Goldenstien Trauma List 8 Flashcards
Classification of sacral fractures (Denis) (3)
- 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%)
Complications of sacral fractures (4)
- Neurologic injury
- Malunion
- Chronic pain
- Infection (with surgery)
Classification of acetabulum fractures (Letournel) (10)
- Simple/elementary
- o Posterior column
- o Posterior wall
- o Anterior column
- o Anterior wall
- o Transverse
- Associated/complex
- o Posterior column/posterior wall
- o Transverse/posterior wall
- o T-shaped
- o Anterior column/posterior hemitransverse
- o Both columns
Acetabular fracture associated injuries (9)
- Head injury
- Spine injury
- Chest injury
- Abdominal injury
- Urogenital injury
- Other fractures
- Nerve injury
- Morel-Lavallee lesion
- Knee ligament injury
(Proximal → distal)
Things to look for on CT scans of acetabular fractures (6)
- Posterior pelvic ring injuries
- Fractures of the quadrilateral plate
- Marginal impaction
- Rotation of articular fragments
- Intra-articular loose bodies
- Femoral head fractures
(Posterior → anterior)
Indications for surgical treatment of acetabular fractures (5)
- Articular incongruity ≥ 1 mm
- Posterior wall fracture with instability (> 20%)
- Loss of congruency between femoral head and dome
- Intra-articular loose bodies
- Marginal impaction
Relative contraindications to surgical treatment of acetabular fractures (7)
- Advanced age
- Medical comorbidities
- Morbid obesity
- Associated soft tissue/visceral injuries
- Contaminated wound
- Delay in treatment > 4 weeks
- DVT with contraindication to IVC filter
(Patient, injury, complications)
Indications for nonoperative treatment of acetabular fractures (8)
- Non-ambulatory patient
- Elderly patient with comminuted fracture
- Severe osteoporosis
- Local/systemic infection
- Displaced fracture with a large portion of the dome intact (> 10mm, > 45° roof-arc angles)
- Secondary congruence
- Non-displaced/minimally displaced fractures
- Posterior wall fracture without instability
(Patient, injury)
Complications of acetabular fractures (8)
- Post-traumatic arthritis (#1)
- Wound infection
- Nerve injury
- Heterotopic ossification
- Venous thromboembolism
- Soft tissue complications
- Osteonecrosis
- LFCN injury
Negative prognostic factors of acetabular fractures (6)
- Femoral head injury
- Marginal impaction
- Fracture-dislocation
- Delay in treatment > 3 weeks
- Residual displacement > 2 mm
- Surgery by an inexperienced individual
Classification of hip dislocation (comprehensive) (5)
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
Hip dislocation associated injuries (8)
- Pelvic fracture
- Acetabular fracture
- Femoral head/neck fracture
- MFCA injury
- Sciatic nerve injury
- Femur fracture
- Patella fracture
- Knee ligament injury
(Proximal → distal)
Indications for surgical treatment of hip dislocations (5)
- Irreducible dislocation
- Nonconcentric reduction
- Post-reduction instability
- Associated acetabular/femoral fracture requiring surgery
- Intraarticular loose bodies
Potential blocks to reduction of hip dislocation (4)
- Inadequate anaesthesia/muscle relaxation
- Interposed soft tissue (capsule, SER)
- Interposed bone fragments (femoral head, posterior wall)
- Labrum
Complications of hip dislocations (7)
- Sciatic nerve injury
- Avascular necrosis
- Post-traumatic arthritis
- Recurrent instability
- Chronic pain
- Infection (with surgery)
- Venous thromboembolism
Risk factors for recurrent instability following a hip dislocation (5)
- Femoral version
- Acetabular version
- Soft tissue impingement
- Labral avulsions
- Capsular laxity
Classification of femoral head fractures (Pipkin) (4)
- Type I: fracture below the fovea capitis
- Type II: fracture above the fovea capitis
- Type III: associated femoral neck fracture
- Type IV: associated acetabular fracture
Indications for surgical treatment of femoral head fracture (4)
- Articular step > 1 mm
- Intraarticular loose bodies
- To allow early ROM with associated fractures
- Polytrauma patient
Goals of surgical treatment of femoral head fractures (5)
- Restore articular congruity
- Restore hip stability
- Treat associated fractures
- Remove loose bodies
- Preserve femoral head blood supply
Complications of femoral head fractures (4)
- Degenerative joint disease
- Osteonecrosis (highest with type III)
- Recurrent dislocation
- Sciatic nerve injury (20%)
Classification of femoral neck fractures (Garden) (4)
- Type I: incomplete valgus impacted
- Type II: complete undisplaced
- Type III: partially displaced varus
- Type IV: completely displaced
Classification of femoral neck fractures (Pauwel’s) (3)
Type I: up to 30° from horizontal
Type II: 30-50° from horizontal
Type III: > 50° from horizontal
Components of the Leadbetter maneuver for closed reduction of femoral neck fractures (4)
- Flexion with mild adduction
- Traction in-line with the femur
- Internal rotation
- Circumduction to abduction and extension while maintaining internal rotation
Principles of surgical stabilization of femoral neck fractures (4)
- Preoperative medical stabilization
- Rapid, anatomic reduction
- Stable internal fixation
- Early postoperative mobilization
Radiographic features of an adequate reduction of a displaced femoral neck fracture
- 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
Complications of femoral neck fractures (8)
- Non-union
- Osteonecrosis
- Loss of fixation
- Malunion
- Femoral neck shortening
- Thromboembolic disease
- Subtrochanteric fracture
- Death
Indications for THA for femoral neck fracture (5)
- Older patient
- High activity level
- Pre-existing arthritis
- Low risk for dislocation
- Able to comply with postoperative restrictions
Classification of intertrochanteric fractures (Evan’s) (4)
Type I: 2-part
Type II: 3-part
Type III: 4-part
Type IV: reverse obliquity
Radiographic findings of unstable intertrochanteric hip fractures (3)
- Posteromedial comminution
- Subtrochanteric extension
- Reverse obliquity pattern
Principles of surgical treatment of intertrochanteric fractures (4)
- Restoration of normal neck-shaft alignment
- Medial cortical contact
- Controlled collapse during healing
- Early mobilization
Complications of intertrochanteric fractures (7)
- Varus Malreduction
- Malrotation deformity
- Non-union (2%)
- Implant failure
- Thromboembolic disease
- Symptomatic hardware
- Death
Risk factors for varus malreduction of intertrochanteric fractures (5)
- Anterosuperior screw placement
- Lack of reduction
- Improper reaming
- Excessive fracture collapse
- Severe osteopenia
(A.L.I.E.S.)
Consequences of varus malreduction of intertrochanteric fractures (4)
- Implant breakage
- Screw cut-out
- Joint penetration
- Screw-sideplate dissociation
Indications for surgical treatment of greater trochanter fractures(4)
- Displacement > 1 cm (young)
- Abductor dysfunction
- Trendelenburg gait
- Symptomatic nonunion
(D.A.T.S.)
Classification of subtrochanteric femur fractures (Russell-Taylor) (4)
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
Complications of subtrochanteric femur fractures (4)
- Malunion (apex anterior, varus)
- Leg length discrepancy
- Implant failure/loss of fixation
- Infection
Classification of femoral shaft fractures (Winquist & Hansen) (6)
- Type 0: no comminution
- Type I: small butterfly fragment
- Type II: large butterfly fragment with > 50% cortical contact
- Type III: large butterfly fragment with < 50% cortical contact
- Type IV: segmental comminution
- Type V: segmental bone loss
Femoral shaft fracture associated injuries (7)
- Open fracture
- Ipsilateral femoral neck fracture
- Floating knee
- Fat embolism
- Ligamentous knee injury
- Chest/abdominal trauma
- Other extremity injuries
Advantages of early stabilization of femoral shaft fractures (< 25 hours) (4)
- Decreased pulmonary complications
- Decreased thromboembolic complications
- Decreased costs of care
- Increased rehabilitation of patients
Advantages of intramedullary fixation of femoral shaft fractures compared to plate fixation (11)
- Less extensive exposure/preserved vascularity
- Less blood loss
- Lower infection rate
- Lower rate of non-union
- Earlier functional use of the extremity
- Improved restoration of length and alignment in comminuted fractures
- Rapid healing
- Lower refracture rate
- Load-sharing device
- Bone graft effect of reaming
- Stronger construct in unstable fractures
