    • 1: valgus impacted
    • 2: Complete undisplaced
    • 3: Complete partially displaced
    • 4: Complete fully displaced
  16. Pauwels classification
    • 1: < 30 degrees from horizontal
    • 2: 30-50 degrees
    • 3: >50 degrees (most unstable)
  17. Femoral neck fracture indication for cannulated screws
    • -Garden 1: in elderly
    • -Displaced femoral neck in young patient in conjunction with anatomic reduction
  18. Indications for DHS in femoral neck fracture
    • -Basicervical
    • -Femoral neck with vertical pattern in young patient > biomechanically stronger
    • - Also DHS has less failure but more AVN
  19. Timing of surgery in elderly
    Within 4 days no difference in outcomes
  20. Cannulated screws technique tips
    • -Start above LT
    • - Inverted triangle
  21. Dislocation in THA vs hemi
    5-7 times higher in THA in fracture setting
  22. Treatment of a femoral neck non union
    Valgus intertrochanteric osteotomy + blade plate
  23. Radial nerve location based on condyles
    • 14 cm prox to lat epicondyle
    • 20 cm prox to medial epicondyle
  24. Holstein lewis fracture
    spiral fracture of the distal thrid humerus associated with radial nerve neuropraxia
  25. Humeral shaft fractures indication for conservative mgmt
    • <20 degrees anterior angulation
    • <30 degrees varus valgus
    • < 3 cm shortening
  26. Absolute indications for ORIF midshaft humerus 6
    • Severe soft tissue injoury or bone loss
    • Vascular injury requiring repair
    • Brachial plexus injury
    • floating elbow
    • open fracture
    • compartment syndrome
  27. Relative indications for midshaft humerus orif
    • Bilateral humerus
    • Polytrauma with lower extremity injury
    • Pathologic #
    • SOft tissue that precludes bracing
    • Short oblique or transverse # patters
  28. Molding of coaptation splint
    valgus:  typically fall into varus
  29. Radial nerve palsy: first to recover
    last to recover
    • brachioradialis
    • extensor indicis
  30. Humerus nailing nerves at risk
    • Radial nerve: lat to medial locking screw
    • Musculocutaneus: AP screw
  31. Vit D deficiency type of non union
    Oligotrophic
  32. IMN humerus vs plating
    • Higher reoperation
    • Higher impingement
  33. Radial nerve enters the posterior compartment
    10cm proximal to radiocapitallar joint: pierces intercompartmental fascia
  34. How to find radial nerve in posterior compartment
    Find posterior antebrachial cutaneous nerveradial nerve proximally
  35. Proximal humerus fracture: preserved vascularity if
    >8mm of calcar are attached to articular segement
  36. Vascular supply of proximal humerus
    Posterior humeral circumflex: Recent studies suggest it is the main supply

    Anterior humeral circomflex: 2 branches >anterolateral ascending branch, arcuate artery.
  37. Course of anterior humaeal circomflex
    Parallel to lateral aspect of long head of biceps in bicipetal groove
  38. Neer classification
    Considered a separate fragment if: displacement>1cm or angulation >45.

    Parts: GT, LT< Shaft, articular surfaxce
  39. Proximal humerus #: common injury
    Axillary nerve: up to 45%
  40. Risk of AVN in proximal humerus # increased if 4
    • 4 part
    • head split
    • short calcar segments
    • disrupted medial hinge
  41. Proximal humerus # malunion type
    varus apex anterior
  42. Location of shoulder prosthesis relative to what structure
    Pec major: should be 5.6 proximal to tendon
  43. Structure at risk in anterolateral acromial approach
    Axillary nerve
  44. Axillary nerve distance from the acromion
    7 cm
  45. Most common complication of proximal humerus ORIF
    screw penetration/cut off
  46. Hip fracture mortality rate
    30% within one year
  47. 6 factors increase mortality in ip fractures
    • Male
    • Intertroch: compared to FN
    • Operative delay >2
    • Age >85
    • 2 or more pre existing conditions
    • AASA III or IV
  48. Tip apex distance
    AP + lat <25mm
  49. Calcaneus fracture mechanism
    Traumatic axial loading
  50. Anterior process fracture mechanism
    INversion and plantar flexion foot: avulsion of bifurcate ligament
  51. Calc #'s: constant fragment
    Superomedial fragment: Includes sustentaculum tali. Stabilized by strong ligaments
  52. Extra-articular cal fractures: mechanism
    Avulsion from contraction of gastrocs
  53. Calcaneus fracture associated ortho injuries
    • Vertebral fracture
    • Extension into the CC joint: 60%
    • Bilateral calc: 10%
  54. Calcaneus anatomy: facets
    • Posterior: Largest and major weight bearing
    • Middle:Anterolateral. On sustentaculum tali
    • Anterior: COnfluent with middle facet
  55. Tendon at risk with calc orif
    FHL: runs inferior to post facet of calc. Can be irritated by long screws
  56. Sustentaculum tali: tendon under it
    Ligaments attached
    • FHL
    • Deltoid, talocalcaneal ligaments
  57. Bifurcate ligament
    In calcaneus: Connects dorsal anterior process to cuboid and navicular
  58. Extra articular calc fractures
    • Anterior process: bifurcate lig avulsion
    • Sustentaculum tali
    • Calc tuberosity: achilles tendon avulsion
  59. 2 calcaneus fracture classifications
    • -Essex lopressi: Tongue type, joint depression type
    • - saunders: based on number of fracture lines seen at the widest point of the posterior facet
  60. Essex lopressi classification
    Primary fracture line goes from the posterior facet then

    • -TOngue type: exits posteriorly
    • -Joint depression: # exits behind posterior facet
  61. Broden view: aim
    technique
    • Visualize posterior facet
    • Ankle neutral dorsiflexion: take x rays at 10-40 degrees of IR
  62. Harrris view: goal
    Technique
    • -See if varus/valgus/shortening
    • -Foot maximal dorsiflexion and angle beam 45 degrees
  63. Xray measurements for calc fractures + normal values
    Bohler angle: 20-40. From superior aspect of tuberosity to top of posterior facet + from top of posterior facet to anterior process.

    • Glissane: 130-145
    • Image Upload 1
  64. CT scan calc fractures: reformating
    30 degree semicoronal
  65. Calcaneus fracture: indications conservative mGMT 4
    • -COmorbidities
    • -Sanders I
    • -extra articual fracture with<2mm dispalcement and intact achilles
    • -Anterior process involving <25% CC joint
  66. Timing for calc ORIF
    Wait 10-14 days for blisters to settle
  67. Calc fracture: factors for bad outcome
    • age>50
    • Obesity
    • Mabual laborer
    • CSSR
    • Smoker
    • Bilateral cal
    • Multiple trauma
    • Vasculopathies
    • Men do worse than women
  68. Calc fracture indication for primary arthrodesis
    Sanders 4: combined with ORIF to restore height
  69. Positive heel squeeze test sign of
    calc strss fracture
  70. Calc malunion: surgery
    indications 4
    Subtalar distraction arthrodesis

    • -decreased calc height
    • -Decreased talocalcaneal angle
    • -Decreased talar declination angle
    • -COllapsed joint from VN
  71. Physical exam finding in missed foot compartment syndrome
    Clawing toes: contracture of intrinsic muscles
  72. Calc fracture risk of wound issues 3
    • Open
    • DIabetic
    • Smoker
  73. Distal radius fractures associated injuries 5
    • DRUJ
    • Radial styloid
    • TFCC
    • Scapholunate: disi
    • Lunotriquetral: visi
  74. Die punch #
    Depressed fracture of the lunate fossa
  75. Distal radius x ray parameters: normal/acceptable
    Radial height
    Radial inclination
    Step off
    VOlar tilt
    • 11mm: <5mm shortening
    • 23 degrees: <5 degree change
    • congrous: <3mm step off
    • 11 degrees: dorsal angulation <5degrees or within 20 degrees of contralateral side
  76. Complications of clsoed reduction of distal radius fracture
    • EPL rupture
    • Acute carpal tunnel
  77. Volar plating: tendon issue
    FPL: secondary to placing plate past the watershed area
  78. EPL rupture treatment
    transfer extensor indices to EPL
  79. Druj: strongest ligaments
    radioulnar ligaments of TFCC
  80. Factors for failed closed reduction distal radius fracture
    • Jupiter: -Initial displacement
    • -Age of patient
    • -Metaphyseal comminution
  81. Physiotherapy post ORIF DR fracture
    No difference compared to home exercice program
  82. 3 peak times of death after trauma
    • -50% within minutes of the trauma: massive blood loss or neuro injury
    • -30% within first few days: Neuro injury
    • -20% within days-weeks: Multi system organ failure and infection
  83. Benefit of an airbag 4
    • Decreases rate of:
    • -CLosed head injuries
    • -Facial fractures
    • -Thoracoabdominal injuries
    • Need fo rextration
  84. ATLS primary survey
    • Airway: includes c spine
    • Breathing
    • Circulation: Includes hemorrage control and rescusitation
    • Disability: GCS
    • Exposure
  85. POsition of pregnant women in trauma evaluation
    Left lateral decubitus: limit positional hypotension
  86. Hemorrhagic shock classification + treatment
    • I: FLuid
    • II: FLuid
    • III: FLuid + blood
    • IV: FLuid + Blood

    Image Upload 2
  87. Circulating blood volume:
    adult
    child
    • 4.7-5L
    • 75-80ml/kg
  88. Massive transfusion ratio
    • 1:1:1
    • Rbc:platelets:plasma
  89. 6 indicators of adequate rescusitation
    • MAP>60
    • HR<100
    • Urine output: 0.5-1ml/kg/hr
    • Lactate<2.5:most sensitive indicator of ischemia
    • Gastric mucosal pH: >7.3
    • Base deficit:-2 to +2
  90. Difference between septic shock and hypovolemic shock
    SVR in increased in hypovolemic and decreased in septic
  91. Parameters to decide who to treat with DCO 8
    • ISS>40 (w/o thoracic trauma)
    • ISS>20 with thoracic trauma
    • GCS <8
    • Multiple injuries with intra abdominal trauma/hemorragic shock
    • Bilateral femoral fractures
    • Pulmonary contusion on CXR
    • Hypothermia <35
    • IL-6 >500
  92. DCO: optimal time for surgery
    From 2-5 days: increased risk of ARDS and Multi organ failure because of surge in inflammatory markers.

    Only treat life or limb threatening injurues during this period
  93. DCO orthopedic conditions to treat 6
    • Compartment
    • Fracture with vascular injury
    • Unreduced dislocations
    • Long bone fractures
    • Unstable spine fractures
    • Open fractures
  94. LEAP study outcome measures
    SIP (sickness impact profile) and return to work not significantly different btw amputation and reconstruction at 2 years in limb threatening injuries

    Most important factor to determine patient reported outcome is ability to return to work
  95. Leap study : decicion to amputate based on 2
    -Severe soft tissue injury: highest impact on decicion making

    • -Absence of plantar sensation: second highest
    • Not contraindication to limb salvage
    • Can recover in long term
  96. Metabolic demand of different amputations (% increased from baseline) 5
    • -Syme: 15%
    • -BKA: 25%
    • -AKA: 68%
    • -Through knee:most proximal level to maintain walking speed in children
  97. Amputation wound healing improved with 6
    • -Albumin >3
    • -Ischemic index >0.5
    • -Transcutaneous oxygen tension >30 mm hg
    • -Toe pressure >40 mm hg
    • -ABI > 0.45
    • -Total lymphocyte count > 1500
  98. Upper extremity amputations indications 5
    • -Vascular
    • -Soft tissue compromise
    • -Malignant tumor
    • -Infection
    • -COngenital anomalies
  99. BKA ideal location
    12-15 cm below joint
  100. Ertl amputation
    Creates a strut from tibia to ficula using a strut from the fibula.

    • Original > osteoperiosteal flap
    • Mofified. FIxation with screw, suture anchor or endo button
  101. Syme amputation:
    -definition
    -equirements
    -benefit
    • -Ankle disarticulation
    • -Patent tib post
    • -more energy efficient than midfoot amputation
  102. Chopart amputation:
    -definition
    -problem
    • -Hindfoot amputation: through TN and CC joints.
    • -Equinus deformity: do achilles lenghtening
  103. Complication in pediatric amputation
    -Bone overgrowth: Prevent by performing disarticulation or making an epiphyseal cap co cover medullary canal
  104. Pelvic ring injury Poor outcome 7
    • SI joint incongruity >1cm
    • High degree initial diplacement
    • Malunion
    • LLD > 2cm
    • Nonunion
    • Neurologic injury
    • Urethral injury
  105. Pelvic ring ligaments 3
    Anterior: Symphyseal (resist ER)

    • Pelvic floor
    • -Sacrospinous:Resist ER
    • -Sacrotuberous: Resist shear

    • Posterior
    • -Ant sacroiliac
    • -Post sacroiliac
    • -Interosseaous sacroiliac
    • -Iliolumbar
  106. Inlet x ray:
    -Good  x ray if
    -Look for
    • -S1 overlaps S2 and scrum looks like bowtie
    • -AP translation, widening symphysis, Widening SI
  107. Outlet x ray:
    -Good if
    -Look for
    • -Pubic symphysis overlies S2 body
    • -Vertical shear
    • -Sacral fractures
  108. Pelvic ring injury classification
    types 7
    -Young-burgess

    • -APC 1-3
    • -LC 1-3
    • -Vertical shear
  109. APC 1-3 
    -Description
    -Treatment
    • APC 1
    • -Symphysis widening <2.5cm
    • -non-op protected weight bearing

    • APC 2
    • -SYmphisis widening >2,5cm + ANterior SI joint diastasis + disruption sacrotuberous/spinous ligaments
    • -ANterior plating vs ex fix +/- POsterior stabilization

    • APC 3
    • -Disruption ant/post SI ligaments + Sacrotuberous/spinous 
    • -Same as 2 but need post fixation
  110. LC 1-3
    -Description 
    -Treatment
    • LC 1
    • -Ramus # + Ipsilateral sacral ala compression #
    • -Non op: Protected weight bearing

    • LC 2
    • -Ramus # + Crescent #
    • -ORIF vs SI screw

    • LC 3
    • -Ipsilateral LC + contralateral APC (windswept pelvis
    • -Posterior stabilization

    • Vertical shear
    • -POsterior +/- anterior stabilization
  111. Pelvic ring injury with highest risk hypovolemic shock
    Vertical shear
  112. Source of bleeding in pelvic ring injuries:
    -Venous
    -Arterial
    -Venous plexus + cancellous bone

    • Arterial
    • -Sup gluteal (most common)
    • -Internal pudendal
    • Obturator
  113. Indications for retrograde urethrogram 3
    • Blood at the meatus
    • high riding prostate
    • hematuria
  114. Supra-acetabular ex fix 3 views and the use
    • Obturator oblique: Starting point
    • Internal oblique: Aim above sciatic notch
    • Obturator inlet oblique; Ensure btw ilium tables
  115. SI screw: structure at risk
    L4-5 nerve roots
  116. Nerve at risk during placement of supra acetabular ex fix
    LFCN
  117. Acetabular # associated ortho injuries 3
    • -Lower extremity injury #6 %
    • -Nerve palsy (13%)
    • -SPine injury (4%)
  118. Acetabular # systemic injury 4
    • -Head
    • -CHest
    • -Abdo
    • -Genitourinary
  119. Acetabular # poor outcomes 5
    • -Polytrauma
    • -Older age
    • -Poor articular congruity
    • -Associated femoral head articular injury
    • -Intraoperative complications
  120. Acetabular posterior column composed of 4
    • -Quadrilateral plate
    • -Posterior wall and dome
    • -Ischial tuberosity
    • -Greater and lesser sciatic notches
  121. Acetabular anterior column composed of 4
    • -Anterior ilium
    • -Anterior wall and dome
    • -Iliopectineal emminence
    • -LAteral superior pubic ramus
  122. Corona mortis is
    - at risk during
    • Anastamosis of external iliac (epigastric) and internal iliac (obturator) Vessels
    • -LAteral dissection over supeior pubic ramus
  123. Letournel classification 10
    • -Post wall
    • -Post column
    • -Ant wall
    • -Ant column
    • -Transverse
    • -ABC
    • -Transverse + POst wall
    • - T shaped
    • -Ant column + POst hemitransverse
    • -Post column + Post wall
  124. Gull sign
    POsterior wall fracture
  125. Spur sign on x ray
    ABC
  126. Judet views
    • Obturator oblique: Ant column post wall
    • Iliac Oblique: Post column ant wall
  127. 6 radiographic landmarks of acetabulum
    • Iliopectineal line: Ant column
    • Ilioischial line: post column
    • Ant wall
    • POst wall
    • Teardrop
    • Sourcil
    • Shenton's line
  128. Roof arc measurement:
    -goal
    -definition
    - does not apply
    • -Define fracture stability
    • -If >45 degrees on all views defined as stable
    • -In ABC
  129. Non operative posterior wall #indications
    • <20% posterior wall involvement
    • EUA to define stability look for medial clear space widening
  130. Indications for acetubular # ORIF 5
    • -Displacement roof >2mm
    • -UNstable # pattern (post wall >20 %)
    • -Marginal impaction
    • -Loose bodies
    • Irreducible fracture dislocation
  131. Hip dislocation reduction timing
    better outcome if <12hrs
  132. Acetabular ORIF delayed fixation
    • Worse outcome if >3weeks
    • Earlier operative time increases chances of anatomic reduction
  133. Use of obturator oblique inlet view
    Ensure supra-acetabular screw between tables of ilium
  134. USe of inlet iliac oblique view
    Position of Screw within pubic ramus
  135. Chose the approach:
    -Anterior wall #
    -ANterior column #
    -T-shaped
    -ABC
    -Post column
    -Post hemitransverse
    • -Ilioinguinal
    • -Ilioinguinal
    • -Kocher
    • -Ilioinguinal
    • -KOcher
    • -Kocher
  136. Ilioinguinal approach risks 4
    • Femoral nerve injury
    • LFCN injury
    • Thrombosis femoral vessels
    • Laceration corona mortis
  137. KOcher langenbach approach risks 3
    • Increased risk HO
    • Sciatic nerve injury
    • Damage to medial femoral circumflex ( AVN )
  138. Treatment of HO in acetabular ORIF
    • Usually for POst approach
    • -Indomethacin 70mg po qd x 5 weeks
    • -Low dose external radiation
    • No difference between both
  139. x ray to best visualize post wall
    Obturator oblique
  140. Tibial plateau #, Associated conditions 5
    • -Lateral meniscus tear: More common than medial, Associted with Shtzker II
    • -Med meniscus tear: Schatzker IV
    • -ACL: Shatzker V/VI
    • - COmpartment
    • -Vascular injury: Shatzker IV
  141. Tibial plateau shape:
    -Medial
    -LAteral
    • -Concave + distal to lat plateau
    • -Convex + proximal to med plateau
  142. Schatzker classification
    • I: LAteral split
    • II: LAt split/depression
    • III: Lat pure depression
    • IV: Medial plateau
    • V: Bicondylar
    • VI: Met-dia dissociation
  143. Tibial plateau # non op indications 3
    • -Min displaced split or depressed #
    • -Low energy, stable varus/valgus alignment
    • -Non ambulatory patients
  144. Tibial plateau fracture indications ORIF 5
    • -Articular step off >3mm
    • -COndylar widening >5mm
    • -Varus/valgus instability
    • -Medial plateau #
    • -Bicondylar #
  145. Tibial plateau:
    -Good outcome if
    -Worse outcomes if 3
    -Restoration of joint stability

    • -Ligamentous instability
    • -Meniscectomy
    • -Alteration mechanical axis >5 degrees
  146. Posteromedial approach to tibial plateau interval
    Pes anserinum and medial head of gastrocs
  147. Signs of lateral meniscus injury in tibial plateau fracture 2
    • -Joint depression > 6mm
    • -Joint widening >5mm
  148. High energy PLC injury > surgical option
    Reconstruction better than repair
  149. In the treatment of tibial plateau #, best substance for grafting to avoid subsidence
    Calcium phosphate cement
  150. Femur fracture - Associated orthopaedic conditions
    • - Ipsilateral: Femoral neck (basicervical,verical,undisplaced)
    • -Bilateral femur #: Increased risk pulm complications/mortality
  151. Thigh compartments (3) and muscles
    • -Anterior: Sartorius + Quads
    • -Posterior: Biceps femoris + SemiT + Semi M
    • -Adductor: Gracilis + adductor brevis/longus/magnus
  152. Femur shaft fracture deforming forces
    • Proximal fragment
    • -Abducted: glut med/min
    • -Flexed: iliopsoas

    • Distal fragment
    • -Varus (adductors)
    • -Extension (gastrocs)
  153. Blood loss in closed femur shaft #
    1-1.5L
  154. Femur shaft #
    -gold standard
    -outcomes improved if
    -Exception
    • -Anterograde femoral nail
    • -Fixation within 24 hrs: decreased ARDS, decreased thromboembolic events, shorter hospital stay
    • - Closed head injury: need avoid hypotension and hypoxia > may need ex fix
  155. Retrograde femoral nail indications 6
    • -Ipsilateral Tibial plateau/shaft
    • -Morbid obesity
    • -Ipsilateral acetabular #
    • -Bilateral femur #
    • -Polytrauma
    • -Ipsilateral femoral neck #
  156. Piriformis entry nail
    -Pro
    -cons
    -Colinear with femoral shaft

    • -More difficult
    • -Damage abductors
    • -AVN in younger patients
  157. Femoral nail reamed vs unreamed
    Reamed: No increase in pulm complications, increased union rates, decreased time to union

    Unreamed: Consider in patients with bilateral pulmonary injuries
  158. Retrograde femur nail starting point 2
    • -Center intercondylar notch on AP
    • -Extension blumensat line on lateral: if posterior can injury cruciate ligaments
  159. Femur shaft + ipsilateral femoral neck what to do
    -technique 3
    • -Priority to femoral neck > avoid AVN
    • -Screws for neck + retrograde nail
    • -Screws for neck + plate for shaft
    • -DHS + retrograde nail
  160. Femoral nail risk of non union 2
    rate
    treatment
    • -use of nsaids
    • -smoking

    -<10%

    -Exchange reamed nail
  161. In retrograde femoral nail, what screw puts branches of deep femoral nerve/A at risk
    A/P proximal locking below the LT
  162. Femoral nail rate of union reamed vs unreamed
    Reamed higher union
  163. Tibiofibular overlap:
    -AP
    -Lat
    • >6mm
    • >1mm
  164. Medial clear space
    <4mm
  165. Tibiofibular clear space
    • <5mm
    • measured 1 cm above from joint line
  166. Talocrural angle
    8-15 degrees
  167. Lauge-hansen classification
    -4
    • Supination - Adduction
    • Supination ER
    • Pronation Abduction
    • Pronation ER
    • 
  168. Supination Adduction
    -Sequence
    • -Talofibular sprain or Distal fibular avulsion
    • -Vertical medial mall + impaction anteromedial distal tibia
  169. Supination ER
    - Sequence
    • -ATFL sprain
    • -Lateral short oblique fibula fracture
    • -PTFL rupture or avulsion
    • -Medial mall transverse # or deltoid disruption
  170. Pronation Abduction
    -Sequence
    • -Medial mall transverse # or deltoid disruption
    • -ATFL sprain
    • -Transverse or comminuted fibula # above level of syndesmosis
  171. Pronation ER
    -Sequence
    • -Medial mall # or deltoid disruption
    • -ATFL disruption
    • -Lateral mall short oblique or transverse # above level syndesmosis
    • -PTFL rupture or avulsion post mall
  172. Bosworth fracture dislocation
    POsterior dislocation of fibula behind incisura fibularis
  173. Ankle fracture > Non operative mgmt (3)
    • -Isolated undisplaced medial mall #
    • -Isolated lat mall # with <3mm displacement and no talar shift
    • -Post mall # with <24% joint involvement and < 2mm step off
  174. Ankle fracture indications ORIF - general (7)
    • -Talar displacement
    • -Displaced medial mal
    • -Displaced lat mal >3mm
    • -Bimalleolar
    • -Post mall >2mm step or >25% involvement
    • -Open #
    • -Bosworth #
  175. Ankle # - worse outcome (5)
    • -Increased age
    • -Medial mall #
    • -Smoking
    • -Decreased education
    • -EtOH
  176. Key technique point for sup-adduction ORIF
    Restoration of anteromedial marginal impaction leads to better outcome
  177. Ankle fracture - when to drive (2)
    • -9 weeks after ORIF> return of braking time
    • -6 weeks after start of weight bearing for periarticular/long bone fractures
  178. Isolated medial mal # mgmtt:
    -Conservative
    -Operative 
    -Techniques (3)
    • -Undisplaced or tip avulsion: symptomatic treatment
    • -Displaced/talar shift
    • -ORIF:lag screw, antiglide plate, tension band
  179. Isolated lateral mal #:
    -Conservative mgmt 3
    -Operative indications 3
    -ORIF technique / advantages /disadvantages
    -Post operative mgmnt 2
    • -Intact mortice, no talar shift, <3mm displacement
    • -Talar shift, displacement >2mm, associated syndesmosis injury
    • -Lateral plate: Lag screw with neutralization plate or bridge plate. Prominent hardwre
    • -Posterior plate: antiglide, lag screw, if placed to distal can irritate peroneals

    • -Immobilization 4-6 weeks post ORIF
    • - Double immobilization period if diabetic
  180. Advantage of post mall fixation
    Restoration of syndesmosis strength to 70% vs 40% for syndesmosis fixation.
  181. Best way to test syndesmosis
    Intra op abduction-ER stress on dorsiflexed foot
  182. Syndesmosis ORIF
    technique 3
    reduction 2
    location/angle
    Post op 2
    • -Screws: 1-2
    • -Cortices: 3-4
    • -Size: 3.5 or 4.5
    • -DIme sign or shentons line
    • -2-4cm above joint line angled 20/30 degrees anterior

    • -NWB 6 weeks
    • - HWR vs broken harware = no difference. Retained intact hardware = worse.
  183. Diabetic ankle fracture complications 3
    -Enhanced fixation 3
    • -Prolonged healing
    • -Hardware infection
    • -Hardware failure

    • -Quadricortical screws
    • -Intramedullary k wire in fibula
    • -Locked plate
  184. SYndesmosis injury, what direction of instabilty for the fibula
    A to P
  185. Tibia shaft fracture indication conservative mgmt 5

    technique
    • -Closed low energy fracture
    • -<5 degrees varus/valgus alignment
    • -<10 degrees ant/post angulation
    • ->50% cortical apposition
    • -<1cm shortening
    • -<10 degrees rotational malaligment

    Long leg cast, coonvert to patellar tendon bearing brace at 4 weeks
  186. Tibial shaft indication for nail 8
    • -Unacceptable alignment
    • -Soft tissue injury not conductive to casting
    • -Segmental #
    • -Comminuted #
    • -Floating knee
    • -Bilateral tibia #
    • -Morbid obesity
    • -Polytrauma
  187. Tibia nail contraindications
    • TKA or previous ORIF
    • Pre existing tibial deformity
  188. Tibia nail reamed vs unreamed
    • SPRINT trial
    • -Reamed superior in closed # for need of future grafting/implant exchange

    recent studies > no adverse effects of remed
  189. Tibial shaft fracture percutaneous plate vs IMN 5
    • -Equivalent time to union
    • -Greater radiation exposure
    • -Longer surgical duration
    • -Lower post op pain scores
    • -More difficult HWR
  190. Tibial shaft fracture risk for non union 3
    • Gapping at # site
    • Transverse #
    • Open #
  191. Tibial shaft fracture reduction techniques 5
    • Femoral distractor
    • Unicortical plate
    • Blocking screws
    • Clamps
    • External fixator
  192. Tibia shaft fracture complications 6
    • Compartment syndrome
    • Malunion: Valgus/procarvatum
    • Knee pain: 50%
    • Non Union: treat with exchange nail or compression plating +/1 posterlateral bone graft
    • Malrotation
    • Nerve injury: sup peroneal in liss plate
  193. tibial shaft fractures: use of tourniquet leads to
    Increased post op pulmonary complications
  194. Tibial shaft fracture with increased risk of varus malunion
    Shaft with intact fibula
  195. Transient peroneal neuropraxia physical exam finding
    Weak EHL
  196. Location of superficial peroneal nerve with respect to tibia liss plate
    around hole 11-13
  197. Proximal tibia # malunion: most common
    • Valgus 
    • Procarvatum: apex anterior
  198. Proximal tibia # deforming forces
    • Patellar tendon: Procarvatum
    • Hamstring: Distal fragment into flexion
    • Pes Anserinum: Proximal fragment into Varus
  199. Indications for conservative mgmt proximal tibia # 5
    • < 5 degrees varus valgus
    • <10 degrees sagital angulation
    • >50% cortical apposition
    • <1 cm shortening
    • <10 degrees rotation
  200. Approach ideal for proximal tibia nail
    Semiextended position:suprapatellar
  201. Starting point tibia IMN
    • Proximal to anterior margin of articular surface
    • Medial to lateral tibial spine
  202. IMN fracture reduction techniques
    Poller screws: Posterior > prevents procarvatum. Lateral concave side > prevent valgus

    Unicortical plating

    Femoral distractor

    Nail in semiextended position
  203. Pilon fracture typical fragments
    • Medial malleolar (deltoid)
    • Postrolateral: Volkman > PITFL
    • Anterolateral: Chaput > AITFL
  204. Pilon # 5 factors for poor prognosis
    • Lower level education
    • Pre existing comorbidities
    • Male
    • WOrk related
    • Lower income
  205. Vascular anatomy of leg 3
    Ant, tibial A: First branch > passes btw 2 heads of tib post and IO membrane. BTW Tib ant and EHL. Ends as dorsalis pedis

    Post tibial A: Terminates in medial and lateral plantar

    Peroneal: 2.5 cm distal to fossa. Terminates as calc branches
  206. Sural nerve composition
    • Tibial:medial
    • Peroneal: lateral
  207. Acute mgmt of tibial pilon #
    Temporizing ex-fix for 10-14 days
  208. Pilon # ex fix frame
    A frame: 2 tibial pins and one trans calc pin
  209. Definition of subtrochanteric
    Area 5 cm below LT
  210. Subtrochanteric fracture deforming forces
    • Abduction: GLut med/min
    • Flex: Iliopsoas
    • ER: Short ER
  211. Atypical femur fractured Major criteria
    • Anywhere along femur distal to LT and proximal to supracondylar flare
    • No or minimal trauma
    • Transverse or short oblique
    • Non Comminuted
    • Medial Spike if complete
  212. Atypical femur fracture minor criteria
    • Lateral beaking
    • Generalized increased cortical thickness of diaphysis
    • Prodromal symptoms
    • Bilateral fractures 
    • Delayed healing
    • Comorbidities
    • MEDS: BP'S, steroids, PPI
    • No FN, IT, metastatic #'s
  213. Malunion after subtroch IMN: most common
    Varus and procarvatum
  214. 4 compartments of leg + muscles
    • Anterior: Tib. ant, EHL, EDL, peroneus tertius.
    • Lateral: Peroneal brevis/longus
    • Deep post: Tib post, FDL, FFHL, 
    • Sup. post: Gastrocs, soleus, plantaris
  215. Compartment pressure measurements: location
    Values
    • WIthin 5 cm fracture site
    • Diastolic differential pressure <30
  216. Fasciotomy 2 incisions
    Anterolateral: Identify sup peroneal nerve. Fasciotomy 1 cm ant and 1 cm post to intermuscular septum

    Posteromedial:Protect saphenous n/v. Incise sup peroneal + detach soleal ridge from back of tibia
  217. Structure at risk with single incision fasciotomy
    common peroneal N
  218. Hoffa #
    Distal femur coronal plane fracture: 38% in Type C #'s
  219. Distal femur #: requirement for retrograde nail
    4 cm intact distal femur: classically used for extra articular, non comminuted.
  220. Distal femur # classic approach
    Anterolateral: Incision from TT to anterior 1/3 distal femoral condyle
  221. Distal femur fracture nonunion rate and location
    19%: in metaphyseal area
  222. Distal femur ORIF how to check screw lenght
    AP knee with leg in 30 degrees IR
  223. Lead intoxication 4
    • Neurotoxicity
    • Anemia
    • Emesis
    • Abdominal Colic
  224. Low velocity GSW: Speed
    Open # type
    gun type
    • <2000 ft/sec
    • 1-2
    • Shot gun, hand gun
  225. High velocity GSW: speed
    open #
    Gun type
    • >2000 ft/sc
    • 3 regardless of size
    • Assault rifle/hunting rifle
  226. GSW associated with bowel injury
    • SPine#
    • Pelvic #
  227. 5 indications for operative mgmt GSW
    • Articular involvement
    • presentation >8 hrs
    • Unstable #
    • Tendon involvement
    • Superficial fragment in palm or sole
  228. Indication for I&D in spine GSW
    Motor weakness with retained fragemnt in the spinal canal
  229. Risk factors for elder abuse 4
    • Increasing age
    • Functional disability
    • Child abuse within regional population
    • Cognitive impairement
  230. Caretaker factors for elder abuse 3
    • Substance abuse
    • Financial dependence on abuse
    • Perceiving the caretaker as a burden
  231. Clinical signs of elder abuse 5
    • Unexplained injuries
    • Delays in seeking care
    • Repeated fractures/burns
    • Change in behaviour
    • Poor hygene
  232. Risk of partner domestic abuse 4
    • Female
    • 19-29
    • Low SES
    • Pregnant
  233. Mechanism for intercondylar distal humerus fracture
    Axial load with elbow flexed >90 degrees
  234. Inserts on sublime tubercle
    Anterior bundle of elbow MCL
  235. primary restraint to valgus stress at the elbow from 30 to 120 degrees
    Elbow MCL
  236. Stabilizer against posterolateral rotatory instability
    LCL
  237. Classification of distal humerus fractures
    Milch

    • Type 1: Lateral trochlear ridge intact
    • Type 2: # through lateral ridge of trochlea
    • Image Upload 3
  238. 3 approaches to distal humerus fracture
    • Olecranon osteotomy
    • Tricep split
    • Tricep sparing
  239. Approach to distal humerus: medial side
    Identify ulnar nerve up to first motor branch to ECU.

    Elevate triceps from posterior aspect of elbow

    elevate posterior bannd of MCL
  240. Approach to distal humerus: lateral side
    Identify radial nerve proper: if fracture mid/distal
  241. Olecranon osteotomy technique
    Locate bare area of sigmoid notch.

    Make chevron: apex distal.
  242. Fixation steps to distal humerus fracture
    First fix articular component then build to medial/lateral column
  243. Distal humerus orif:plate configuration
    2 orthogonal plates

    2 parallel plates
  244. Distal humerus ORIF post op protocol
    Splint to 70 degrees

    Remove splint at 1 week

    Begin ROM: AROM+AAROM, no PROM

    Strenghtening at 6 weeks
  245. Distal humerus ROIF and heterotrophic ossification
    Do not use: has been shown to increase the rate of no union
  246. Distal humerus # malunion deformity 2
    Cubitus valgus: lateral column fractures

    Cubitus varus: medial column fractures
  247. Double arc sign
    Distal humerus capitellar shear fracture
  248. Most common complication of distal humerus #
    decreased ROM
  249. Midshaft clavicle fracture deforming forces
    SCM: Pulls medial fragment superiorly

    Pec major: Pulls distal fragment inferiorly
  250. AC joint: static stabilizers 3 + strongest within each
    • AC ligament: Strongest is superior ligament
    • CC ligaments: trapezoid, conoid. Conoid is strongest
    • Capsule
  251. AC joint dynamic stabilizer
    • Deltoid
    • Trapezius
  252. Zanca view x ray
    For clavicle #

    15 degree cephalic tilt: determine sup/inf displacement
  253. Clavicle # indication for ORIF: absolute 6
    • Open 
    • Skin tenting
    • Vascular injury
    • Floating shoulder
    • Symptomatic malunion
    • Symptomatic non union
  254. Clavicle # advantages of ORIF 5
    In pationts with >2cm shortening and 100% displacement

    • -Less pain with overhead activities
    • -Faster time to union
    • -Decreased symptomatic malunion
    • -Improved cosmetic
    • -Improved strenght and endurance
  255. Non operative clavicle fracture protocol
    • Sling
    • Start ROm 2 weeks
    • Strenghtening 6 weeks
  256. Olecranon fractures mechanism of injury + fracture pattern 2
    • Direct blow: Comminuted #
    • Indirect: FOOSH, transverse/oblique #
  257. Olecranon ORIF 3 techniques/indications
    • Tension band: transverse
    • Plate: COmminuted, oblique fractures
    • Excisision + tricep advancement: Elderly patients. Fracture involves < 50% joint surface
  258. Olecranon tension band: nerve at risk
    AIN
  259. Talar neck # mechanism of injury
    Forced dorsiflexion with axial load
  260. Blood supply to talus 4
    Posterior tibial artery: via artery of tarsal canal(dominant supply)

    Anterior tibial artery: head and neck

    Perforating peroneal: via artery of tarsal sinus

    Deltoid artery: supplies body
  261. Talar neck fracture classification
    Hawkins

    • I: Non displaced > 0-10%
    • II:Subtalar dislocation> 25-50%
    • III: Subtalar and tibiotalar > 20-100
    • IV: ST + TT + TN > 70-100%
  262. Canale view: used for
    How to do it
    -View of talar neck

    -Maximus equinus, 15 degrees pronation, x ray 75 degree from horizontal
  263. Treatment of extruded talus
    Replaced and treated with ORIF
  264. Talar neck fracture complications 5
    • Post traumatic OA
    • Mal-union
    • Non-union
    • Infection
    • Wond dehiscence
  265. ORIF talar neck # approach
    2 approaches

    -Anteromedial: btw Tib ant/post. Preserve deep deltoid ligament (blood supply). may need medial mall osteotomy

    -Anterolateral: btw tib/fib in line with 4th ray. Elevate EDB
  266. Hawkins sign
    Subchondral lucency best seen in mortice view at 6-8 weeks

    Indicates intact vascularity: resorption of subchondral bone
  267. Talar neck fracture malunion deformity + treatment
    Varus: medial opening wedge osteotomy

    Leads to Decreased subtalar eversion> weight bearing on lateral border of foot.
  268. Varus malalignment after a talar neck fracture with medial comminution causes a decrease in what motion
    Eversion
  269. Radial head fracture mechanism of injury
    FOOSH: elbow in extension and forearm pronation
  270. Deficiency in what ligament leads to posterolateral rotatory instability
    LUCL
  271. Lateral collateral ligament complex components 4
    • LUCL
    • Radial collateral ligament
    • Accesory lateral collateral ligament
    • Annular ligament
  272. Elbow MCL bundles
    • Anterior: primary stabilizer to valgus stress
    • Posterior
    • Transverse
  273. Radial head provides 2 types of stability
    Valgus: Secondary restraint to valgus

    Longitudinal: Restraint to proximal migration of the radius
  274. Radial head fracture classification
    Mason

    • I: non diplaced, displacement <2mm
    • II: Displaced > 2mm or angulated.
    • III: Comminuted and displaced > mechanical block
    • IV: Associated with elbow dislocatio
  275. Radial head # indication for ORIF
    • Mason II with block to motion
    • Mason III when ORIF feasable
    • Presence of other complex elbow injuries
  276. ORIF radial head with worse outcomes if
    >3 fragments
  277. Indications for radial head arthroplasty 2
    Mason type 3 with >3 fragments where ORIF not possible

    Elbow # dislocations/essex lopresti lesion
  278. Mason 3 ORIF vs arthroplasty
    Better outcome with arthroplasty: stability, patient ssatisfaction
  279. Indications for radial head resection
    Low demand patient

    In delayed setting to treat persistent pain
  280. Location of PN nerve
    Muscle substance of supinator: 4 cm distal to radial head
  281. How to protect PIN
    Forearm pronation during lateral approach to elbow
  282. Kocher approach interval
    • ECU (pin)
    • Anconeus (radial)
  283. Kaplan approach interval
    • EDC: pin
    • ECRB: radial
  284. kocher vs kaplan approach
    • Kocher: less risk of PIN/radial n. injury. More risk damaging LUCL
    • Kaplan: More risk nerve injury, less risk damaging LUCL
  285. radial head orif: Plate placement
    Safe zone: radial styloid to lister's tubercle with arm in neutral rotation.

    Bicepetal tuberosity: is distal limit of plate placement
  286. Terrible triad definition
    • Elbow dislocation
    • Radial head/neck fracture
    • Coronoid fracture
  287. Coronoid: restraint position
    POsterior subluxation beyond 30 deg of flexion
  288. Inserts on sublime tubercle
    Anterior band of MCL
  289. Avulsion site of LCL
    Usually from distal humerus
  290. ORIF for coronoid fracture involving<10%
    Not necessary

    Only address if: instability persisting after addressing radial head/LCL complex > MCL repair > coronoid
  291. Position of arm when fixing LCL
    • In pronation/flexion: MCL intact
    • In supination/flexion: Injured MCL > avoid medial gapping from overtightening.
  292. Indication for MCL repair
    Persistent instability following LCL +  fracture fixation
  293. Most common type of elbow dislocation
    Posterolateral: 80%
  294. Progression of injury in elbow dislocation
    Lateral to medial

    LCL > MCL
  295. Primary static stabilizers of elbow 3
    • Ulnohumeral joint
    • Anterior bundle MCL
    • LCL complex
  296. Secondary static stabilizers of the elbow
    • Radiocapitellar joint
    • Joint capsule
    • Origins of common flexor/extensor tendons
  297. Dynamic stabilizers of the elbow
    • Anconeus
    • Brachialis
    • Triceps
  298. Cause of varus posteromedial instability fo the elbow
    LCL injury + fracture to anteromedial facet of coronoid
  299. Erb palsy
    C5-C6:Upper trunk
  300. Klumpke Palsy
    C8-T1
  301. Mechanism of traumatic upper brachial plexus injury
    Caudally forced shoulder
  302. Mechanism of injury of traumatic lower root injury
    Forced arm abduction
  303. Rate of nerve regeneration
    1mm/day
  304. Worst prognosis brachial plexus injuries
    Root avulsion: preganglionic
  305. Preganglionic injury:definition
    Avulsion proximal to dorsal root ganglion: Involves CNS which does not regenerate. Worse prognosis
  306. Lesions suggesting preganglionic brachial plexus injury
    • Horner syndrome: sympathetic chain disruption
    • Winged scapula: Loss of serratus anterior(long thoracic), rhomboids (dorsal scapular)
  307. Erb palsy clinical presentation
    • Shoulder: Adduction,, IR
    • Elbow: Pronated, extended
  308. Horner syndrome 3 features
    • Drooping left eyelid
    • Pupillary constriction
    • Anhidrosis
  309. Horner syndrom roots involved
    C8-T1
  310. MRI signs of root avulsion
    • Pseudomeningocele
    • Empty nerve root sleeves
    • Cord shifts away from midline
  311. Location of bipartite patella
    Posterolateral
  312. MOst important blood supply to patella
    inferior pole
  313. Indication for conservative mgnt patella # 3
    • Intact extensor mechanism
    • Non displaced #
    • Vertical fracture pattern
  314. Indication for partial patellectomy
    Severly comminuted inferior ple fractue not amenable to ORIF
  315. FLOW trial results
    Low flow with saline better than the rest
  316. Open # treatment based on gustillo
    • 1-2: 1st generation cephalosporin. Clinda or vanco if allergy
    • 3: 1st generation cephalosporin + aminoglycoside
  317. Tetanus prophylaxis: type/dose
    Toxoid: 0.5ml. If not updated within 5 years

    • Immunoglobulin: 
    • - <5 75U
    • - 5-10 125U
    • - >10 250 units
  318. ARDS: 3 phases
    Exudative: initially >>membrane comprised of hyaline membrane forms

    Proliferative: 3 days >>alveolar exudate resolves or organizes

    Fibrotic: 3-4 weeks: alveolar ducts and spaces undergo fibrosis
  319. ARDS symptoms 3
    • Dyspnea
    • fever
    • mottled or cyanotic skin
  320. 3 categories of ARDS based on hypoxemia
    • MIld: PaO2/FiO2 ratio <300
    • Moderate: PaO2/FiO2 ratio <200
    • Severe: PaO2/FiO2 ratio <100
  321. ARDS treatment
    Supportive: oxygenation using PEEP

    Early stabilization of femur fractures
  322. Laeral process of talus fracture mechanism
    Forced dorsiflexion , axial loading, inversion and external rotation: snowboarders
  323. Muscular and tendinous attachments of talus
    NOne
  324. What articulates with: talar head
    Lateral process talus
    Posterior process talus
    • Navicular and sustentaculum tali
    • Posterior facet calc and lateral mal

    Consists of medial and lateral tubercle separated by groove for FHL
  325. Classification of lateal process talus #
    • Type 1: Do not involve articular surface
    • Type 2: INvolve the subtalar and tibiotalar joints
    • Type 3: have comminution
  326. What causes the following: talar posteromedial tubercle fracture
    Talar posterolateral tubercle fracture
    • Avulsion of posterior deltoid
    • Avulsion posterior talofibular ligament
  327. Talus fractures other than neck: indications for ORIF + what approach for
    Lateral process
    Talar body
    • DIsplacement >2mm
    • Lateral process: lateral approach over sinus tarsi reflecting edb distally
    • Boyd: combined medial and lateral approach
  328. Excision of a fragment >1cm of lateral process leads to
    Lateral talocalcaneal ligament incompetence: does not lead to ankle instability
  329. 3 Risk factors for femoral head non union
    • High pauwels angle: type 3 > 70
    • Garden IV
    • Posterior comminution
  330. Femoral neck non union treatment
    If no OA can revise with valgus intertrochanteric  osteotomy to make orientation of fracture more horizontal
  331. 4 fracture characteristics that increase the risk of humeral fracture malunion
    • 3-4 part
    • Humeral head split
    • Displaced tuberosity #
  332. Normal humerus anatomy: version
    Head shaft angle
    GT position
    • 30 degree retroverted
    • 130-140 degrees
    • 6mm inferior to upper edge of humeral head
  333. Distal 1/3 clavicle fracture: insertion of trapezoid
    Inserion of conoid
    • 3cm from end of clavicle: lateral
    • 4,5 cm from the end of the clavicle: medial
  334. Distal third clavicle fracture classification + treatement
    Type 1: lateral to CC ligament ....CC ligaments intact >>>non op


    • Type 2A
    • Fracture medial to CC ligaments
    • CC ligaments intact
    • Unstable
    • ORIF

    • Type 2B
    • # btw CC ligaments >>conoid torn, trapezoid intact
    • or # lateral to CC ligaments but CC ligaments torn
    • UNstable: medial clavicle displacement
    • ORIF

    • Type 3
    • Intraarticular extending to AC joint
    • Ligaments intact
    • Stable
    • Non op

    • Type 4
    • Physeal fracture in skeletally immature
    • Ligaments intact
    • Stable
    • Non op

    • Type 5
    • COmminuted
    • Ligaments intact
    • Significant medial clavicle displacement
    • ORIF
  335. 3 absolute indications for ORIF distal clavicle #
    • Open
    • SUbclavian artery or vein injury
    • FLouating shoulder: associated scapula  neck #
  336. Femoral head # % associated with hip dislocation
    5-15
  337. blood supply to femoral head 3
    • Extracapsular arterial ring: medial femoral circumflex is main contributor
    • Ascending femoral branches
    • Artery to the ligamentum teres: from obturator of MFCA
  338. Describe pipkin classification
    • Type 1: infrafoveal
    • Type 2: suprafoveal
    • Type 3: associated FN #
    • Type 4: Associated with acetabular #
  339. Inidications for non op mgmt of femoral head # (2)
    • Pipkin 1
    • Pipkin 2 with < 1mm step off

    • No interposed fragments
    • Stable hip joint
  340. Indications for operative mgmt femoral head # 5
    • Pipkin 2 >1mm step
    • Loose bodies
    • Associated acetabular or femoral neck #
    • Pipkin 4
    • Irreducible # dislocation
  341. Surgical approach for: Pipkin 1-3
    Pipkin 4
    • Anterior smith pete or watson jones
    • Kocher langenbeck to fix acetabular #
  342. Femoral head # for complications
    • HO: most common
    • AVN
    • Sciatic nerve neuropraxia: usually peroneal division
    • OA
  343. Chose antibiotic in open #: Gustillo 1
    Gustillo 2 
    Gustillo 3
    Farm injury
    Fresh water injury
    • 1st generation cephalosporin
    • 1st generation cephalosporin + aminoglycoside (gram -ve coverage)
    • Penicillin G: farm injury
    • FLuoroquinilone: can be used if allergic to clinda or cephalosporin
  344. Scapulothoracic Dissociation: mechanism
    most common vascular injury
    Mortality
    x ray finding
    What determines functional outcome
    • Lateral traction to shoulder girdle
    • Subclavian artery
    • 10%
    • Edge of scapula >1cm from spinous process as compared to contralateral side
    • Degree of neurologic compromise
  345. Insertion of anterior bundle of MCL with respect to coranoid tip
    18mm from tip
  346. 3 associated conditions to coronoid #
    • PMRI: coronoid anteromedial facet # and LCL disruptin (from Varus)
    • PLRI: Terrible triad ...radial head #, coronoid tip, LCL injury (valgus stress)
    • Olecranon # dislocation: large piece olecranon #
  347. O drisscoll classification of coronoid #
    Tip: less than or greater than 2 mm coronoid height

    Anteromedial facet

    • Anteromedal rim
    • Anteromedial rim and tip
    • Anteromedial rim and sublime tubercle

    • Basal
    • Coronoid body and base
    • Transolecranon basal coronoid #
  348. Describe medial approach to coronoid
    • Isolate and protect ulnar nerve
    • BTW 2 heads of FCU
  349. Scapula #: most common location
    Body and spine (50%)
  350. Coracoid # classifiction
    • Type 1: proximal to CC ligaments
    • Type 2: distal to CC ligaments
  351. Acromioal fracture classification 3
    • Type 1: undispalced
    • Type 2: Displaced but does not compromise subacromial space
    • Type 3: Displaced and compromises subacromial space
  352. Indications for ORIF of scapular # 4
    • > 25% articular surface glenoid involvement and humerus subluxation
    • Scapular neck displaced: >40 degrees angulation or 1 cm translation
    • Open #
    • coracoid # with >1cm displacement
  353. Judet approach: internervous plane
    SUprascapular (infraspinatus) and teres minor (axillary
  354. Capitellar # 2 associated injuries
    • LCL
    • Radial head
  355. Capitellar # classification
    • Type 1: large osseous piece
    • Type 2: kocher-lorenz>>>shear # of articular cartilage
    • Type 3: COmminuted
    • Type 4: McKEE coronal shear that includes capitellum and trochlea
  356. INdications for ORIF capitellum # 2
    + how to fix
    • Displacement >2mm
    • Type 4: mckee double arc sign because it involves the trochlea

    Lateral column approach
  357. Most common: pathogen of Septic arthritis in adults
    Location
    • Staph aureus
    • Knee > hip > shoulder
  358. Septic arthritis: timing of cartilage injury
    Mechanism of cartilage destruction
    • Can start within 8 hours
    • Release of proteolytic enzymes from PMN's
  359. 3 etiologies of bacterial seeding of joints
    • Bacteremia
    • Diret inoculation from traumaor surgery
    • Contiguous spread from adjacent osteomyelitis
  360. Most common organism in septic arthritis in young adults
    Neisseria Gonorrhea
  361. Best way to follow response to treatment in septic arthritis
    Follow CRP: normalizes within one week of treatment
  362. name of biofilm that protects bacteria from antibiotics
    exopolysaccharide glycocalx
  363. x ray findings in chronic infections 2
    Involucrum: reactive bone surrounding active infection

    Sequestrum: retained nidus of infected necrotic bone
  364. Crescent fracture: what is it

    younge and burgess type
    SI fracture dislocation: posterior ilium remains attached to sacrum by posterior ligaments, anterior ilium dislocates with an internal rotation deformity

    LC-2
  365. Name the posterior pelvic ligaments 4
    • sacrospinous
    • sacrotuberous
    • anterior sacroiliac
    • posterior sacroiliac
  366. Nerve at risk during placement of si screws
    L5 nerve root on sacral ala
  367. Mangled extremity severity score: number predictive of amputation
    Score 7 or higher
  368. Galeazzi fracture: definition
    Incidence of druj injury based on location
    • Distal 1/3 radius fracture and druj injury
    • Fracture < 7.5 mm away from joint: unstable druj 55%...if >7.5 cm>>unstable 6%
  369. 4  x ray signs of druj injury
    • Ulnar styloid #
    • WIdening of druj on AP
    • dorsal or volar displacement on lateral x ray
    • Radial shortening > 5mm
  370. If cannot reduce druj, what an be interposed.
    ECU tendon
  371. Monteggia #: definition
    Proximal 1/3 uln fracture and radial head dislocation
  372. Bado classificatio
    Type 1: Anterior dislocation of radial head....most common in the young

    Type 2: posterior dislocation of radial head >>>common in adults

    Type 3: lateral dislocation of radial head

    Type 4: Fracture of both radius and ulna with dislocation of radius in any directon
  373. Monteggia #: most likely nerve injury
    How to cast 
    Block to reduction
    PIN

    • In supination: if lateral or anterior dislocation
    • In pronation: if posterior dislocation

    Annular ligament: especially in type 3
  374. Subtalar dislocation: most common
    most common open

    3 associated fractures with medial dislocation

    4 associated with lateral dislocation
    • Medial: 65-80 %
    • lateral

    • Dorsomedial talar head
    • Posterior process oftalus
    • navicular

    • Cuboid
    • Anterior calc
    • lateral process talus
    • Fibula
  375. Subtalar dislocatiob: position of foot if medial
    Position of foot if lateral
    • Locked in supination
    • Locked in pronation
  376. How to tell direction of subtalar dislocation on lateral  xray
    Medial dislocation if talar headis superior to navicular

    Lateral dislocationif talar head colinear or inferior to navicular
  377. Subtalar dislocation: blocks to reduction if medial 3
    blocks to reduction if lateral 3
    • Peroneal tendons
    • EDB
    • TN capsule

    • Tib post
    • FHL
    • FDL
  378. COntraindication to reduction of hip dislocation
    Ipsilateral femoral neck fracture
  379. What is the next step after reduction of a hip doslocation
    CT scan
  380. 6 factors in nec fasc LRINEC scoring system
    • CRP
    • WBC
    • Hgb
    • Sodium
    • Creat
    • Glucose
  381. 3 functions of lower sacral nerve roots (S2-5)
    • Anal sphincter/voluntary contraction
    • Bulbocavernosus reflex
    • Perianal sensation
  382. Denis classification of sacral fractures
    Type 1 Fracture lateral to foramina

    Type 2: fracture through foramina...highly unstable if shear component

    Type 3: medial to sacral foramina: hihest rate of neuro injury >>bowel and bladdder dysfunction
  383. Indication for ORIF of sacral fracture
    Displacement >1cm

    Decompression if evidenceof neuro injury
  384. 3 surgical techniques to deal with unstable sacral fractures
    SI screw

    Posterior tension band plating

    Iliosacral and lumbopelvic fixatiob
  385. 5 causes of pediatric neonatal compartment syndrome
    • Fetal posture
    • Oligohydramnios
    • Umbilical cord loops
    • Amniotic band constriction
    • Direct birth trauma
  386. What compartments to release in forearm compartment syndrome
    • Mobile wad: rarely involved (ECRL/ECRB /BR)
    • Dorsal
    • Volar
  387. Compartments in the hand
    • 10 total
    • 4 dorsal interosseous
    • 4 volar interosseus
    • Thenar
    • Hypothenar
  388. forearm fasciotomy technique
    2 incisions

    Volar incision: Start medial epicondyle and jsut radial to FCU at the wrist + can extend to release carpal tunnel >>>open lacertus fibrosus and fascia over fcu then release fascia of deep compartment

    Dorsal incision: lateral and distal to lat epicodnyle btw EDC and ECRB >>decompress mobile wad and dorsal compartemnt
  389. Describe hand fasciotomy
    2 longitudinal incisions over 2nd and 4th metacarpals: dorsal and volar interossei and adductor compartment

    Longitudinal incision radial side of 1st MC: decompress thenar

    Longitudinal incision over ulnar aspect 5th MC:decompress hypothenar compartment
  390. SC dislocation: most common direction
    More serious
    • Anterior
    • Posterior: mediastinal structures at risk
  391. SC joint: most important ligament for Superior displacement
    AP displacement
    • anterior SC ligament
    • Posterior capsular ligament
  392. SC joint dislocation: what x ray to order
    Serendipity view: 40 degree cephalad tilt
  393. SC joint dislocation: acute anterior <3 weeks
    Posterior dislocation
    Closed reduction: Abduct, extend, traction to arm and direct pressure over clavicle

    Open reduction and reconstruction with thoracic surgery available
  394. Osteomyelitis: organism present in sickle cell
    positive prognostic factor after treatment
    • Staph a: but salmonella is classic for sickle cell
    • Decrease in ESR: CRP decreases faster
  395. OSteomyelitis classification
    • Stage 1: medullary
    • Stage 2: Superficial
    • Stage 3: Localized
    • Stage 4: diffuse

    Host

    • Type a: normal
    • Tyoe b: compromised
    • Type c: treatment is worse than infection
  396. Popliteal artery: 2 sites of tethering in knee dislocation
    • Proximal: fibrous tunnel at adductor hiatus
    • DIstal: fibrous tunnel at soleus muscle
  397. knee dislocation: most common
    Highest rate vascular injury
    Highest rate peroneal njury
    ROtational - what direction + classic finding
    • anterior: hyperextension injury
    • Posterior: also highest rate of complete transection
    • Lateral: varus or valgus force
    • Posterolateral: irreducible bc of buttonholing of femoral condyle through capsule
  398. Contraindication to closed reduction of knee dislocation
    DImple sign: buttonholing femoral condyle in posterolateral rotatory dislocation
Author
egusnowski
ID
345822
Card Set
Trauma - Orthobullets
Description
Trauma orthobullets
Updated