lower extremity Fx classification and surgical HY Flashcards
Posterior hip dislocation
Thompson & Epstein
- insignificant posterior wall fragment
- single large posterior wall fragment
- comminuted posterior wall fragment
- Fracture of acetabular floor
- Fracture of femoral head
Anterior hip dislocation
Epstein
- Superior dislocation
- inferior dislocation
a. nofracture
b. assoc fx or impaction of femoral head
c. assoc fx of acetabulum
femoral neck fx
garden
- nondisplaced, incomplete
- nondisplaced, complete
- complete with partial displacement
- completely displaced, trabecular patttern/parallel
subroch hip fx
Russel-Taylor
- fx with an intact piriformis fossa
1a. lesser troch is attached to prox fragment
1b. lesser troch is detached from prox fragmet - fx extens into piriformis fossa
2a. stable medial construct (posteromedial cortex)
2b. comminution of piriformis fossa & lesser troch
Femoral shaft fx
Winquist & Hansen
- minimal/no comminution
- cortices of both fragments >50% intact
- 50-100% cortical comminution
- circumferential comminutin w/ no cortical contact
femoral head fx
Pipkin
- inferior femoral head fx
- femoral head fx superior to fovea capitis
- Type 1 or 2 w/ assoc. femoral neck fx
- type 1 or 2 w/ assoc. acetabular wall fx
intertroch fx
Evans
- stable, posteromedial cortex intact
- unstable, comminution of post/med cortex
- reverse obliquity, unstable
periprosthetic hip fx
Vancouver
A. Fx in trochanteric, AG(gr troch), AL (lesser troch)
B. Fx around or distal to stem, B1-stable, B2-unstable (loose stem)
C. Well below stem
Pilon fx
Ruedi & Allgower
- nondisplaced fx
- displaced fx w/ minimal impaction
- displaced fx w/ articular comminution & metaphyseal impaction
tibial plateau fx
Schatzker
- Lateral plateau, split fx
- lateral plateau, split depressed fx
- lateral plateau, depressed fx
- medial plateau fx
- bicondyler plateau fx
- plateau fx w/ separation of metaphysis>diaphysis
ankle fx by mechanism
Lauge-Hansen
Supination-Adduction (SA)15%/vertical med mal fx
supination-external rot (SER) 70%/ spiral fib fx AI>PS
Pronation-abduction (PA) 10%/high transverse fib fx
Pronation-external rot (PER) 10%/spiral fib fx AS>PI
Ankle fx by fibula fx location
Weber
A. Fibula fx below level of tibial plafond
B. Fibula fx beginning at level of syndesmosis
C. Fibula fx above syndesmosis, assoc. w/ maisoneuve
Talar neck fx
Hawkins
- nondisplaced fx (15% AVN)
- subtalar dislocation (25-50%)
- Subtalar & ankle dislocatin (50-100%AVN)
- Type 3 + talonavicular dislocation (100%AVN)
calcaneus fx
Sanders
- nondisplaced fx
- 2-part fx, subtkypes A,B,C = lateral, middle, medial
- 3-part fx w/ central depressed, subtype AB, AC, BC
Pelvic fx lateral compression
Young&Burgess
Lateral compression (LC)-transverse puic rami fx + :
1. sacral compression fx
2. iliac wing fx (on side of impact)
3. LC-1 or LC-2, contralateral open book (APC) injury
Pelvic fx anterior posterior compression
Young & Burgess
Anterior>Posterior compression (APC) :
Diastasis of pubic symphysis or longitudinal rami fx
1. 2.5cm of symphysis diastasis, disrupted anterior SI ligaments, intact posterior SI ligaments.
3. Complete disruption of symphysis, ant & post SI ligaments, lateral displacement
Pelvic fx vertical shear
Young & Burgess Vertical Shear (VS)- vertical displacement
Acetabular Fx
Judet-Letournel
5 elementary
1. posterior wall
2. Posterior column (fx line exists at gr sciatic notch)
3. Anterior wall
4. Anterior column (disrupts iliopectineal line)
5. Transverse (transtectal, juxtatectal, infratectal)
5 associatied
1. posterior column + post wall
2. T-Shaped
3. Transverse + post wall
4. Anterior column + posterior hemitransverse
5. both column (spur sign on obturator oblique view)
Periprosthetic femur fx about TKA
Lewis and Rorabeck
type 1. nondisplaced
type 2. displaced
type 3. Loose prosthesis
Pelvis x-ray special views
- obturator oblique: 45 internal rotation/ visualizes anterior column & posterior wall.
- Iliac oblique: 45 external rotation/ visualizes posterior column, anterior wall, iliac wing.
6 anatomic landmarks of pelvis on xray
- Iliopectineal line (anterior column)
- Ilioischial line (posterior column)
- Anterior wall
- Posterior wall
- Tear drop
- Acetabular dome
main blood supply to femoral head
ascending branch of medial circumflex
surgical approches to pelvis
- Kocher-langenbach: posterior wall & column, complications sciatic nerve palsy, heterotopic ossification 20%.
- Ilioinguinal: anterior wall & column, complications lateral femoral nerve 20%.
- Extended iliofemoral: T-type or transverse fx, complications heterotopic ossification 20-50%.
Talus blood supply: main arteries supplying it
posterior tibial artery, dorsalis pedis, perforating peroneal artery.
Talus blood supply: name branches off the main arteries and what part they supply
Branches: tarsal sinus, tarsal canal, deltoid Tarsal canal (main supply) body, tarsal sinus + deltoid supply head and neck
Tibial plateau fx operative indications
- all medial or bicondylar plateau fx’s
- varus/valgus instability
- 3mm of articular stepoff
- 5mm of condylar widening
Tibial plateau fx approaches
lateral: hockey-stick incision, plate is placed anterior and medial to Gerdy’s tubercle.
Posteromedial: prox medial epicondyle in line with MCL to insertion on tibia, semimembranosus, gracilis, sartorious retracted, medial head of gastroc retracted posterior.
Tibial plateau fx plates used for ORIF of different classes
Type 1-4: T or L buttress plates.
Type 5 and 6 fx: LISS locking plates
distal tibial closure order
central>medial>lateral>posterior>anterior
Subcapital hip fx surgical treatment
percutaneous pinning, inveted triangle. most inferior screw must be above the lesser trochanter
ankle fx syndesmotic screw technique
Place 3.5mm syndesmotic screw at 2.5cm above plafond, in PL to AM direction
Tibial shaft IM rod starting point
Medial to lateral tibial spine, anterior extra articular
