Low Yield Flashcards

1
Q

What antibiotics are indicated for each GA classification? Salt water? Allergic to other abx? Fresh water?

A

GA I, II- 1st gen cephalosporin (G+)
GA III- 1st gen cephalosporin and aminoglycoside ( G-)
Farm injury- PCN (clostridia)
Allergic to ancef or gent- give fluoroquinolone
Fresh water- fluoroquinolone
Salt water- doxycyline or ceftazadime

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2
Q

What are risk factors for hardware infections?

A

1) host immunocompetency
2) extremes of age
3) diabetes
4) obesity
5) alcohol or tobacco abuse
6) steroid use
7) malnutrition
8) medications
9) previous radiation
10) vascular insufficiency

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3
Q

Infected non-union typically presents with what?

A

Pain at fracture site

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4
Q

After open reduction and internal fixation of long bone fractures, at what time period should C-reactive protein start to decrease?

A

48hrs; CRP is most predictive of infection during 1st week post-op

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5
Q

Describe clostridia?

A

Gram positive obligate anaerobe spore forming rod that releases exotoxins

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6
Q

What is first line treatment of gas gangrene?

A

IV penicillin G and radical surgical debridement

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7
Q

What determines the outcome after a scapulothoracic dissociation?

A

Neurologic injury; 52% result in flail extremity

Overall 10% mortality rate; early amputation in 20%

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8
Q

What is the classification of capitellum fractures?

A

Bryan and Morrey:
I- Hahn-Steinthal, coronal split that does not involve the trochlea
II- Kocher-Lorenz, shear fracture that involves mostly articular cartilage with some subchondral bone
III- Boberg-Morrey, comminuted
IV- McKee, coronal shear fracture that involves a large portion of the trochlea (will see “double arc” on lateral xray)

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9
Q

What is the treatment options for capitellum fractures?

A

1) Posterior splint for 3 wks:
Type I and II 2mm displacement
A to P headless screw
3) Fragment excision:
Type II and III with >2mm displacement
4) TEA:
Elderly patients with non reconstructible fxs

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10
Q

What is the most common complication of capitellum fracture?

A

Elbow contractures

Other complications are non-union, HO, AVN and ulnar nerve palsy

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11
Q

What is the classification of coronoid fractures?

A

Regan and Morrey:
I- fracture of the tip
II- 50% of the height
III- >50% of the height

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12
Q

What is the approach to treat an isolated coronoid fracture?

A

Medial approach through the two heads of FCU

Uses either no 5. ethibond, cerclage wires, retrograde cannulated screws or buttress plate for fixation

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13
Q

What causes early failure of coronoid fractures?

A

Unrecognized and untreated elbow instability

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14
Q

What is defined as a Monteggia fracture?

A

Fracture of the proximal 1/3 of the ulna with associated radial head dislocation/instability

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15
Q

What is the classification for Monteggia fractures?

A

Bado: (“think APL-B)
Type I: Anterior dislocation of the radial head with fracture of ulnar diaphysis at any level with anterior angulation
Type II: Posterior/posterolateral dislocation of the radial head with fracture of ulnar diaphysis with posterior angulation
Type III: Lateral/anterolateral dislocation of the radial head with fracture of ulnar metaphysis
Type IV: Anterior dislocation of the radial head with fractures of both radius and ulna within proximal third at the same level

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16
Q

Failure of the radial head to reduce after ulnar fixation in a Monteggia fracture can be a result of?

A

1) Malreduction of ulna
2) Interposition of annular ligament
3) Interposition of PIN (rare)

17
Q

What is the definition of a Galeazzi fracture?

A

Distal 1/3 radius fracture and injury to DRUJ

18
Q

What is the incidence of DRUJ instability with distal 1/3 radius fractures?

A

if radial fracture is 7.5 cm from articular surface; unstable in 6%

19
Q

Which position is the DRUJ most stable?

A

supination

20
Q

In an irreducible DRUJ, what structure is most likely preventing reduction?

A

ECU tendon

21
Q

What are signs of a DRUJ injury?

A

1) ulnar styloid fx
2) widening of joint on AP view
3) dorsal or volar displacement on lateral view
4) radial shortening (≥5mm)

22
Q

In a patient with a dashboard injury resulting in posterior hip dislocation, what is the most likely concomitant injury?

A
Meniscal tear (~30%)
effusion (37%), bone bruise (33%), and meniscal tear (30%) being the most common findings
23
Q

What imaging is ordered following a closed reduction of a hip dislocation?

A

CT pelvis to look for:

1) loose bodies
2) femoral head fx
3) acetabular fx

24
Q

What is the timing of reduction in a primary hip dislocation?

A

8-12hrs

25
Q

What complications of hip dislocation have higher incidence with increased time to reduction?

A

1) femoral head osteonecrosis (5-40%)

2) Sciatic nerve injury (8-20%)

26
Q

What is the classification for femoral head fractures?

A

Pipkin:
I- Fx below fovea
II- Fx above fovea
III- Type I/II with associated femoral neck fx
IV- Type I/II with associated acetabular fx

27
Q

In a Pipkin IV femoral head fracture what technique can help preserve the femoral head blood supply?

A

Greater trochanteric osteotomy with trochanteric flip

28
Q

What percentage of knee dislocations result in a vascular injury?

A

40-50%

Also 25% will have a common peroneal nerve injury as well

29
Q

What injuries are a/w knee dislocations based on direction of dislocation?

A

Anterior- (30-50%) most common, intimal tear of politeal a., PCL tear
Posterior- (25%) 2nd most common, complete popliteal rupture
Lateral- (13%) peroneal n., ACL and PCL
Medial- PCL, PLC

30
Q

What is the treatment algorithm for knee dislocations?

A

1) Close reduce if deformity (50% spontaneously reduce)
2) Check pulses; if present then ABI
2a: ABI>0.9 then serial checks
2b: ABI

31
Q

In a knee dislocation with vascular injury, what is the surgical treatment order?

A

1) External fixator
2) Excision damaged segment
3) reverse vein graft