Indications for Treatment Flashcards
Indications for nonop tx for clavicle fxs?
Sling for comfort + ROM exercises at 2-4 weeks
- nondisplaced group I
- stable group II (types I, III, IV)
- nondisplaced group III
- pediatric distal clavicle fxs
Absolute indications for ORIF of clavicle fxs?
- unstable group II (types IIA/B, V)
- open fxs
- displaced fx with skin tenting
- NV injury
- floating shoulder (clavicle + scapula neck fx)
- sxs nonunion
- posteriorly displaced group III fxs
- displaced group I with >2cm shortening
Relative indications for ORIF of clavicle fxs?
- brachial plexus injury
- closed head injury
- seizure disorder
- polytrauma pt
Indications for nonop tx of proximal humerus fxs?
Sling immobilization: 85% of prox humerus fxs are tx nonop
- minimally displaced surgical neck fxs
- GT fx displaced <5mm
- fxs in pts who are not surgical candidates
Indications for CRPP for proximal humerus fxs?
- 2-part surgical neck fxs
- 3-part and valgus-impacted 4-part fxs in pts with good bone quality, minimal metaphyseal comminution, and intact medial calcar
Indications for ORIF for proximal humerus fxs?
- GT fxs displaced >5mm
- 2, 3, and 4-part fxs in younger pts
- head splitting fxs in younger pts
Indications for IMN rodding for proximal humerus fxs?
- surgical neck fxs or 3-part GT fxs in younger pts
- combine proximal humerus + humeral shaft fxs
Indications for hemiarthroplasty for proximal humerus fxs?
- anatomic neck fxs in elderly or severely comminuted
- 4-part fxs and fx-dx
- RTC compromise
- glenoid surface intact and healthy
- chronic nonunions/malunions
- head-splitting fxs with incongruity of humeral head
- humeral head impression defect of >40% of articular surface
- detachment of articular blood supply
Indications for TSA for proximal humerus fxs?
- RTC intact
- glenoid surface is compromised
Indications for reverse TSA for proximal humerus fxs?
- elderly pts with nonreconstructible tuberosities
Indicaitons for nonop tx for humeral shaft fxs?
Coaptation splint or hanging cast (must be upright for both to work) followed by functional (Sarmiento) brace–indicated in vast majority:
- <3cm shortening
- 20 degrees anterior angulation
- 30 degrees varus angulation
Absolute contraindications for nonop tx of humeral shaft fxs?
- severe soft tissue/bone loss
- vascular injury requiring repair
- brachial plexus injury
T/F Radial nerve palsy is a contraindication to nonop tx for humeral shaft fxs.
FALSE
Absolute indications for ORIF of humeral shaft fxs?
- open fxs
- vascular injury requiring repair
- brachial plexus injury
Relative indications for ORIF of humeral shaft fxs?
- ipsilateral forearm fx (floating elbow)
- b/l humerus fx
- polytrauma
- pathologic fxs
- burns/soft tissue injury
- distraction at fx site, long oblique/proximal spiral fx, intraarticular extension
Relative indications for IMN of humeral shaft fxs?
- pathologic fxs
- segmental fxs
- severe osteoporotic bone
- overlying skin compromise limits open approach
- polytrauma
Indications for nonop tx for olecranon fxs?
Immobilization in 45-90 degrees flexion for 3 weeks:
- nondisplaced fxs
- displaced fxs in low demand/elderly pts
Indications for tension band wiring for olecranon fxs?
- transverse fxs with no comminution
Indications for IM fixation for olecranon fxs?
Same indication as tension band
Indications for ORIF for olecranon fxs?
- comminuted fxs
- Monteggia fxs
- fx-dx
- oblique fxs that extend distal to coronoid
Indications for excision and triceps advancement for olecranon fxs?
- elderly pts with osteoporotic bone
- <50% joint surface involvement
- nonunions
Indications for nonop tx for Monteggia fxs?
Cast in supination:
- pediatric fxs
Indications for ORIF for Monteggia fxs?
- adult fxs
Indications for nonop tx for nightstick fxs?
Functional fx brace + good interosseous mold:
- <10 degrees angulation
Indications for ORIF of BBAF?
All BBAF are treated operatively
Indications for nonop tx of distal radius fxs?
Initial sugartong splint followed by short arm cast:
- nondisplaced/minimally displaced fxs
- most extraarticular fxs
- <5 degree dorsal angulation or within 20 degree of contralateral distal radius
Indications for CRPP of distal radius fxs?
Kapandji “intrafocal” pinning:
- extraarticular fxs or 2-part intraarticular fxs
Indications for ORIF of distal radius fxs?
- > 2mm articular displacement
- Barton fxs
- volar comminution
- metaphyseal-diaphyseal extension
- assoc distal ulnar shaft fxs
- die-punch fxs
How do you tx Galeazzi fxs?
ALL require ORIF of radius + DRUJ stabilization
Indications for nonop tx for pelvic ring injuries?
WBAT–in mechanically stable injuries
- LC1 (
- APC1 (<2.5cm diastasis)
- isolated pubic ramus fxs
Indications for ORIF of pelvic ring injuries?
- > 2.5cm diastasis
- > 1cm SIJ displacement
- > 1cm displacement of sacral fx
- displacement/rotation of hemipelvis
- open fxs
Indications for nonop tx for hip dxs?
Emergent CR within 6 hours:
- acute anterior and posterior dxs
Contraindications–assoc femoral neck fxs
Indications for antegrade IMN for femoral shaft fxs?
- gold standard for diaphyseal femur fxs
Indications for retrograde IMN for femoral shaft fxs?
- ipsilateral femoral neck fxs
- floating knee (ipsilateral tibial shaft fx)
- ipsilateral acetabular fx
- morbid obesity
- b/l femur fxs (avoid repositioning)
Indications for ORIF with plate for femoral shaft fxs?
- ipsilateral neck fx requiring screw fixation
- fx at distal metaphyseal-diaphyseal junction
- inability to access medullary canal
Indications for ORIF of distal femur fxs?
- displaced fxs
- intraarticular fx
- nonunion
Indication for retrograde IMN of distal femur fxs?
- supracondylar fx without significant comminution
- osteoporotic bone
Indications for nonop tx for patella fxs?
Extension knee immobilizer and WBAT:
- intact extensor mechanism
- nondisplaced/minimally displaced fxs
- vertical fx patterns
Indications for tension band wiring for patellar fxs?
- extensor mechanism failure
- open fxs
- > 2mm articular displacement
- > 3mm patellar fx displacement
Indications for partial patellectomy?
Communited superior/inferior pole fxs measuring <50% patellar height ONLY if ORIF not possible
Indications for total patellectomy?
Severe/extension comminution not amenable to salvage
Indications for nonop tx of tibial plateau fxs?
Hinged knee brace, PWB for 8-12 weeks, immediate PROM:
- minimally displaced split or depressed fxs
- low energy fx stable to varus/valgus alignment
- nonambulatory pts
Indications for ORIF of tibial plateau fxs?
- > 3mm articular stepoff
- > 5mm condylar widening
- varus/valgus instability
- ALL medial plateau fxs
- ALL bicondylar fxs
Criteria for nonop tx/acceptable reduction of proximal tibia/tibial shaft fxs?
Initially long leg posterior splint then long leg cast 3-5 days later (knee flexed 10-15 degrees, ankle plantarflexed):
- 50% cortical contact
- <5 degrees varus/valgus angulation
(ASIS, center of patella, and base of 2nd MT should be colinear)
Indications for nonop tx of isolated medial malleolous fxs?
Short leg walking cast/boot:
- nondisplaced fx/tip avulsions
Indications for lag screw fixation of isolated medial malleolous fxs?
Transverse fxs
Indications for antiglide plate + lag screw for isolated medial malleolous fxs?
Vertical shear fxs
Indications for nonop tx of isolated lateral malleolous fxs?
Short leg walking cast/boot:
- if intact mortise
- no talar shift
- <4-5mm medial clear space widening on stress radiographs
Indications for ORIF of isolated lateral malleolous fxs?
- if talar shift
- > 3mm displacement
- > 4-5mm medial clear space widening on stress radiographs (bimall equivalent)
Indications for tx of bimalleolar fxs?
- any lateral talar shift
Criteria for repairing posterior malleolar fxs?
- > 25% articular surface involvement
- > 2mm articular stepoff
- Syndesmotic instability
Indications for syndesmotic screw fixation?
- > 4-5mm medial clear space widening
- tib-fib clear space (AP) greater than 5mm (measured 1cm above plafond)
- tib-fib overlap (mortise) narrowed
Criteria for operative tx for proximal/middle phalanx fxs?
- any rotational deformity
- irreducible/unstable fxs
- transverse fxs with >10 degrees angulation or >2mm shortening
- long oblique fxs
