Goldenstien Trauma List 5 Flashcards
Stabilizers preventing posterolateral rotatory instability (3)
- Lateral ulnar collateral ligament
- Common extensor origin
- Joint capsule
Indications for surgical treatment of acute elbow dislocations (7)
- Open injuries
- Neurovascular injury
- Irreducible dislocation
- Incongruent reduction
- Incarcerated bony fragments/soft tissue
- Inability to maintain reduction in a safe position
- To treat associated fractures
Complications of elbow injuries in adults (4)
- Neurovascular injury
- Post-traumatic stiffness
- Heterotopic ossification
- Recurrent instability
Risk factors for heterotopic ossification in elbow injuries (5)
- Increasing severity of injury
- Delayed reduction of dislocation
- Forced passive motion
- Associated head injury
- Associated burns
Classification of Monteggia fractures (4)
- Type I: anterior (60%)
- Type II: posterior (15%)
- Type III: lateral
- Type IV: with proximal radius fracture
Causes of malreduction of the radial head in Monteggia fractures (3)’
- Non-anatomic reduction of the ulna
- Interposed annular ligament/capsule
- Intraarticular osteochondral fragment
Complications of Monteggia fractures (4)
- PIN palsy
- Redislocation/subluxation
- Proximal radioulnar synostosis
- Loss of ROM
Indications for surgical treatment of forearm shaft fractures (4)
- > 10° of angulation or > 50% shaft displacement
- Open fractures
- Both bones forearm fracture
- Polytrauma
Indications for acute bone grafting of forearm fractures (3)
- Comminution involving > 1/3 of the diaphyseal cortex
- Segmental bone loss
- Severe open fractures with poor local biology
Complications of forearm fractures (8)
- Compartment syndrome
- Nerve injury
- Infection
- Non-union
- Malunion
- Radioulnar synostosis
- Refracture after hardware removal
Risk factors for nonunion of forearm fractures
- Open fracture
- Comminution
- Segmental fractures
- Segmental bone loss
- Inadequate fixation
- Both bones fractures
Risk factors for refracture after hardware removal (3)
- Large plates
- Removal before 18 months
- No immobilization post-removal
Risk factors for radioulnar synostosis after surgical treatment of forearm fractures (13)
- Same level fracture of both bones
- Proximal 1/3 fractures
- Open fractures
- High energy injury
- Associated head injury
- Associated burns
- Delayed surgery
- Single incision surgery
- Insufficient stabilization
- Faulty plate location
- Screws projecting into the interosseous gap
- Primary corticocancellous bone grafting (especially if in contact with interosseous membrane)
- Cast immobilization post-osteosynthesis
(Injury, pre-op, operative, post-op)
Poor prognostic factors for outcome after synostosis resection (4)
- Proximal location
- Large synostosis
- Severity of the initial injury
- Later timing of resection
Radiographic signs of DRUJ instability in Galeazzi fractures (4)
Ulnar styloid fracture
Ulnar head dislocation on a true lateral XR
Widened DRUJ on PA XR
≥ 5 mm of radial shortening
Classification of distal radius fractures (Frykman) (8)
- Type I: extraarticular
- Type II: type I with an ulnar styloid fracture
- Type III: enters radiocarpal joint
- Type IV: type III with an ulnar styloid fracture
- Type V: enters radioulnar joint
- Type VI: type V with an ulnar styloid fracture
- Type VII: enters both radiocarpal and radioulnar joints
- Type VIII: type VII with an ulnar styloid fracture
Risk factors for distal radius fractures (5)
- Decreased bone mineral density (femoral neck osteopenia/osteoporosis)
- Female
- Ethnicity (Caucasian)
- Heredity (family history of osteoporosis)
- Early menopause
Distal radius fractures associated injuries (8)
- Carpal fractures
- Medial nerve injury
- TFCC injury
- Carpal ligament injury
- Tendon injury
- Open fracture
- DRUJ injury
Causes of median nerve injury with distal radius fractures (3)
- Direct contusion
- Mechanical deformation
- Abnormally high pressures in the carpal tunnel
Treatment of median nerve compression with distal radius fractures (4)
- Elevation
- Release of constricting bandages/casts
- Closed/open reduction of deformity
- Surgical decompression
Indications for carpal tunnel release in distal radius fractures (3)
- Symptoms don’t improve after closed reduction/dressing removal
- Symptoms are progressive
- Symptoms lasting longer than 6 hours
Things to look for on radiographs of distal radius fractures (11)
PA
- Radial shortening/comminution
- Ulnar styloid fracture
- Radial inclination
- Lunate facet depression
- Scapholunate dissociation
- Gilula’s lines
Lateral
- Volar tilt
- Metaphyseal comminution
- Volar cortex displacement
- Scapholunate angle
- Position of the DRUJ
Indications of unstable distal radius fractures (8)
- Older age
- Both volar and dorsal metaphyseal comminution
- Radial shortening > 5 mm
- Articular depression > 2 mm
- Dorsal tilt > 20°
- Displaced articular margin fractures (Barton’s, Smith’s, Chauffeur’s)
- Fractures that displace during cast immobilization
- Loss of ≥ 5° of radial inclination
Indications for surgical intervention for distal radius fractures (5)
- Open fracture
- Associated median nerve compromise
- ≥ 2 mm articular step or gap
- ≥ 5 mm radial shortening
- ≥10° dorsal tilt