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Orthobullets/ FRCSC Canadian Board > Goldenstien Trauma List 3 > Flashcards

Goldenstien Trauma List 3 Flashcards

1
Q

Causes of compartment syndrome (7)

A

Intrinsic

  1. Fracture
  2. Ischemia-reperfusion
  3. Rhabdomyolysis
  4. Space occupying processes (abscess/hematoma)

Extrinsic

  1. Tight wound closure
  2. Tight dressings/splints/casts
  3. Circumferential burns (eschar)
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2
Q

Cierny classification of osteomyelitis (4)

A
  1. Type I: medullary
  2. Type II: superficial
  3. Type III: localized
  4. Type IV: diffuse
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3
Q

Cierny host types (3)

A
  1. A: little/no immunocompromise, normal response to infection
  2. B: mild systemic/local immunocompromise, impaired response to infection
  3. C: severe immunocompromise, no response to infection
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4
Q

XR findings of osteomyelitis (6)

A
  1. Soft tissue swelling (earliest)
  2. Trabecular destruction/lysis
  3. Cortical destruction
  4. Periosteal reaction
  5. Involucrum formation
  6. Sequestrum
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5
Q

Indications for surgical debridement of osteomyelitis (4)

A
  1. Presence of an abscess
  2. Presence of a sequestrum
  3. Presence of metallic implants
  4. Refractory cases
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6
Q

Possible indications for removal of implants (8)

A
  1. Pain at the implant site
  2. Risk of late infection
  3. Implant dislodgement/migration
  4. Stress-shielding
  5. Implant corrosion
  6. Implant-induced metal hypersensitivity
  7. Tumorigenesis
  8. Teratogenesis
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7
Q

IM nail hoop stresses decreased by (4)

A
  1. Posterior start point
  2. Slotted nails
  3. Thin-walled nails
  4. Titanium nails
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8
Q

IM nail stiffness increased by (5)

A
  1. Interlocking
  2. Increased nail diameter
  3. Increased wall thickness
  4. Open sections (slotted)
  5. Stainless steel nail (vs. titanium)
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9
Q

Types of plate fixation (5)

A
  1. Compression (static)
  2. Tension band (dynamic compression)
  3. Neutralization
  4. Buttress
  5. Bridging
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10
Q

Ways to maximize screw pullout strength (4)

A
  1. Larger outer diameter
  2. Smaller root diameter
  3. Finer pitch
  4. Increased bone density
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11
Q

Rule of 7 70’s for brachial plexus injury (Narakas) (7)

A
  1. 70% caused by motor vehicle accidents
  2. 70% involve motorcycles/bicycles
  3. 70% have multiple injuries
  4. 70% of brachial plexus injuries are supraclavicular
  5. 70% have at least one root avulsion
  6. 70% with a root avulsion have a lower plexus (C7-T1) root avulsion
  7. 70% with a lower root avulsion develop chronic pain
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12
Q

Findings of preganglionic brachial plexus injury (5)

A
  1. Horner’s syndrome
  2. Scapular winging (serratus anterior or rhomboids)
  3. Diaphragmatic paralysis
  4. Early neuropathic pain
  5. Preserved sensory nerve action potentials
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13
Q

Components of early nonoperative management of brachial plexus injuries (3)

A
  1. EMG at 6 weeks and 3 months
  2. Early referral to plastic surgery
  3. Splinting
  4. Physiotherapy to prevent contractures
  5. Antagonist botox injections
  6. Neuromodulating medications for pain control

(E.E.S.P.A.N.)

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14
Q

Options for surgical treatment of brachial plexus injuries

A
  1. Exploration and primary repair
  2. Neuroma excision and cable grafting
  3. Neurotization (root avulsions)
  4. Tendon transfers
  5. Free innervated muscle transfer
  6. Arthrodesis
  7. Amputation
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15
Q

Surgical priorities when treating brachial plexus injuries (3)

A

#1 – elbow flexion

  1. Nerve transfer
  2. Tendon transfer

#2 – stable shoulder

  1. Nerve transfer
  2. Arthrodesis

#3 – hand function

  1. Nerve transfer
  2. Tendon transfer/tenodesis
  3. Arthrodesis
  4. Free innervated muscle transfer
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16
Q

Decision-making factors regarding peripheral nerve repair (5)

A
  1. Age of the patient (#1)
  2. Patient expectations
  3. Rehabilitation potential
  4. Type and severity of nerve injury
  5. Alternate reconstruction options
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17
Q

Good prognostic factors for outcome of peripheral nerve injury (5)

A
  1. Younger age (< 20)
  2. Sharp, clean wounds
  3. Early repair (10-14 days)
  4. Direct repair
  5. Healthy, clean, vascular bed
18
Q

Poor prognostic factors for outcome of peripheral nerve injury (5)

A
  1. Age > 20
  2. Blast or rupture injury
  3. Delayed repair (> 14 days)
  4. Segmental defect
  5. Infected or scarred bed
19
Q

Principles of nerve repair (5)

A
  1. Healthy, vascular bed
  2. Tension-free repair
  3. 8-0 suture to gauge tension then 9-0/10-0
  4. Appropriate orientation of the nerve
  5. Postoperative immobilization for 3 weeks
20
Q

Methods of determining correct nerve orientation (3)

A
  1. External topography
  2. Fascicular arrangement
  3. Vascular anatomy
21
Q

Methods of dealing with nerve gaps

A
  1. Shorten the bone
  2. Neurolysis
  3. Transposition
  4. Nerve graft
  5. Bioactive conduits
22
Q

Types of nerve repairs (3)

A
  1. Basic epineural suture (digital/sensory nerves)
  2. Group fascicular repair (major mixed peripheral nerves)
  3. Conduit repair (single function nerves with short gaps)
23
Q

Classification of glenoid fractures (Mayo) (5)

A
  1. Type I: anteroinferior glenoid rim, body intact
  2. Type II: superior 1/3-1/2 of glenoid with coracoid, body intact
  3. Type III: inferior/posteroinferior glenoid, body intact
  4. Type IV: inferior glenoid with extension into body
  5. Type V: type IV plus additional coracoid, acromion or free superior articular fragment
24
Q

Injuries associated with scapular fractures (12)

A
  1. Head injury
  2. Skull fractures
  3. Cervical spine injuries
  4. Brachial plexus injuries
  5. Arterial injury (not aorta)
  6. Clavicle fractures
  7. Rib fractures
  8. Pneumo/hemothorax
  9. Pulmonary contusions
  10. Intraabdominal injury
  11. Pelvic fractures
  12. Extremity fracture

(Proximal → distal)

25
Q

Indications for ORIF of scapula fractures (5)

A

glenohumeral instability

  1. > 25% glenoid involvement with subluxation of humerus
  2. > 5mm of glenoid articular surface step off or major gap
  3. excessive medialization of glenoid

displaced scapula neck fx

  1. with > 40 degrees angulation or 1 cm translation

open fracture

loss of rotator cuff function

coracoid fx with > 1cm of displacement

26
Q

Indications for ORIF of glenoid fossa fractures (3)

A
  1. > 5 mm displacement of the articular surface
  2. Displacement with subluxation of the humeral head
  3. > 25% involvement of the glenoid
  4. excessive medialization of glenoid
27
Q

Indications for ORIF of glenoid neck fractures (3)

A
  1. > 1 cm of medial displacement
  2. > 40° angulation of the glenoid
  3. Floating shoulder
28
Q

Injuries associated with scapulothoracic dissociation (3)

A
  1. Axillary artery disruption
  2. Brachial plexus injury (90%)
  3. Clavicle fracture (50%)
29
Q

Classification of clavicle fractures (11)

A

Group I – middle third (80%)

Group II – distal third (15%)

  • Type I: minimally displaced, LATERAL to the intact coracoclavicular ligaments
  • Type II: displaced, medial to CC ligaments
  • Type III: intraarticular with AC ligament injury
  • Type IV: displaced with periosteal avulsion/rupture
  • Type V: comminuted

Group III – medial third

  • Type I: minimally displaced, ligaments intact
  • Type II: displaced, ligaments ruptured
  • Type III: intraarticular
  • Type IV: physeal separation
  • Type V: comminuted
30
Q

Deforming forces acting on midshaft clavicle fractures (3)

A
  1. Superior pull of sternocleidomastoid
  2. Inferior weight of the arm
  3. Medial pull of pectoralis major
31
Q

Clavicle fractures associated injuries (4)

A
  1. Sternoclavicular/acromioclavicular joint separations
  2. Brachial plexus injury
  3. Vascular injury
  4. Pneumothorax
32
Q

Injuries associated with open clavicle fractures (4)

A
  1. Closed head injuries
  2. Cervical/thoracic spine fractures
  3. Scapulothoracic dissociation
  4. Pulmonary injuries
33
Q

Indications for surgical intervention in clavicle fractures (8)

A
  1. Open fractures
  2. Neurovascular injury
  3. Floating shoulder
  4. Skin compromise
  5. Type III distal clavicle fractures
  6. Midshaft fractures with > 2 cm of shortening
  7. Symptomatic nonunions
  8. Segmental fractures (?)
34
Q

Complications of clavicle fractures (5)

A
  1. Non-union
  2. Malunion
  3. Skin numbness
  4. Symptomatic hardware
  5. Neurologic symptoms
35
Q

Risk factors for non-union of clavicle fractures (8)

A
  1. Inadequate immobilization
  2. Refracture
  3. Marked displacement
  4. Primary ORIF
  5. Type III lateral clavicle fractures
  6. Increased age
  7. Female
  8. Comminution
36
Q

Outcomes of surgically treated displaced midshaft clavicle fractures vs. nonoperative treatment (5)

A
  1. Higher patient satisfaction
  2. Similar ROM
  3. Improved strength
  4. Improved endurance
  5. Decreased nonunion rates
37
Q

Indications for surgical treatment of a “floating shoulder” (5)

A
  1. Glenohumeral instability
  2. Articular displacement > 5 mm
  3. Open injury
  4. Neurovascular compromise
  5. Any indication for treatment of the isolated injuries
38
Q

Stabilizers of the acromioclavicular joint (5)

A

Static

  1. Capsule
  2. AC ligaments
  3. Coracoclavicular ligaments

Dynamic

  1. Anterior deltoid
  2. Trapezius
39
Q

Classification of acromioclavicular joint injuries (Rockwood) (6)

A
  1. Type I: AC sprain
  2. Type II: AC rupture, CC ligaments intact (< 25% superior displacement)
  3. Type III: AC rupture, CC disruption (25-100% superior displacement)
  4. Type IV: posterior displacement of lateral clavicle
  5. Type V: > 100% superior displacement of lateral clavicle through deltotrapezial fascia
  6. Type VI: subcoracoid displacement of lateral clavicle
40
Q

Nonoperative treatment of AC joint injuries (4)

A
  1. Sling for comfort until pain gone
  2. Start PT for ROM when non-painful
  3. Strengthening when symmetric shoulder ROM
  4. Return to contact sports at 3-4 months (type III)

Orthobullets/ FRCSC Canadian Board (121 decks)

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