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Orthobullets/ FRCSC Canadian Board > Goldenstein Trauma List 2 > Flashcards

Goldenstein Trauma List 2 Flashcards

1
Q

External fixator stability increased by (9)

A
  1. End-to-end contact of fracture fragments (#1)
  2. Larger diameter pins (#2)
  3. Larger diameter rods
  4. Increased number of pins
  5. Increased number of rods
  6. Pins in different planes
  7. Rods in different planes
  8. Decreased bone-rod distance
  9. Increased spacing between pins
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2
Q

Circular external fixator stability increased by (9)

A
  1. Olive wires
  2. More wires
  3. Increased wire tension
  4. Larger diameter wires and half pins
  5. Decreased ring diameter
  6. Increased number of rings
  7. Decreased spacing between adjacent rings
  8. 2 central rings close to the fracture site
  9. Wires/pins crossing at 90°
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3
Q

Tscherne grading of soft tissue injury (4)

A
  • Grade 0: Minimal soft tissue damage
  • Grade 1: superficial abrasion/contusion
  • Grade 2:Deep abrasion, muscle contusion and/or contaminated skin
  • Grade 3: severe degloving, crushing, compartment syndrome or vascular injury
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4
Q

Gustilo classification of open fractures (5)

A

I: clean wound < 1 cm

II: clean wound 1-10 cm

IIIA: clean wound > 10 cm, contaminated wound or extensive injury that can be closed primarily

IIIB: needs flap for coverage

IIIC: arterial injury

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5
Q

ER treatment of open fractures (5)

A
  1. Splint
  2. Tetanus
  3. Antibiotics
  4. Neurovascular exam
  5. Dressing

(S.T.A.N.D.)

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6
Q

Tetanus-prone wounds (6)

A
  1. > 6 hours old
  2. Irregular configuration
  3. Depth > 1 cm
  4. Due to a projectile injury, crush, burn or frostbite
  5. Devitalized tissue
  6. Gross contamination
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7
Q

Indications for tetanus booster (3)

A
  1. Any wound with an incomplete or unknown immunization history
  2. Any wound with a complete initial series but > 10 years since last booster
  3. Tetanus prone wound with complete initial series and > 5 years since last booster
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8
Q

Indication for tetanus immunoglobulin (1)

A

Tetanus prone wound with an incomplete initial series or unknown immunization history

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9
Q

Indications for prophylactic antibiotics (4)

A
  1. Open fractures
  2. Bone exposed
  3. Hardware placed
  4. Large hematoma
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10
Q

Signs of muscle viability:

A
  1. Contractility
  2. Color
  3. Consistency
  4. Capacity to bleed

(4 C’s)

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11
Q

Signs of vascular injury (10)

A

Hard (5):

  1. Absent pulses
  2. Pulsatile bleeding
  3. Expanding hematoma
  4. Bruit
  5. Thrill

Soft (5):

  1. Diminished pulses
  2. Decreased capillary refill
  3. Hypesthesia
  4. Decreased leg temperature
  5. Pallor
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12
Q

Fracture complications

A

Early systemic (5)

  1. Venous thromboembolism
  2. Fat embolism syndrome
  3. MOSF
  4. ARDS
  5. Shock

Early local (5)

  1. Open wounds
  2. Hemorrhage
  3. Fracture blisters
  4. Skin necrosis
  5. Infection

Late systemic (2)

  1. Venous thromboembolism
  2. Sepsis

Late local (7)

  1. Infection
  2. Delayed union
  3. Non-union
  4. Malunion
  5. Post-traumatic arthritis
  6. CRPS
  7. Heterotopic ossification
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13
Q

Indications for bone growth stimulators (4)

A
  1. Delayed union
  2. No infection
  3. No/minimal deformity
  4. Stable internal fixation
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14
Q

Contraindications to bone growth stimulators (3)

A
  1. Synovial pseudarthrosis
  2. Mobile non-union
  3. Fracture gap > 1 cm
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15
Q

Causes of fracture non-union (5) systemise\local

A
  1. Poor patient (local/systemic)
  2. Inadequate stability
  3. Fracture gap
  4. Loss of blood supply
  5. Infection
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16
Q

Classification of fracture non-union (4)

A

Septic

Aseptic

  • Hypertrophic
  • Oligotrophic
  • Atrophic
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17
Q

Principles of atrophic non-union treatment (4)

A
  1. Apposition of viable bone ends
  2. Stable internal fixation
  3. Grafting to fill defects/provide biology
  4. Preservation/creation of healthy/well-vascularized soft tissue envelope
18
Q

Principles of septic non-union treatment (5)

A
  1. Remove infected/devitalized tissue
  2. Apposition of viable bone ends
  3. Stabilization of fracture
  4. Preservation/creation of healthy/well-vascularized soft tissue envelope
  5. Local and systemic antibiotics
19
Q

Indications for acute deformity correction (3)

A
  1. Modest deformities
  2. Mobile/atrophic non-unions
  3. Small bone defects
20
Q

Indications for gradual deformity correction (4)

A
  1. Large deformities
  2. Associated limb length discrepancy requiring lengthening
  3. Associated segmental defect requiring bone transport
  4. Stiff/hypertrophic non-unions
21
Q

Management of segmental bone defects (4)

A
  1. Acute limb shortening
  2. Delayed limb shortening
  3. Defect reconstruction
  4. Amputation
22
Q

Reconstruction of segmental bone defects (4)

A
  1. Autograft
  2. Allograft
  3. Bone graft substitutes
  4. Distraction osteogenesis
23
Q

Advantages of acute limb shortening (6)

A
  1. Short treatment time
  2. Lowest complication rate
  3. Fracture healing starts immediately
  4. Improved stability
  5. Facilitation of wound closure
  6. Excellent residual limb function
24
Q

Advantages of autogenous cancellous grafting (4)

A
  1. Widely applicable
  2. Easy to perform
  3. Low cost
  4. Osteoconductive and osteoinductive
25
Q

Disadvantages of autogenous cancellous grafting (4)

A
  1. Donor site morbidity
  2. Slow, unreliable incorporation
  3. No structural support
  4. Not applicable for large defects
26
Q

Indications for distraction osteogenesis (4)

A
  1. Limb lengthening
  2. Deformity correction
  3. Hypertrophic non-unions
  4. Segmental bone loss
27
Q

Advantages of distraction osteogenesis (4)

A
  1. Appropriate for large defects
  2. Immediate stability/weight bearing
  3. Can address concomitant angular deformity
  4. Allows for care of soft tissues
28
Q

Disadvantages of distraction osteogenesis (4)

A
  1. Prolonged treatment time
  2. Pin tract infection
  3. Specialized equipment/training
  4. Psychosocial impact of external fixator
29
Q

Principles of distraction osteogenesis (9)

A
  1. Lengthen through metaphysis whenever possible
  2. Low-energy corticotomy/osteotomy
  3. Minimal soft tissue stripping
  4. Stable external fixation
  5. Latency period
  6. Distraction of 0.25 mm 3-4x/day
  7. Neutral fixation interval during consolidation
  8. Normal physiologic use of the extremity
  9. Limit lengthening to 20% of bone length per period
30
Q

Indications for free vascularized fibular grafting (3)

A
  1. Conventional bone grafting has failed
  2. Large defects
  3. Poor soft tissue bed
31
Q

Advantages of free vascularized fibular grafting (5)

A
  1. Large defects
  2. Resistant to infection
  3. Immediate stability
  4. Rapid healing
  5. High union rates
32
Q

Disadvantages of free vascularized fibular grafting (3)

A
  1. Donor site morbidity
  2. Graft fracture
  3. Specialized techniques/training required
33
Q

Advantages of antibiotic beads in bone defect management (3)

A
  1. Higher local concentration of antibiotics
  2. Improved dead space management (↓ scar/hematoma)
  3. Improved contour/easier elevation of soft tissue flaps
34
Q

Order of deformity correction in malunion (4)

A
  1. Angulation
  2. Translation
  3. Length
  4. Rotation
35
Q

Sequence of repair in traumatic amputations (5)

A
  1. Skeletal stabilization
  2. Arteries
  3. Veins
  4. Nerves
  5. Muscle
36
Q

Indications for debridement of gunshot wounds (8)

A
  1. Bullet in a joint
  2. Vascular disruption
  3. Gross contamination
  4. Palpable missile in the palm/sole
  5. Massive hematoma
  6. Severe soft tissue injury
  7. Compartment syndrome
  8. Late pain/loss of function with retained missile
37
Q

Indications for immediate/early amputation (7)

A
  1. Limb is a threat to patient’s life
  2. Non-viable limb
  3. Irreparable vascular injury
  4. Warm ischemia time > 8 hours
  5. Severe crush with minimal viable soft tissue
  6. Reconstruction demands incompatible with patient’s personal/sociologic/economic needs
  7. Salvage may precipitate MOSF/ARDS
38
Q

Predictors of lower functional scores with extremity reconstruction (9)

A
  1. Rehospitalization for a major complication
  2. Low education
  3. Non-white
  4. Poverty
  5. Lack of private health insurance
  6. Poor social supports
  7. Low self-efficacy
  8. Smoking
  9. Disability/compensation litigation
39
Q

XR findings of stress fracture (4)

A
  1. Periosteal new bone
  2. Cortical thickening
  3. Endosteal thickening
  4. Linear cortical radiolucency
40
Q

Cardinal features of compartment syndrome

A
  1. Pain out of proportion with injury
  2. Pain with passive stretch
  3. Pallor
  4. Paresthesias
  5. Pulselessness
  6. Paralysis

(6 P’s)

Orthobullets/ FRCSC Canadian Board (121 decks)

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