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4-Goldstien list > Goldenstien Trauma List 5 > Flashcards

Goldenstien Trauma List 5 Flashcards

1
Q

Stabilizers preventing posterolateral rotatory instability (3)

A
  1. Lateral ulnar collateral ligament
  2. Common extensor origin
  3. Joint capsule
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2
Q

Indications for surgical treatment of acute elbow dislocations (7)

A
  1. Open injuries
  2. Neurovascular injury
  3. Irreducible dislocation
  4. Incongruent reduction
  5. Incarcerated bony fragments/soft tissue
  6. Inability to maintain reduction in a safe position
  7. To treat associated fractures
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3
Q

Complications of elbow injuries in adults (4)

A
  1. Neurovascular injury
  2. Post-traumatic stiffness
  3. Heterotopic ossification
  4. Recurrent instability
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4
Q

Risk factors for heterotopic ossification in elbow injuries (5)

A
  1. Increasing severity of injury
  2. Delayed reduction of dislocation
  3. Forced passive motion
  4. Associated head injury
  5. Associated burns
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5
Q

Classification of Monteggia fractures (4)

A
  1. Type I: anterior (60%)
  2. Type II: posterior (15%)
  3. Type III: lateral
  4. Type IV: with proximal radius fracture
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6
Q

Causes of malreduction of the radial head in Monteggia fractures (3)’

A
  1. Non-anatomic reduction of the ulna
  2. Interposed annular ligament/capsule
  3. Intraarticular osteochondral fragment
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7
Q

Complications of Monteggia fractures (4)

A
  1. PIN palsy
  2. Redislocation/subluxation
  3. Proximal radioulnar synostosis
  4. Loss of ROM
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8
Q

Indications for surgical treatment of forearm shaft fractures (4)

A
  1. > 10° of angulation or > 50% shaft displacement
  2. Open fractures
  3. Both bones forearm fracture
  4. Polytrauma
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9
Q

Indications for acute bone grafting of forearm fractures (3)

A
  1. Comminution involving > 1/3 of the diaphyseal cortex
  2. Segmental bone loss
  3. Severe open fractures with poor local biology
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10
Q

Complications of forearm fractures (8)

A
  1. Compartment syndrome
  2. Nerve injury
  3. Infection
  4. Non-union
  5. Malunion
  6. Radioulnar synostosis
  7. Refracture after hardware removal
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11
Q

Risk factors for nonunion of forearm fractures

A
  1. Open fracture
  2. Comminution
  3. Segmental fractures
  4. Segmental bone loss
  5. Inadequate fixation
  6. Both bones fractures
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12
Q

Risk factors for refracture after hardware removal (3)

A
  1. Large plates
  2. Removal before 18 months
  3. No immobilization post-removal
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13
Q

Risk factors for radioulnar synostosis after surgical treatment of forearm fractures (13)

A
  1. Same level fracture of both bones
  2. Proximal 1/3 fractures
  3. Open fractures
  4. High energy injury
  5. Associated head injury
  6. Associated burns
  7. Delayed surgery
  8. Single incision surgery
  9. Insufficient stabilization
  10. Faulty plate location
  11. Screws projecting into the interosseous gap
  12. Primary corticocancellous bone grafting (especially if in contact with interosseous membrane)
  13. Cast immobilization post-osteosynthesis

(Injury, pre-op, operative, post-op)

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14
Q

Poor prognostic factors for outcome after synostosis resection (4)

A
  1. Proximal location
  2. Large synostosis
  3. Severity of the initial injury
  4. Later timing of resection
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15
Q

Radiographic signs of DRUJ instability in Galeazzi fractures (4)

A

Ulnar styloid fracture

Ulnar head dislocation on a true lateral XR

Widened DRUJ on PA XR

≥ 5 mm of radial shortening

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16
Q

Classification of distal radius fractures (Frykman) (8)

A
  1. Type I: extraarticular
  2. Type II: type I with an ulnar styloid fracture
  3. Type III: enters radiocarpal joint
  4. Type IV: type III with an ulnar styloid fracture
  5. Type V: enters radioulnar joint
  6. Type VI: type V with an ulnar styloid fracture
  7. Type VII: enters both radiocarpal and radioulnar joints
  8. Type VIII: type VII with an ulnar styloid fracture
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17
Q

Risk factors for distal radius fractures (5)

A
  1. Decreased bone mineral density (femoral neck osteopenia/osteoporosis)
  2. Female
  3. Ethnicity (Caucasian)
  4. Heredity (family history of osteoporosis)
  5. Early menopause
18
Q

Distal radius fractures associated injuries (8)

A
  1. Carpal fractures
  2. Medial nerve injury
  3. TFCC injury
  4. Carpal ligament injury
  5. Tendon injury
  6. Open fracture
  7. DRUJ injury
19
Q

Causes of median nerve injury with distal radius fractures (3)

A
  1. Direct contusion
  2. Mechanical deformation
  3. Abnormally high pressures in the carpal tunnel
20
Q

Treatment of median nerve compression with distal radius fractures (4)

A
  1. Elevation
  2. Release of constricting bandages/casts
  3. Closed/open reduction of deformity
  4. Surgical decompression
21
Q

Indications for carpal tunnel release in distal radius fractures (3)

A
  1. Symptoms don’t improve after closed reduction/dressing removal
  2. Symptoms are progressive
  3. Symptoms lasting longer than 6 hours
22
Q

Things to look for on radiographs of distal radius fractures (11)

A

PA

  1. Radial shortening/comminution
  2. Ulnar styloid fracture
  3. Radial inclination
  4. Lunate facet depression
  5. Scapholunate dissociation
  6. Gilula’s lines

Lateral

  1. Volar tilt
  2. Metaphyseal comminution
  3. Volar cortex displacement
  4. Scapholunate angle
  5. Position of the DRUJ
23
Q

Indications of unstable distal radius fractures (8)

A
  1. Older age
  2. Both volar and dorsal metaphyseal comminution
  3. Radial shortening > 5 mm
  4. Articular depression > 2 mm
  5. Dorsal tilt > 20°
  6. Displaced articular margin fractures (Barton’s, Smith’s, Chauffeur’s)
  7. Fractures that displace during cast immobilization
  8. Loss of ≥ 5° of radial inclination
24
Q

Indications for surgical intervention for distal radius fractures (5)

A
  1. Open fracture
  2. Associated median nerve compromise
  3. ≥ 2 mm articular step or gap
  4. ≥ 5 mm radial shortening
  5. ≥10° dorsal tilt
25
Q

Indications for ORIF for distal radius fractures

A
  1. Articular margin fractures (Barton’s, Smith’s, Chauffeur’s)
  2. Complex intraarticular fractures
  3. Die-punch fractures
  4. Polytrauma
26
Q

Options for surgical treatment of distal radius fractures (4)

A
  1. Percutaneous interfocal pinning
  2. Percutaneous intrafocal (Kapandji) pinning
  3. External fixation
  4. ORIF
27
Q

Advantages of volar vs. dorsal plating of distal radius fractures (4)

A
  1. Large bone surface for plate application
  2. Plate protected by pronator quadratus
  3. Anatomic reduction of thick volar cortex gives significant stability
  4. Lower risk of tendon rupture
28
Q

Complications of external fixation of distal radius fractures (9)

A
  1. Superficial radial nerve injury
  2. Extensor tendon injury
  3. CRPS
  4. Pin loosening
  5. Pin tract infections
  6. Pin breakage
  7. Delayed union
  8. Carpal tunnel syndrome (“cotton loder” position)
  9. Finger stiffness
29
Q

Complications of distal radius fractures (7)

A
  1. Malunion (#1)
  2. Nonunion
  3. Tendon irritation/rupture
  4. CRPS
  5. Carpal tunnel syndrome
  6. Compartment syndrome
  7. DRUJ instability
30
Q

Consequences of malunion of distal radius fractures

A

Extraarticular

  1. DRUJ incongruity
  2. Ulnocarpal impingement
  3. Midcarpal instability

Intraarticular

  1. Arthritis
31
Q

Consequences of radial shortening after distal radius fracture (5)

A
  1. DRUJ pain
  2. Ulnar impaction syndrome
  3. Loss of grip strength
  4. Loss of forearm rotation
  5. Unsightly cosmetic deformity
32
Q

Consequences of dorsal angulation after distal radius fracture (5)

A
  1. Loss of wrist flexion
  2. Acquired DISI
  3. Midcarpal instability
  4. Dorsal subluxation of the carpus
  5. Concentration and dorsal shift of radius contact loads (arthritis)
33
Q

Factors associated with a poor outcome following distal radius fracture (4)

A
  1. Articular incongruity > 2 mm
  2. Residual lunate facet depression
  3. Residual dorsal tilt
  4. Static DISI deformity (radiolunate angle > 25°)
34
Q

Classification of Smith’s fractures (Thomas) (3)

A
  1. Type I: volar tilt but no translation (extraarticular)
  2. Type II: intraarticular volar fracture with volar translation of the carpus or intraarticular dorsal fracture with dorsal translation of the carpus
  3. Type III: volar translation but no tilt (extraarticular)
35
Q

Classification of scaphoid fractures (Herbert) (4)

A

Type A: stable acute fractures

1 – tubercle

2 – incomplete waist

Type B: unstable acute fractures

1 – distal oblique

2 – complete waist

3 – proximal pole

4 – transscaphoid perilunate #/dislocation

Type C: delayed union

Type D: established nonunion

  1. Fibrous union
  2. Pseudarthrosis
36
Q

Indications for surgical treatment of scaphoid fractures (8)

A
  1. Displaced > 1 mm
  2. Unstable
  3. Proximal pole
  4. Delayed diagnosis (> 4 weeks)
  5. Delayed union
  6. Patient preference
  7. Associated perilunate ligamentous injury
  8. DISI deformity
37
Q

Advantages of percutaneous reduction and fixation techniques for scaphoid fractures (4)

A
  1. Preservation of blood supply
  2. Maintenance of inherent ligamentous stability
  3. Minimal iatrogenic soft tissue disruption
  4. Earlier restoration of wrist motion
38
Q

Advantages of surgical stabilization over nonoperative treatment of undisplaced scaphoid fractures (5)

A
  1. Improved healing rates
  2. Accelerated functional recovery
  3. Decreased morbidity from prolonged casting
  4. Decreased time to bony union
  5. Faster return to work
39
Q

Complications of scaphoid fractures (5)

A
  1. Nonunion
  2. Malunion
  3. Post-traumatic arthritis
  4. Avascular necrosis
  5. Carpal instability
40
Q

Risk factors for nonunion of scaphoid fractures (4)

A
  1. Smoking
  2. Delay in diagnosis
  3. Inadequate immobilization
  4. Associated ligamentous injury

4-Goldstien list (15 decks)

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