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4-Goldstien list > 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
**Indications for ORIF of scapula fractures (5)**
***_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
**Indications for ORIF of glenoid fossa fractures (3)**
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
**Indications for ORIF of glenoid neck fractures (3)**
1. **\> 1 cm of medial displacement** 2. **\> 40° angulation of the glenoid** 3. **Floating shoulder**
28
**Injuries associated with scapulothoracic dissociation (3)**
1. **Axillary artery disruption** 2. **Brachial plexus injury (90%)** 3. **Clavicle fracture (50%)**
29
**Classification of clavicle fractures (11)**
***_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
**Deforming forces acting on midshaft clavicle fractures (3)**
1. **Superior pull of sternocleidomastoid** 2. **Inferior weight of the arm** 3. **Medial pull of pectoralis major**
31
**Clavicle fractures associated injuries (4)**
1. **Sternoclavicular/acromioclavicular joint separations** 2. **Brachial plexus injury** 3. **Vascular injury** 4. **Pneumothorax**
32
**Injuries associated with open clavicle fractures (4)**
1. **Closed head injuries** 2. **Cervical/thoracic spine fractures** 3. **Scapulothoracic dissociation** 4. **Pulmonary injuries**
33
**Indications for surgical intervention in clavicle fractures (8)**
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
**Complications of clavicle fractures (5)**
1. **Non-union** 2. **Malunion** 3. **Skin numbness** 4. **Symptomatic hardware** 5. **Neurologic symptoms**
35
**Risk factors for non-union of clavicle fractures (8)**
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
**Outcomes of surgically treated displaced midshaft clavicle fractures vs. nonoperative treatment (5)**
1. **Higher patient satisfaction** 2. **Similar ROM** 3. **Improved strength** 4. **Improved endurance** 5. **Decreased nonunion rates**
37
**Indications for surgical treatment of a “floating shoulder” (5)**
1. **Glenohumeral instability** 2. **Articular displacement \> 5 mm** 3. **Open injury** 4. **Neurovascular compromise** 5. **Any indication for treatment of the isolated injuries**
38
**Stabilizers of the acromioclavicular joint (5)**
***_Static_*** 1. **Capsule** 2. **AC ligaments** 3. **Coracoclavicular ligaments** ***_Dynamic_*** 1. **Anterior deltoid** 2. **Trapezius**
39
**Classification of acromioclavicular joint injuries (Rockwood) (6)**
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
**Nonoperative treatment of AC joint injuries (4)**
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)**

4-Goldstien list (15 decks)

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