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**2.Part II - Updated Crozer > 9. Trauma > Flashcards

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
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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
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3
Q

What should always be asked with a break in the skin?

A

Tetanus status

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4
Q

what is a clinical test for a fracture?

A

point tenderness over fracture site

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5
Q

what are common fracture patterns?

A
  • transverse
  • greenstick
  • torus
  • oblique (spiral)
  • comminuted
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6
Q

which fracture pattern is the most stable?

A

transverse

transverse fracture pattern is the most stable

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7
Q

what is the weakest region of the physis?

A

zone of cartilage maturation

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8
Q

what is the Vassal principle?

A

initial fixation of the PRIMARY fracture will assist stabilization of the secondary fracture

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9
Q

name possible complications of fractures

A
  • delayed union
  • non-union
  • pseudoarthrodesis
  • osteoarthritis
  • avascular necrosis
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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
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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
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12
Q

treatment: delayed union

A

can often be healed by strict immobilization alone

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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
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14
Q

treatment: non-union

A
  • intervention might include:
    • bone stimulator
    • operative means
  • atrophic nonunions often require a bone graft
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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
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16
Q

treatment: pseudoarthrosis

A

operative intervention is the only reliable method of forming a union involving a pseudoarthrosis

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17
Q

define: malunion

A

a fracture that heals in an anatomically incorrect position

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18
Q

most common cause:

non-healing for a bone fracture

A

improper mobilization

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19
Q

name 5 LOCAL factors of

non-healing of bone fractures

A
  1. improper immobilization (MC)
  2. infection
  3. poor fixation
  4. distracted fracture
  5. vascular status
  6. severity of injury (comminution, local tissue damage)
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20
Q

name 5 GENERAL/SYSTEMIC factors of

non-healing of bone fractures

A
  1. smoking
  2. diabetes
  3. endocrinopathies
    • thyroid, parathyroid, testosterone deficiency, vit D deficiency
  4. malnutrition
  5. medications
    • steroids, chemo, bisphosphonates
  6. bone quality
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21
Q

who was Lisfranc?

A

he was a field surgeon in Napoleon’s army

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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

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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
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24
Q

what is the classification for:

talar dome lesions

A

Berndt & Hardy

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25
Q

which stages of Berndt & Hardy classification are often associated with:

lateral ankle ligament ruptures

A

stages 2, 3, & 4

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26
Q

what are the common:

  1. locations of talar dome lesions,
  2. their mechanisms of injury
A

(DIAL a PIMP)

  • Dorsiflexion Inversion – Anterior Lateral (unstable, shallow, wafer-shaped lesion)
  • Plantarflexion Inversion – Medial Posterior (deep, cup-shaped lesion)
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27
Q

define: Hawkins sign

A
  • 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
Q

what is the Sneppen classification

A

Talar BODY fractures

29
Q

percentage of talar fractures involving the calcaneus

A

60%

60% of talar fractures involve the calcaneus

30
Q

of the 60% of talar fractures that involve the calcaneus,

what percentage involves the joint?

A

75% of the talar fx + calc fx ALSO involve the joint

31
Q

define: Mondor sign

A

Plantar, rearfoot ecchymosis that is pathognomonic for calcaneal fractures

32
Q

how is the Bohler angle affected by a calcaneal fracture?

A

Bohler angle DECREASES with intra-articular calcaneal fracture

(Normal: 20-40o)

33
Q

how is Gissane angle affected by a calcaneal fracture?

A

INCREASES with intra-articular calcaneal fracture

(Normal: 120-145o)

34
Q

what fractures are commonly associated with calcaneal fractures?

A
  • vertebral fractures, especially L1
  • femoral neck
  • tibial plateau
35
Q

MOI: anterior process fracture

A

inversion with plantarflexion

*Mechanism of injury for anterior process fracture on calcaneus

36
Q

clinical tests for ankle ligament pathology

A
  • Anterior drawer test
  • Calcaneofibular-stress inversion
  • Abduction stress
  • Ankle arthrogram
  • Peroneal tenography
37
Q

anterior drawer test: outcomes

A
  • 5-8 mm drawer → rupture of ATF
  • 10-15 mm drawer → rupture of ATF + CF
  • >15 mm drawer → rupture of ATF + CF + PTF
38
Q

talar tilt test: outcomes

A

>10° → rupture of CFL

39
Q

stress inversion test: outcomes

A
  • 5° inversion → rupture of ATF
  • 10-30° inversion → rupture of ATF + CF
40
Q

Achilles tendon rupture: clinical symptoms

A
  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
Q

define: Thompson test

A

A positive test results when squeezing of the calf muscle does not plantarflex the foot

42
Q

define: Hoffa sign

A
  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
Q

radiographic finding of Achilles Tendon Rupture

A

Disruption of Kagers triangle

44
Q

MC common location for Achilles tendon to rupture

A

Watershed area: 1.5-4 cm proximal to calcaneal insertion

45
Q

define:

Pott fracture

A

Bimalleolar fracture

46
Q

define:

Cotton

A

Trimalleolar fracture

47
Q

define:

Tillaux-Chaput

A

Avulsion fracture of anterior, lateral tibia from AITFL

48
Q

define:

Wagstaff fracture

A

Avulsion fracture of anterior, medial fibula from AITFL

49
Q

define:

Cedell fracture

A

Fracture of posterior medial process of talus

50
Q

define:

Shepard fracture

A

Fracture of posterior lateral process of talus

51
Q

define:

Foster fracture

A

Entire posterior process of the talus

52
Q

define:

Bosworth fracture

A

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
Q

define:

Maisonneuve fracture

A

Proximal fibular fracture

(*Weber Type C high fibula fracture)

54
Q

MC MOI:

ankle fracture

A

SER

supination external rotation

55
Q

MOI:

transverse lateral malleolar fracture

A

SAD I

supination adduction

56
Q

MOI:

short, oblique medial malleolar fracture

A

SAD II

supination adduction II

57
Q

MOI:

short, oblique lateral malleolar fracture

A

PAB III

pronation abduction III

58
Q

MOI:

spiral, lateral malleolar fracture with a posterior spike

(AP and lateral views)

A

SER II

supination external rotation II

59
Q

MOI:

high fibular fracture

A

PER III

pronation external rotation III

(also called Maisonneuve fracture)

60
Q

what is a Lauge-Hansen Type V?

A

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
Q

When should a posterior malleolar fracture be fixated?

A

ORIF when fragment is greater than 25% of the posterior malleolus

62
Q

what direction should transsyndesmotic screws be inserted using a lag technique?

A

Approximately 30° from the sagittal plane

from posterior-lateral to anterior-medial

63
Q

should transsyndesmotic screws be inserted using a lag technique?

A

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
Q

what do you clinically test via Jack Toe Test?

A

Foster fracture –

a fracture of the entire posterior process

65
Q

define:

Thurston-Holland sign

A

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*

**2.Part II - Updated Crozer (17 decks)

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