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Orthobullets/ FRCSC Canadian Board > Goldenstien Trauma List 8 > Flashcards

Goldenstien Trauma List 8 Flashcards

1
Q

Classification of sacral fractures (Denis) (3)

A

- Zone 1: fracture lateral to sacral foramina (6% risk of neurologic injury)/most common (50%)

- Zone 2: fracture through foramina

- Zone 3: fracture medial to foramina into central sacral canal/highest rate of neurologic deficit (60%)

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2
Q

Complications of sacral fractures (4)

A
  1. Neurologic injury
  2. Malunion
  3. Chronic pain
  4. Infection (with surgery)
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3
Q

Classification of acetabulum fractures (Letournel) (10)

A

- Simple/elementary

  1. o Posterior column
  2. o Posterior wall
  3. o Anterior column
  4. o Anterior wall
  5. o Transverse

- Associated/complex

  1. o Posterior column/posterior wall
  2. o Transverse/posterior wall
  3. o T-shaped
  4. o Anterior column/posterior hemitransverse
  5. o Both columns
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4
Q

Acetabular fracture associated injuries (9)

A
  1. Head injury
  2. Spine injury
  3. Chest injury
  4. Abdominal injury
  5. Urogenital injury
  6. Other fractures
  7. Nerve injury
  8. Morel-Lavallee lesion
  9. Knee ligament injury

(Proximal → distal)

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5
Q

Things to look for on CT scans of acetabular fractures (6)

A
  1. Posterior pelvic ring injuries
  2. Fractures of the quadrilateral plate
  3. Marginal impaction
  4. Rotation of articular fragments
  5. Intra-articular loose bodies
  6. Femoral head fractures

(Posterior → anterior)

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6
Q

Indications for surgical treatment of acetabular fractures (5)

A
  1. Articular incongruity ≥ 1 mm
  2. Posterior wall fracture with instability (> 20%)
  3. Loss of congruency between femoral head and dome
  4. Intra-articular loose bodies
  5. Marginal impaction
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7
Q

Relative contraindications to surgical treatment of acetabular fractures (7)

A
  1. Advanced age
  2. Medical comorbidities
  3. Morbid obesity
  4. Associated soft tissue/visceral injuries
  5. Contaminated wound
  6. Delay in treatment > 4 weeks
  7. DVT with contraindication to IVC filter

(Patient, injury, complications)

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8
Q

Indications for nonoperative treatment of acetabular fractures (8)

A
  1. Non-ambulatory patient
  2. Elderly patient with comminuted fracture
  3. Severe osteoporosis
  4. Local/systemic infection
  5. Displaced fracture with a large portion of the dome intact (> 10mm, > 45° roof-arc angles)
  6. Secondary congruence
  7. Non-displaced/minimally displaced fractures
  8. Posterior wall fracture without instability

(Patient, injury)

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9
Q

Complications of acetabular fractures (8)

A
  1. Post-traumatic arthritis (#1)
  2. Wound infection
  3. Nerve injury
  4. Heterotopic ossification
  5. Venous thromboembolism
  6. Soft tissue complications
  7. Osteonecrosis
  8. LFCN injury
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10
Q

Negative prognostic factors of acetabular fractures (6)

A
  1. Femoral head injury
  2. Marginal impaction
  3. Fracture-dislocation
  4. Delay in treatment > 3 weeks
  5. Residual displacement > 2 mm
  6. Surgery by an inexperienced individual
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11
Q

Classification of hip dislocation (comprehensive) (5)

A

Type I: no significant fractures, no post-reduction instability

Type II: irreducible dislocation without associated significant fractures

Type III: unstable hip post-reduction or incarcerated labrum/cartilage/bone

Type IV: associated acetabular fracture with hip instability

Type V: associated femoral head/neck fracture

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12
Q

Hip dislocation associated injuries (8)

A
  1. Pelvic fracture
  2. Acetabular fracture
  3. Femoral head/neck fracture
  4. MFCA injury
  5. Sciatic nerve injury
  6. Femur fracture
  7. Patella fracture
  8. Knee ligament injury

(Proximal → distal)

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13
Q

Indications for surgical treatment of hip dislocations (5)

A
  1. Irreducible dislocation
  2. Nonconcentric reduction
  3. Post-reduction instability
  4. Associated acetabular/femoral fracture requiring surgery
  5. Intraarticular loose bodies
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14
Q

Potential blocks to reduction of hip dislocation (4)

A
  1. Inadequate anaesthesia/muscle relaxation
  2. Interposed soft tissue (capsule, SER)
  3. Interposed bone fragments (femoral head, posterior wall)
  4. Labrum
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15
Q

Complications of hip dislocations (7)

A
  1. Sciatic nerve injury
  2. Avascular necrosis
  3. Post-traumatic arthritis
  4. Recurrent instability
  5. Chronic pain
  6. Infection (with surgery)
  7. Venous thromboembolism
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16
Q

Risk factors for recurrent instability following a hip dislocation (5)

A
  1. Femoral version
  2. Acetabular version
  3. Soft tissue impingement
  4. Labral avulsions
  5. Capsular laxity
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17
Q

Classification of femoral head fractures (Pipkin) (4)

A
  1. Type I: fracture below the fovea capitis
  2. Type II: fracture above the fovea capitis
  3. Type III: associated femoral neck fracture
  4. Type IV: associated acetabular fracture
18
Q

Indications for surgical treatment of femoral head fracture (4)

A
  1. Articular step > 1 mm
  2. Intraarticular loose bodies
  3. To allow early ROM with associated fractures
  4. Polytrauma patient
19
Q

Goals of surgical treatment of femoral head fractures (5)

A
  1. Restore articular congruity
  2. Restore hip stability
  3. Treat associated fractures
  4. Remove loose bodies
  5. Preserve femoral head blood supply
20
Q

Complications of femoral head fractures (4)

A
  1. Degenerative joint disease
  2. Osteonecrosis (highest with type III)
  3. Recurrent dislocation
  4. Sciatic nerve injury (20%)
21
Q

Classification of femoral neck fractures (Garden) (4)

A
  1. Type I: incomplete valgus impacted
  2. Type II: complete undisplaced
  3. Type III: partially displaced varus
  4. Type IV: completely displaced
22
Q

Classification of femoral neck fractures (Pauwel’s) (3)

A

Type I: up to 30° from horizontal

Type II: 30-50° from horizontal

Type III: > 50° from horizontal

23
Q

Components of the Leadbetter maneuver for closed reduction of femoral neck fractures (4)

A
  1. Flexion with mild adduction
  2. Traction in-line with the femur
  3. Internal rotation
  4. Circumduction to abduction and extension while maintaining internal rotation
24
Q

Principles of surgical stabilization of femoral neck fractures (4)

A
  1. Preoperative medical stabilization
  2. Rapid, anatomic reduction
  3. Stable internal fixation
  4. Early postoperative mobilization
25
Q

Radiographic features of an adequate reduction of a displaced femoral neck fracture

A

- Neck-shaft angle 130-150 deg

- < 10 degrees of anterior/posterior angulation

- Garden’s alignment index

  • o Primary compressive trabeculae 160-180 degrees on AP
  • o Primary compressive trabeculae 160-180 degrees on lateral

- < 5 mm translation on AP and lateral

- S-shaped contour of the head-neck junction

26
Q

Complications of femoral neck fractures (8)

A

- Non-union

- Osteonecrosis

- Loss of fixation

- Malunion

- Femoral neck shortening

- Thromboembolic disease

- Subtrochanteric fracture

- Death

27
Q

Indications for THA for femoral neck fracture (5)

A
  1. Older patient
  2. High activity level
  3. Pre-existing arthritis
  4. Low risk for dislocation
  5. Able to comply with postoperative restrictions
28
Q

Classification of intertrochanteric fractures (Evan’s) (4)

A

Type I: 2-part

Type II: 3-part

Type III: 4-part

Type IV: reverse obliquity

29
Q

Radiographic findings of unstable intertrochanteric hip fractures (3)

A
  1. Posteromedial comminution
  2. Subtrochanteric extension
  3. Reverse obliquity pattern
30
Q

Principles of surgical treatment of intertrochanteric fractures (4)

A
  1. Restoration of normal neck-shaft alignment
  2. Medial cortical contact
  3. Controlled collapse during healing
  4. Early mobilization
31
Q

Complications of intertrochanteric fractures (7)

A
  1. Varus Malreduction
  2. Malrotation deformity
  3. Non-union (2%)
  4. Implant failure
  5. Thromboembolic disease
  6. Symptomatic hardware
  7. Death
32
Q

Risk factors for varus malreduction of intertrochanteric fractures (5)

A
  1. Anterosuperior screw placement
  2. Lack of reduction
  3. Improper reaming
  4. Excessive fracture collapse
  5. Severe osteopenia

(A.L.I.E.S.)

33
Q

Consequences of varus malreduction of intertrochanteric fractures (4)

A
  1. Implant breakage
  2. Screw cut-out
  3. Joint penetration
  4. Screw-sideplate dissociation
34
Q

Indications for surgical treatment of greater trochanter fractures(4)

A
  1. Displacement > 1 cm (young)
  2. Abductor dysfunction
  3. Trendelenburg gait
  4. Symptomatic nonunion

(D.A.T.S.)

35
Q

Classification of subtrochanteric femur fractures (Russell-Taylor) (4)

A

Type IA: outside piriformis fossa, LT not involved

Type IB: outside piriformis fossa, LT involved

Type IIA: into piriformis fossa, LT not involved

Type IIB: into piriformis fossa, LT involved

36
Q

Complications of subtrochanteric femur fractures (4)

A
  1. Malunion (apex anterior, varus)
  2. Leg length discrepancy
  3. Implant failure/loss of fixation
  4. Infection
37
Q

Classification of femoral shaft fractures (Winquist & Hansen) (6)

A
  1. Type 0: no comminution
  2. Type I: small butterfly fragment
  3. Type II: large butterfly fragment with > 50% cortical contact
  4. Type III: large butterfly fragment with < 50% cortical contact
  5. Type IV: segmental comminution
  6. Type V: segmental bone loss
38
Q

Femoral shaft fracture associated injuries (7)

A

- Open fracture

- Ipsilateral femoral neck fracture

- Floating knee

- Fat embolism

- Ligamentous knee injury

- Chest/abdominal trauma

- Other extremity injuries

39
Q

Advantages of early stabilization of femoral shaft fractures (< 25 hours) (4)

A
  1. Decreased pulmonary complications
  2. Decreased thromboembolic complications
  3. Decreased costs of care
  4. Increased rehabilitation of patients
40
Q

Advantages of intramedullary fixation of femoral shaft fractures compared to plate fixation (11)

A
  1. Less extensive exposure/preserved vascularity
  2. Less blood loss
  3. Lower infection rate
  4. Lower rate of non-union
  5. Earlier functional use of the extremity
  6. Improved restoration of length and alignment in comminuted fractures
  7. Rapid healing
  8. Lower refracture rate
  9. Load-sharing device
  10. Bone graft effect of reaming
  11. Stronger construct in unstable fractures

Orthobullets/ FRCSC Canadian Board (121 decks)

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