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Orthopedics > Indications for Treatment > Flashcards

Indications for Treatment Flashcards

1
Q

Indications for nonop tx for clavicle fxs?

A

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
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2
Q

Absolute indications for ORIF of clavicle fxs?

A
  • 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
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3
Q

Relative indications for ORIF of clavicle fxs?

A
  • brachial plexus injury
  • closed head injury
  • seizure disorder
  • polytrauma pt
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4
Q

Indications for nonop tx of proximal humerus fxs?

A

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
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5
Q

Indications for CRPP for proximal humerus fxs?

A
  • 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
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6
Q

Indications for ORIF for proximal humerus fxs?

A
  • GT fxs displaced >5mm
  • 2, 3, and 4-part fxs in younger pts
  • head splitting fxs in younger pts
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7
Q

Indications for IMN rodding for proximal humerus fxs?

A
  • surgical neck fxs or 3-part GT fxs in younger pts

- combine proximal humerus + humeral shaft fxs

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8
Q

Indications for hemiarthroplasty for proximal humerus fxs?

A
  • 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
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9
Q

Indications for TSA for proximal humerus fxs?

A
  • RTC intact

- glenoid surface is compromised

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10
Q

Indications for reverse TSA for proximal humerus fxs?

A
  • elderly pts with nonreconstructible tuberosities
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11
Q

Indicaitons for nonop tx for humeral shaft fxs?

A

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
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12
Q

Absolute contraindications for nonop tx of humeral shaft fxs?

A
  • severe soft tissue/bone loss
  • vascular injury requiring repair
  • brachial plexus injury
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13
Q

T/F Radial nerve palsy is a contraindication to nonop tx for humeral shaft fxs.

A

FALSE

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14
Q

Absolute indications for ORIF of humeral shaft fxs?

A
  • open fxs
  • vascular injury requiring repair
  • brachial plexus injury
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15
Q

Relative indications for ORIF of humeral shaft fxs?

A
  • 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
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16
Q

Relative indications for IMN of humeral shaft fxs?

A
  • pathologic fxs
  • segmental fxs
  • severe osteoporotic bone
  • overlying skin compromise limits open approach
  • polytrauma
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17
Q

Indications for nonop tx for olecranon fxs?

A

Immobilization in 45-90 degrees flexion for 3 weeks:

  • nondisplaced fxs
  • displaced fxs in low demand/elderly pts
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18
Q

Indications for tension band wiring for olecranon fxs?

A
  • transverse fxs with no comminution
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19
Q

Indications for IM fixation for olecranon fxs?

A

Same indication as tension band

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20
Q

Indications for ORIF for olecranon fxs?

A
  • comminuted fxs
  • Monteggia fxs
  • fx-dx
  • oblique fxs that extend distal to coronoid
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21
Q

Indications for excision and triceps advancement for olecranon fxs?

A
  • elderly pts with osteoporotic bone
  • <50% joint surface involvement
  • nonunions
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22
Q

Indications for nonop tx for Monteggia fxs?

A

Cast in supination:

- pediatric fxs

23
Q

Indications for ORIF for Monteggia fxs?

A
  • adult fxs
24
Q

Indications for nonop tx for nightstick fxs?

A

Functional fx brace + good interosseous mold:

- <10 degrees angulation

25
Q

Indications for ORIF of BBAF?

A

All BBAF are treated operatively

26
Q

Indications for nonop tx of distal radius fxs?

A

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
27
Q

Indications for CRPP of distal radius fxs?

A

Kapandji “intrafocal” pinning:

- extraarticular fxs or 2-part intraarticular fxs

28
Q

Indications for ORIF of distal radius fxs?

A
  • > 2mm articular displacement
  • Barton fxs
  • volar comminution
  • metaphyseal-diaphyseal extension
  • assoc distal ulnar shaft fxs
  • die-punch fxs
29
Q

How do you tx Galeazzi fxs?

A

ALL require ORIF of radius + DRUJ stabilization

30
Q

Indications for nonop tx for pelvic ring injuries?

A

WBAT–in mechanically stable injuries

  • LC1 (
  • APC1 (<2.5cm diastasis)
  • isolated pubic ramus fxs
31
Q

Indications for ORIF of pelvic ring injuries?

A
  • > 2.5cm diastasis
  • > 1cm SIJ displacement
  • > 1cm displacement of sacral fx
  • displacement/rotation of hemipelvis
  • open fxs
32
Q

Indications for nonop tx for hip dxs?

A

Emergent CR within 6 hours:
- acute anterior and posterior dxs
Contraindications–assoc femoral neck fxs

33
Q

Indications for antegrade IMN for femoral shaft fxs?

A
  • gold standard for diaphyseal femur fxs
34
Q

Indications for retrograde IMN for femoral shaft fxs?

A
  • ipsilateral femoral neck fxs
  • floating knee (ipsilateral tibial shaft fx)
  • ipsilateral acetabular fx
  • morbid obesity
  • b/l femur fxs (avoid repositioning)
35
Q

Indications for ORIF with plate for femoral shaft fxs?

A
  • ipsilateral neck fx requiring screw fixation
  • fx at distal metaphyseal-diaphyseal junction
  • inability to access medullary canal
36
Q

Indications for ORIF of distal femur fxs?

A
  • displaced fxs
  • intraarticular fx
  • nonunion
37
Q

Indication for retrograde IMN of distal femur fxs?

A
  • supracondylar fx without significant comminution

- osteoporotic bone

38
Q

Indications for nonop tx for patella fxs?

A

Extension knee immobilizer and WBAT:

  • intact extensor mechanism
  • nondisplaced/minimally displaced fxs
  • vertical fx patterns
39
Q

Indications for tension band wiring for patellar fxs?

A
  • extensor mechanism failure
  • open fxs
  • > 2mm articular displacement
  • > 3mm patellar fx displacement
40
Q

Indications for partial patellectomy?

A

Communited superior/inferior pole fxs measuring <50% patellar height ONLY if ORIF not possible

41
Q

Indications for total patellectomy?

A

Severe/extension comminution not amenable to salvage

42
Q

Indications for nonop tx of tibial plateau fxs?

A

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
43
Q

Indications for ORIF of tibial plateau fxs?

A
  • > 3mm articular stepoff
  • > 5mm condylar widening
  • varus/valgus instability
  • ALL medial plateau fxs
  • ALL bicondylar fxs
44
Q

Criteria for nonop tx/acceptable reduction of proximal tibia/tibial shaft fxs?

A

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)

45
Q

Indications for nonop tx of isolated medial malleolous fxs?

A

Short leg walking cast/boot:

- nondisplaced fx/tip avulsions

46
Q

Indications for lag screw fixation of isolated medial malleolous fxs?

A

Transverse fxs

47
Q

Indications for antiglide plate + lag screw for isolated medial malleolous fxs?

A

Vertical shear fxs

48
Q

Indications for nonop tx of isolated lateral malleolous fxs?

A

Short leg walking cast/boot:

  • if intact mortise
  • no talar shift
  • <4-5mm medial clear space widening on stress radiographs
49
Q

Indications for ORIF of isolated lateral malleolous fxs?

A
  • if talar shift
  • > 3mm displacement
  • > 4-5mm medial clear space widening on stress radiographs (bimall equivalent)
50
Q

Indications for tx of bimalleolar fxs?

A
  • any lateral talar shift
51
Q

Criteria for repairing posterior malleolar fxs?

A
  • > 25% articular surface involvement
  • > 2mm articular stepoff
  • Syndesmotic instability
52
Q

Indications for syndesmotic screw fixation?

A
  • > 4-5mm medial clear space widening
  • tib-fib clear space (AP) greater than 5mm (measured 1cm above plafond)
  • tib-fib overlap (mortise) narrowed
53
Q

Criteria for operative tx for proximal/middle phalanx fxs?

A
  • any rotational deformity
  • irreducible/unstable fxs
  • transverse fxs with >10 degrees angulation or >2mm shortening
  • long oblique fxs

Orthopedics (11 decks)

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