9. Trauma Flashcards
1
Q
What should be done FIRST when assessing a patient with trauma?
A
Primary survey (ABCDE)
- Airway
- Breathing
- Circulation with hemorrhage control
- Disability – assess neurologic status
- Exposure of patient and environmental control
Secondary survey
- Full history – medical and drug
- Thorough examination
- Evaluate tenderness and stability as well as neurovascular status of each limb
- Is there injury to joint above or below?
- X-rays and/or CT of all suspected fractures
2
Q
What are the components of a PRIMARY trauma surgery?
A
(ABCDE)
- Airway
- Breathing
- Circulation with hemorrhage control
- Disability – assess neurologic status
- Exposure of patient and environmental control
3
Q
What should always be asked with a break in the skin?
A
Tetanus status
4
Q
what is a clinical test for a fracture?
A
point tenderness over fracture site
5
Q
what are common fracture patterns?
A
- transverse
- greenstick
- torus
- oblique (spiral)
- comminuted
6
Q
which fracture pattern is the most stable?
A
transverse
transverse fracture pattern is the most stable
7
Q
what is the weakest region of the physis?
A
zone of cartilage maturation
8
Q
what is the Vassal principle?
A
initial fixation of the PRIMARY fracture will assist stabilization of the secondary fracture
9
Q
name possible complications of fractures
A
- delayed union
- non-union
- pseudoarthrodesis
- osteoarthritis
- avascular necrosis
10
Q
what is the timeframe is considered a delayed union?
what about a non-union?
A
- delayed union: 4-6 months
- non-union: minimum of 9 month old fracture, with at least 3 months of no progress
11
Q
define: delayed union
A
- considered a delayed union at 4-6 months
- healing has not advanced at the average rate for the location and type of fracture/osteotomy
12
Q
treatment: delayed union
A
can often be healed by strict immobilization alone
13
Q
define: non-union
A
- minimum of 9-month-old fracture with no improvement for 3 months
- fracture or osteotomy that does not show improvement during the above timeframe
14
Q
treatment: non-union
A
- intervention might include:
- bone stimulator
- operative means
- atrophic nonunions often require a bone graft
15
Q
define: pseudoarthrosis
A
- end-stage of a non-union;
- a fibrocartilaginous surface site and a joint space develops that may contain synovial fluid
16
Q
treatment: pseudoarthrosis
A
operative intervention is the only reliable method of forming a union involving a pseudoarthrosis
17
Q
define: malunion
A
a fracture that heals in an anatomically incorrect position
18
Q
most common cause:
non-healing for a bone fracture
A
improper mobilization
19
Q
name 5 LOCAL factors of
non-healing of bone fractures
A
- improper immobilization (MC)
- infection
- poor fixation
- distracted fracture
- vascular status
- severity of injury (comminution, local tissue damage)
20
Q
name 5 GENERAL/SYSTEMIC factors of
non-healing of bone fractures
A
- smoking
- diabetes
-
endocrinopathies
- thyroid, parathyroid, testosterone deficiency, vit D deficiency
- malnutrition
-
medications
- steroids, chemo, bisphosphonates
- bone quality
21
Q
who was Lisfranc?
A
he was a field surgeon in Napoleon’s army
22
Q
are dorsal or plantar Lisfranc dislocations more common?
A
DORSAL dislocations are more common
because the plantar ligaments are stronger than dorsal ligaments
23
Q
what are the Ottowa Ankle Rules?
A
- A series of ankle X-ray films is required only if there is any pain in the malleolar zone and any of the following findings:
- Bone tenderness at posterior edge or distal 6 cm of lateral malleolus
- Bone tenderness at posterior edge or distal 6 cm of medial malleolus
- Inability to bear weight both immediately and in ED
- A series of foot X-ray films is required only if there is any pain in midfoot zone and any of the following findings:
- Bone tenderness at base of 5th metatarsal
- Bone tenderness at navicular
- Inability to bear weight both immediately and in ED
24
Q
what is the classification for:
talar dome lesions
A
Berndt & Hardy
25
which stages of **Berndt & Hardy** classification are often associated with:
## Footnote
**lateral ankle ligament ruptures**
stages 2, 3, & 4
26
what are the common:
1. **locations** of talar dome lesions,
2. their **mechanisms of injury**
(DIAL a PIMP)
* **Dorsiflexion Inversion – Anterior Lateral** (unstable, shallow, wafer-shaped lesion)
* **Plantarflexion Inversion – Medial Posterior** (deep, cup-shaped lesion)
27
define: **Hawkins sign**
* presence of _subchondral talar dome osteopenia seen 6-8 weeks_ after the talar fracture **signifying intact vascularity**
* absence of sign implies avascular necrosis
On x-ray, look for **radiolucent line** below the subchondral bone; MC seen on medial side in mortise view
28
what is the **Sneppen classification**
Talar BODY fractures
29
percentage of talar fractures involving the calcaneus
**60%**
*60% of talar fractures involve the calcaneus*
30
of the 60% of talar fractures that involve the calcaneus,
what percentage involves the joint?
75% of the talar fx + calc fx ALSO involve the joint
31
define: **Mondor sign**
Plantar, rearfoot ecchymosis that is pathognomonic for calcaneal fractures
32
how is the Bohler angle affected by a calcaneal fracture?
Bohler angle DECREASES with intra-articular calcaneal fracture
(Normal: 20-40o)
33
how is Gissane angle affected by a calcaneal fracture?
INCREASES with intra-articular calcaneal fracture
(Normal: 120-145o)
34
what fractures are commonly associated with calcaneal fractures?
* vertebral fractures, especially L1
* femoral neck
* tibial plateau
35
MOI: anterior process fracture
**inversion with plantarflexion**
*\*Mechanism of injury for anterior process fracture on calcaneus*
36
clinical tests for ankle ligament pathology
* Anterior drawer test
* Calcaneofibular-stress inversion
* Abduction stress
* Ankle arthrogram
* Peroneal tenography
37
**anterior drawer test:** outcomes
* 5-8 mm drawer → rupture of ATF
* 10-15 mm drawer → rupture of ATF + CF
* \>15 mm drawer → rupture of ATF + CF + PTF
38
**talar tilt test:** outcomes
\>10° → rupture of CFL
39
**stress inversion test:** outcomes
* 5° inversion → rupture of ATF
* 10-30° inversion → rupture of ATF + CF
40
**Achilles tendon rupture:** clinical symptoms
1. Pain with history of "pop"
2. Weakness or loss of function
3. Palpable dell in area of ruptured tendon
4. Inability to perform single leg rise
5. Increased ankle dorsiflexion
41
define: **Thompson test**
A positive test results when squeezing of the calf muscle does not plantarflex the foot
42
define: **Hoffa sign**
1. **Increased dorsiflexion** compared to the contralateral side, along with the
2. **Inability to perform a single-leg rise test**
*(\*indicates an Achilles tendon rupture)*
43
radiographic finding of Achilles Tendon Rupture
Disruption of Kagers triangle
44
MC common location for Achilles tendon to rupture
Watershed area: 1.5-4 cm proximal to calcaneal insertion
45
# define:
**Pott fracture**
Bimalleolar fracture
46
# define:
**Cotton**
Trimalleolar fracture
47
# define:
**Tillaux-Chaput**
Avulsion fracture of _anterior, lateral_ **tibia** from AITFL
48
# define:
**Wagstaff fracture**
Avulsion fracture of _anterior, medial_ **fibula** from AITFL
49
# define:
**Cedell fracture**
Fracture of _posterior medial_ process of **talus**
50
# define:
**Shepard fracture**
Fracture of _posterior lateral_ process of **talu****s**
51
# define:
**Foster fracture**
_Entire posterior_ process of the **talus**
52
# define:
**Bosworth fracture**
**Lateral malleolar** fracture (fibula) with ankle displacement
*\*this is a rare fracture-dislocation of the ankle caused by extreme external rotation of a supinated foot*
53
# define:
**Maisonneuve fracture**
_Proximal_ **fibular** fracture
*(\*Weber Type C high fibula fracture)*
54
MC MOI:
## Footnote
**ankle fracture**
SER
## Footnote
*supination external rotation*
55
MOI:
## Footnote
**transverse _lateral_ malleolar fracture**
SAD I
## Footnote
*supination adduction*
56
MOI:
## Footnote
**short, oblique _medial_ malleolar fracture**
**SAD II**
*supination adduction II*
57
MOI:
## Footnote
**short, oblique _lateral_ malleolar fracture**
PAB III
## Footnote
*pronation abduction III*
58
MOI:
**spiral, lateral malleolar fracture with a posterior spike**
(AP and lateral views)
SER II
## Footnote
*supination external rotation II*
59
MOI:
## Footnote
**high fibular fracture**
PER III
*pronation external rotation III*
(also called Maisonneuve fracture)
60
what is a **Lauge-Hansen Type V**?
PRONATION DORSIFLEXION
1. Vertical tibial malleolar tip fracture
2. Anterior tibial lip fracture
3. Supramalleolar fibular fracture
4. Transverse posterior tibia fracture level with proximal aspect of anterior tibial fracture
61
When should a posterior malleolar fracture be fixated?
ORIF when fragment is greater than 25% of the posterior malleolus
62
what direction should **transsyndesmotic screws** be inserted using a lag technique?
**Approximately 30° from the sagittal plane**
from posterior-lateral to anterior-medial
63
should **transsyndesmotic screws** be inserted using a lag technique?
**No.**
* Fully-threaded cortical screws are placed **across both cortices** of the fibula and the lateral cortex of the tibia.
* The **goal is stabilization rather than compression**.
64
what do you clinically test via **Jack Toe Test**?
**Foster fracture** –
a fracture of the entire posterior process
65
# define:
**Thurston-Holland sign**
Epiphysis is separated from the physis with the fracture extending into the metaphysis resulting
in a triangular fracture fragment (AKA Flag sign)
* \*fracture through the epiphysis transversely going through metaphysis (triangle)*
* \*MOST COMMON SALTER-HARRIS FRACTURE*
