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4-Goldstien list > Goldenstien Trauma List 7 > Flashcards

Goldenstien Trauma List 7 Flashcards

1
Q

Principles of flexor tendon reconstruction

A

- Stage I

o Excise tendon remnants

o Pulley reconstruction

o Silicone rod placement (secure distally)

o Aggressive passive ROM

- Stage II (3 months)

o Remove silicone rod

o Tendon graft secured distally

o Bring through pulleys

o Tension and secure

o Rehabilitation

o Delayed tenolysis as needed

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2
Q

Blocks to successful closed reduction of DIP dorsal dislocations

A
  1. Volar plate
  2. Flexor digitorum profundus
  3. Osteochondral fracture fragment
  4. Sesamoid bone
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3
Q

Indications for surgical treatment of PIP collateral ligament injuries

A
  1. Radiographic evidence of soft tissue interposition
  2. Displaced Condylar fracture
  3. Continued instability after 3 weeks of static splinting
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4
Q

Classification of PIP dorsal fracture-dislocations

A

- Acute

o Type I: < 30% (stable)

o Type II: 30-50% (tenuous)

o Type III: > 50% (unstable)

- Chronic

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5
Q

Indications for surgical treatment of dorsal PIP dislocations

A
  1. Open injury
  2. Irreducible dislocation
  3. > 40% joint involved and unstable
  4. highly comminuted “pilon” fracture-dislocations
  5. chronic injuries
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6
Q

Complications of dorsal PIP dislocations

A
  1. Flexion contracture
  2. Pseudoboutonniere deformity
  3. Hyperextension instability
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7
Q

Complications of volar PIP dislocations

A
  1. Extension contracture
  2. Progressive boutonniere deformity
  3. Global instability
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8
Q

Classification of dorsal MCP dislocations

A

- Simple

  1. o “no table” test
  2. o Angular deformity
  3. o Reduced in flexion

- Complex

  1. o Shortening with minimal angular deformity
  2. o MC head caught between flexor tendon/lumbrical and natatory band/intermetacarpal ligaments
  3. o Irreducible
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9
Q

Indications for MCP collateral ligament injury

A

- Thumb ulnar

o Complete tear

o Partial tear with ≥ 35° of opening

o Displaced fragment with a Stener’s lesion

- Thumb radial

o Complete tear

o Partial tear with instability/volar subluxation of phalanx

- Finger

o Fracture ≥ 20% of articular surface or 2 mm of displacement

o Index or 5th digit RCL

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10
Q

Complications of thumb UCL injury

A
  1. Residual instability
  2. Pain
  3. Reduced lateral key-pinch strength
  4. Volar subluxation of the MCP joint
  5. Post-traumatic arthritis
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11
Q

Indications for operative treatment of metacarpal and phalangeal fractures

A

- Unstable fractures

- Irreducible fractures

- Malrotation

- Intraarticular fractures

- Open fractures

- Segmental bone loss

- Multiple fractures

- Fracture with associated soft tissue injury

- Polytrauma patients

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12
Q

Phalangeal fracture complications

A

- Loss of motion

- Malunion

- Infection

- Nonunion

- Symptomatic hardware

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13
Q

Indications for surgical treatment of metacarpal neck fractures

A

- > 40° angulation

- < 40° angulation with unacceptable cosmetic deformity

- > 15° angulation of 2nd/3rd MC neck

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14
Q

Indications for surgical treatment of metacarpal shaft fractures

A

- Malrotation

- Dorsal angulation > 10° (2 or 3) or > 20° (4 or 5)

- Shortening > 3 mm

- Multiple displaced metacarpal shaft fractures

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15
Q

Complications of metacarpal shaft fractures

A

- Malunion

- Nonunion

- MCP joint contractures

- Extrinsic tightness

- Refracture

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16
Q

Predictors of poor prognosis following hand fracture fixation

A

- Open fractures

- Intraarticular fractures

- Associated nerve injury

- Associated tendon injury

- Crush injury

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17
Q

Classification of 4th/5th CMC (hamatometacarpal) fracture-dislocations (Cain)

A

- Type IA: ligamentous injury

- Type IB: dorsal hamate fracture (#1)

- Type II: comminuted dorsal hamate fracture

- Type III: coronal hamate fracture

18
Q

Complications of CMC dislocations

A

- Incomplete reduction

- Instability

- Chronic pain

- Weakness

- Post-traumatic arthritis

19
Q

Classification of thumb metacarpal base fractures (4)

A

- Bennett’s – partial articular fracture (#1)

- Rolando’s – complete articular with 3 fragments

- Epibasal – extraarticular

- Comminuted

20
Q

Indications for surgical treatment of thumb metacarpal base fractures (2)

A

- Articular incongruity ≥ 2 mm

- CMC joint subluxation/instability

21
Q

Complications of thumb metacarpal base fractures (7)

A

- Weak lateral key pinch

- Difficulty with opposition

- Stiffness

- Post-traumatic arthritis

- Instability

- Malunion

- Nonunion

22
Q

Pelvis fracture classification (Young & Burgess) (8)

A

- Anterior-posterior compression

  1. o APC I: symphysis widened up to 2 cm, SI ligaments intact
  2. o APC II: symphysis widened > 2 cm, anterior SI/sacrotuberous ligaments disrupted
  3. o APC III: symphysis widened > 5 cm, posterior SI/sacrospinous ligaments disrupted

- Lateral compression

  1. o LC I: anterior ring injury with ipsilateral sacral crush
  2. o LC II: anterior ring injury with ipsilateral “crescent” fracture
  3. o LC III: windswept pelvis (LCI with contralateral open book injury)

- Vertical shear

- Combined mechanism

23
Q

Pelvis fracture classification (Tile) (11)

A

- Type A: stable

o 1 – avulsion fracture with intact ring

o 2 – nondisplaced pelvic ring injury

o 3 – transverse fracture of sacrum/coccyx

- Type B: rotationally unstable, vertically stable

o 1 – anterior-posterior compression

 1: symphysis < 2.5 cm

 2: symphysis > 2.5 cm, unilateral posterior injury

 3: symphysis > 2.5 cm, bilateral posterior injury

o 2 – lateral compression with ipsilateral posterior crush

o 3 – lateral compression with contralateral posterior opening

- Type C: rotationally and vertically unstable

o 1 – ipsilateral anterior and posterior injuries

o 2 – bilateral hemipelvic disruption

o 3 – any pelvic fracture with an associated acetabular fracture

24
Q

Correlates of pelvic fracture mechanism of injury (5)

A

- Fluid resuscitation requirements

- Associated organ injuries

- Energy transmission

- Need for acute pelvic stabilization

- Patient survival

25
Q

Pelvic fracture associated injuries (9)

A

- Closed head injuries (LC)

- Chest/abdominal trauma (APC)

- Bowel injury (LCIII)

- Urogenital injury (10%)

- Lumbosacral plexus injury (10%)

- Musculoskeletal injuries (60-80%)

- Hemorrhage (75% - APC II/III)

- Open fractures

- Death (LCIII, APC II/III, open)

- (Proximal → distal)

26
Q

Signs of a urethral injury (7)

A

- Scrotal/labial swelling or ecchymosis

- Blood at the urethral meatus

- High-riding/mobile prostate

- Inability to void despite a full bladder

- Elevated bladder on IVP

- Dye leakage on IVP/retrograde urethrogram

- Inability to pass a foley catheter

27
Q

Options for treatment of hemorrhage associated with pelvic fracture (4)

A

- Pelvic binder application

- External fixation

- Angiographic embolization

- Retroperitoneal packing

28
Q

Components of management of open pelvic fractures (5)

A

- Management of hemorrhage

- ER removal of gross debris, tetanus and antibiotics

- OR layer-by-layer irrigation and debridement

- External fixation of the pelvis

- General surgery assessment for possible diverting colostomy and rectal washout

29
Q

Indications for nonoperative management of pelvic fractures (3)

A

- Stable pelvic ring fracture

- Isolated avulsion fracture or iliac wing fracture

- Unstable fractures in patients with contraindications to surgical intervention

30
Q

XR findings of pelvic fracture instability (5)

A

- Displacement of posterior SI complex > 1 cm

- Posterior fracture gap

- Avulsion of the L5 transverse process

- Avulsion fractures of the sacrum or ischial spine

- Avulsion fractures of the ischial tuberosity

31
Q

Indications for surgical treatment of pelvic fractures (5)

A

- Open fracture

- Symphysis diastasis > 2.5 cm

- Anterior and posterior SI ligament disruption

- Vertical instability

- Sacral fracture with displacement > 1 cm

32
Q

Indications for surgical stabilization of iliac wing fractures (5)

A

- Associated with an open wound

- Iliac/flank skin compromise

- Severely displaced/comminuted

- Unstable fractures that compromise pulmonary function

- Bowel entrapment

33
Q

Options for stabilization of anterior pelvis injuries (3)

A

- Symphyseal plating

- External fixation

- Screw fixation (ramus #)

34
Q

Options for stabilization of posterior pelvic ring injuries (6)

A
  1. Anterior SI plating
  2. Posterior SI plating
  3. Sacroiliac screws
  4. Transiliac bars/rods
  5. Posterior transiliac plating
  6. Spinal-pelvic fixation
35
Q

Indications for pelvic external fixation (3)

A
  1. Temporary stabilization in hemodynamically unstable patient
  2. Temporary anterior fixation if contraindication to symphyseal plating
  3. Definitive treatment of pelvic fracture
36
Q

Contraindications to symphyseal plating (4)

A
  1. Non-resuscitated patient
  2. Contaminated open wound
  3. Bladder injury (?)
  4. Female of child-bearing age
37
Q

Relative contraindications to anterior SI joint plating (4)

A
  1. Morbid obesity
  2. Comminuted ipsilateral sacral fracture
  3. Iliac crest external fixation
  4. Ipsilateral colostomy
38
Q

Complications of posterior SI screw fixation (4)

A
  1. Neurologic injury
  2. Hardware malposition
  3. Malreduction/malunion
  4. Failure of fixation
39
Q

Complications of pelvic fractures (13)

A
  1. DVT (35-50% - #1)
  2. PE (symptomatic 2-10%, fatal 0.5-2%)
  3. Infection (deep 5-10% if ORIF)
  4. Hemorrhagic shock
  5. Nerve injury (10-15%)
  6. Urogenital injury
  7. Bladder dysfunction
  8. Sexual dysfunction/dyspareunia (5-20%)
  9. Morel-Lavallee lesions
  10. Malunion
  11. Osteitis pubis
  12. Heterotopic ossification (10%)
  13. Death
40
Q

Negative prognostic factors for functional outcome following pelvic fracture (10)

A
  1. Medical comorbidities
  2. Higher severity of injury
  3. Open fractures
  4. Neurologic injury
  5. Associated injuries
  6. Associated soft tissue injury
  7. Posterior Malreduction
  8. Leg length discrepancy
  9. Degenerative SI joint disease

(Patient, injury, surgery, complications)

41
Q

Indications for surgical treatment of volar PIP dislocations

A
  1. if > 40% joint involvement
  2. Open injury
  3. Irreducible dislocation
  4. highly comminuted “pilon” fracture-dislocations
  5. chronic injuries

4-Goldstien list (15 decks)

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