Trauma - SA

  1. List 8 things that will make you decide on DCO versus primary treatment.
    • ISS >40
    • ISS >20 if thoracic trauma
    • Bilateral femur #
    • Pulmonary contusion visible on CXR
    • Hypothermia <35
    • GCS 8 or less
    • Head injury with AIS of 3 or more
    • IL-6 values >500
    • Hemorragic shock and multiple injuries
  2. Patient with grade 2 open tibia fracture. Allergy to penicillin (gets anaphylactic reaction) and does not know his tetanus status A - List the antibiotic treatment B - List the tetanus treatment C - State the surgical treatment
    A: clindamycin 600 mg IV

    B tetanus toxoid + tetanus immunoglobulin if contaminated wound

    C: I&D + nail vs exfix depending on soft tissue
  3. Describe the Leadbetter maneuver to reduce a displaced femoral neck fracture (4)
    • FLexion with adduction
    • traction in line with femur
    • IR
    • Circumduction by bringing the leg into abduction and extension while keeping IR nd traction
  4. List 3 radiographic criteria for determining a good reduction of a displaced femoral neck fracture
    • Garden index: 160-180
    • Double s shape in lateral x ray
    • Neck shaft angle 130-150 degrees
  5. Patient sustained an elbow dislocation that was reduced but remained unstable at 45 degrees with posterolateral instability A - List 3 stabilizers to posterolateral instability B - What is most likely injured? C - What is the treatment?
    A: LCL, radial head,  MCL

    B: LCL

    C: Splint in pronation and flexion and reevaluate weekly
  6. List 2 components of the push-up test for assessing posterolateral rotatory instability (PLRI)
    Try to get up from hair or do push up with arm maximally pronated and supinated

    Test is positive if pain/symptoms present in supination but not pronation
  7. What are clinical features of Class IV shock? (5)
    • Hypotension: <90
    • Tachycardia: >140
    • Negligible urne output
    • Mental status: lethargic
    • Skin: cold pale
  8. What are 8 chest radiographic findings of aortic arch rupture?
    • Widened mediastinum > 8cm
    • Obliteration of aortic knob
    • Deviation trachea to the right
    • Deviation of esophagus to the right
    • Obliteration of space btw pulmonary artery and aorta
    • Elevation of right mainstem broncus
    • Left hemothorax
    • Depression of left mainstem bronchus
  9. Given an x-ray of a varus malunited femoral neck fracture. List 4 clinical findings found on physical exam other than decreased ROM.
    • LLD
    • Trendelenburg gait
    • FAI
    • Pain on terminal abdyction
  10. List 6 causes of acquired coxa vara.
    • Femoral neck malunion
    • SCFE
    • LCP
    • AVN
    • Fibrous dysplasia
    • Metabolic (rickets)
  11. List 4 complications of a radial head fracture.
    • Stiffness
    • Pain
    • Arthritis
    • Synostosis
  12. List 6 risk factors of radioulnar synostosis that occurs after surgery.
    • Same level fracture
    • Hardware.bone in IOM
    • Interosseous membrane dissection/disruption
    • Ankylosing spondylitis
    • Closed head injury
    • SIngle incision
  13. List 3 complications of doing an ankle ORIF in a patient with DM.
    • Charcot joint
    • Infection
    • Hardware failure
    • Non union
    • Surgical site infection
  14. Give 2 advantages of doing a piriformis starting point vs. a trochanteric starting point for an antegrade femoral nail.
    • Piriformis entry inline with medullary canal
    • Decrease risk of fracture: medial wall blowout
  15. List 3 advantages of locking plates vs DCS for the treatment of distal femur fractures.
    • Improved fixation in osteoporotic bone
    • Can be done percutaneously
    • Increased construct rigidity
  16. Proximal tibiofibular dislocation A - Mechanism (2) – leg position and knee position B - Clinical findings (5) C - How to reduce (2)
    A; fall onto knee flexed, leg adducted

    B: palpable bony prominence, peroneal nerve palsy, limited knee extension, lateral knee pain aggravated by pressure over fibular head,  crepitus

    C: Knee flexion to 80-100 degrees, ER and apply pressure over fibular head
  17. List 4 signs of post-tourniquet syndrome.
    • Skeletal muscle injury: worse at compression site
    • Nerve injury: worse at compression site
    • Metabolic dysfucntion: elevated lactic acid and pH
    • COagulopathy: increased fibrinolytic activity
  18. List 3 techniques to avoid varus deformity when nailing a subtrochanteric femur fracture.
    • Medial start point
    • Nail in the lateral decubitus position
    • use femoral distractior
    • Open reduction: unicortical plate or cerclage wire
  19. List 3 ways that will help you make sure you don't overstuff the joint when doing a radial head replacement
    • Reassemble radial head on back table
    • X ray of wrist to ensure maintained ulnar variance
    • Neck should not be more than 1 mm proximal to lateral coronoid or sigmoid notch
    • Look for joint asymmetry on x rays
  20. Four principles of managing a Pilon excluding soft tissue
    • Anatomic reduction articular surface
    • Fix metaphysis to articular surface with plate construct
    • Bone graft for bone loss
    • Reagin length and alignment: can fix fibula to help restore length but must be anatomic
  21. List three radiographic criteria suggesting syndesmotic injury
    • Widening medial clear space > 5mm
    • Tib fib overlap <1mm on mortice
    • Tib fib overlap < 6mm on AP
  22. Terrible triad; list the three injuries making this up
    • Radial head fracture
    • Posterior elbow dislocation
    • Coronoid fracture
  23. List 4 ways a plate can function other than a buttress
    • Bridge
    • Tension band
    • Neutralization
    • Dynamic compression
  24. List 5 indications for ORIF of a mid shaft humerus fracture
    • FLoating elbow
    • Brachial plexus injury
    • Vascular injury
    • Open fracture
    • Pathologic #
  25. List 3 ways to prevent procurvatum in a proximal tibia fracture
    • Nail semiextended position
    • Poller screws: posterior
    • Unicortical plate
    • Femoral distractor
  26. List 4 reasons to do ORIF of a scaphoid fracture acutely
    • Humpback deformity: intrascaphoid angle > 35 degrees
    • Perilunate fracture dislocation
    • Proximal pole #
    • Displacement >1mm
    • Vertical shear fracture line
  27. List 5 features associated with increased risk of peri-operative mortality in hip fractures
    • Male
    • Delay OR >48 hrs
    • Poor mental status
    • Age
    • Medical comorbidities/ASA
  28. List 5 features associated with increased risk of peri-operative mortality in hip fractures
    • Male
    • Delay OR >48 hrs
    • Poor mental status
    • Age
    • Medical comorbidities/ASA
  29. List 4 complications with a traction table and hemi-lithotomy position
    • Well leg compartment syndrome
    • Pudendal nerve injury
    • Sciatic/peroneal nerve neuropraxia
    • Perineal soft tissue injury
  30. List 4 reasons for placing an ex-fix on a both bone forearm fracture
    • Vascular injury
    • Extensive soft tissue damage
    • DCO
    • Major bone loss
  31. A patient of yours is being worked up for Fat Embolus Syndrome. List 4 Major criteriaList 4 Minor criteria
    Major

    • Hypoxemia < 60mmhg
    • Axillary or subconjuctival petachiae
    • CNS depression disproportionate to hypoxemia
    • Pulmonary edema

    • MInor
    • HR >110
    • Temp >38.5
    • Fat in Urine
    • Emboli in retina
    • Elevated ESR
    • Thrombocytopenia
  32. When performing an IM nailing of the femur on a fracture table, name 3 radiologic criteria you can use to prevent malrotation of the femur
    Comparison of LT profile with the uninjured limb using fluoroscopy

    Using the built in 15 degrees anteversion in the nail and building to it

    Assess cortical width of proximal and distal fargments attempting to see a smooth transition
  33. Talus malunion: most common types and 3 ways to prevent?
    Varus malunion

    • Dual approach: reduction based on lateral read due to medial comminution
    • Avoid medial compression screws
    • Use structural bone graft medially
  34. 5 Radiographic features of atypical femur fractures?
    • Transverse or short oblique
    • Femoral shaft or subtrochanteric
    • Cortical beaking: usually medial
    • No comminution: simple line
    • Increased cortical thickness
  35. 6 risk factors for non-union
    • Smoking
    • DM
    • Open fracture
    • Compromised vascular supply
    • Inadequate fracture fixation
    • Infection
    • Soft tissue interposition
  36. Type II tibial spine fracture: Block to reduction? Consequence of non-anatomic reduction
    Intermeniscal ligament or anterior horn of medial meniscus

    ACL laxity or extension block from impingement
  37. Given 2 x-rays and a 3D CT scan of an elbow. Describe 4 surgical principles in managing a coronoid anteromedial facet fracture. (Posteromedial Varus rotatory instability= PMRI)
    • Anatomic reduction
    • Butress fixation usually
    • Assess and reconstruct LCL
    • Asesss MCL and reconstruct if necessary
  38. Give 5 indications for early amputation in trauma?
    • Ischemia > 6 hrs
    • MESS > 7
    • Irreparable vascular injury
    • Severe crush injury with minimal viable tissue
    • Retained limb in chronic setting is threat to patient's survival


     
  39. What factors are the main predictors of instability and redisplacement after manipulation in distal radial fractures?
    • Metaphyseal comminution
    • Age >60
    • Associated ulnar #
    • Initial displacement: lat >1cm or > 5mm radial shortening
  40. What 3 factors make up the lethal triad in the polytraumatized patient?
    • Hypothermia
    • Hypercoagulable
    • hypotension
  41. Give 5 factors associated with increased risk of mortality in the polytrauma patient?
    • INcreased age
    • Head injury
    • Elevated ISS
    • Hemodynamic instability
    • Base deficit on presentaion and throughout rescucitation
  42. Give 5 reasons to perform a retrograde IMN for the femur?
    • Bilateral femur #
    • Obesity
    • Ipsilateral acetabular #
    • Ipsilateral tibial plateau #
    • Pregnancy
  43. Give 5 non-operative indications for acetabular fractures?
    • COncentric hip
    • Dispalcement < 2mm
    • Low anterior column #
    • Low transverse #
    • ROof arc angle >45
    • posterior wall # < 20%
    • No marginal impaction
  44. Give 5 poor prognostic factors in calcaneus fractures
    • Age >50
    • workman compensation
    • SMoker
    • DM
    • Bilateral calc #
  45. Give 5 factors that help to increase stability in an external fixator
    • Large diameter pins
    • Decrease bone to rod distance: close to skin
    • Pins and rods in different planes
    • Multiple rods
    • Increasing space between pins
  46. List 5 physiologic changes in pregnancy related to trauma
    • INcreased plasma volume
    • Dilutional anemia
    • INcreased cardiac output after 35 weeks
    • Supine position can compress venous sytem: place in left lateral decubitus
  47. What are the anatomic changes associated with Volkmann's contracture?
    • Elbow flexion
    • Forearm pronation
    • Thumb adducton
    • Wrist flexion
    • No intrinsic function
Author
egusnowski
ID
345830
Card Set
Trauma - SA
Description
Trauma sa
Updated