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Orthobullets > OITE - Trauma > Flashcards

OITE - Trauma Flashcards

1
Q

Single most important factor for increased risk of infection in open LE fx? Study?

A

Time to transfer to a definitive trauma centre (LEAP study)

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2
Q

Utility of obturator-oblique INLET view?

A

Supra-acetabular screw/pin placement relative to tables of the ilium

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3
Q

Utility of Iliac-oblique INLET view?

A

AP position of superior ramus screws

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4
Q

LISS? Where holes place SPN at risk?

A

1-Less invasive stabilization system (synthes)

2-Holes 11 to 13

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5
Q

Distance from tip of acromion to axillary nerve?

A

7cm

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6
Q

Axillary nerve innervates which 2 muscles?

Exits which space, with what structure?

A

1-Deltoid, Teres minor

2-Quadrangular space, with posterior humeral circumflex art.

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7
Q

3 possible mal-alignment complications of tibia fx IMN?

A

Valgus, procurvatum, anterior translation of proximal fragment.

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8
Q

One technique to maintain reduction while placing IMN for tibia fracture?

A

Anterior uni-cortical plating

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9
Q

Indication for buttress plating in a tib plateau fx?

A

Simple partial articular. Not for articular depressed fx.

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10
Q

Locked plating indicated for?

A

1-Intra-articular fx
2-osteoporotic bone
3-comminuted fx needing bridging

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11
Q

Most common complication of proximal humerus locking plate construct, for 2- part fx?

A

Screw penetration (or cut out)

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12
Q

Second most common complication of prox-humeral fx ORIF with locked plating?

A

Varus displacement

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13
Q

Two recommended views for AP orientation in sacral screw placement?

A

1-Lateral sacral view

2-Pelvic inlet view

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14
Q

Recommended views for Sup-Inferior orientation in sacral screw placement?

A

Pelvic outlet view

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15
Q

Proximal locking screws for femur IMN, above or below LT?

A

Safer above LT, danger if within 4-5 cm below LT.

Dangers: Profunda femoral artery, femoral nerve

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16
Q

The 5 simple acetabular fractures?

A

1-Posterior column
2-Posterior wall
3-Anterior column
4-Anterior wall 5-Transverse

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17
Q

The 5 associated acetabular fracture patterns?

A

1-T-type. 2-Transverse and posterior wall
3-Post column and posterior wall
4-Anterior and posterior hemi-transverse
5-Associated both column (ABC)

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18
Q

Surgical access for posterior wall and column fractures?

A

Kocher-Langenbeck

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19
Q

Surgical approach for both column fractures?

A

Extended ilio-femoral

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20
Q

Surgical approach for anterior wall, or anterior column fracture?

A

Ilio-inguinal approach

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21
Q

Surgical approach for Anterior column as well as the internal aspect of the iliac wing and quadrilateral plate?

A

Modified stoppa

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22
Q

Anterior cortex penetration of femur by IMN, due to lesser or greater radius of curvature?

A

Greater radius of curvature (ie. straighter nail)

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23
Q

Valgus IT osteotomy, converts what to what? (2 points)

A

1-vertical fracture non-union to horizontal

2-Shear force to compressive force

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24
Q

Denis Zone 3 sacral fx?

A

Medial to sacral foramina, highest rate of nerve injury (56%)

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25
Q

Denis Zone 2 sacral fx?

A

Through sacral foramina

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26
Q

DR fx + ulnar styloid fx, do you fix or not fix ulnar styloid fx too?

A

No difference on wrist stability or function, if not fixed

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27
Q

Which posterior wall fx are deemed unstable (ie percentage involved)? Stable?

A

Unstable: 40-50% involvement of posterior wall
Stable: less than 20%
Unknown: 20 to 40%

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28
Q

To prevent procurvatum in proximal tibial fx IMN, what intra-op technique?

A

Posterior blocking screws in proximal tibial segment

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29
Q

Advantage to ORIF of mid-shaft clavicle fx?

A

1-Faster time to union
2-Decreased rate of non-union
3-Decreased rate of symptomatic mal-union

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30
Q

TAD (tip to apex distance) measurement?

A

Summation of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs

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31
Q

Ideal TAD?

A
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32
Q

Right or left sided IT fx at increased risk of proximal fragment mal reduction, due to SHS?

A

Left sided, as clockwise torque of SHS causes flexion deformity.

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33
Q

Proximal humerus GT fx, associated with what kind of dislocation?

A

Anterior dislocation

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34
Q

Proximal humerus LESSER Troch fx, associated with what kind of dislocation?

A

posterior dislocation

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35
Q

3 reasons to restore length, alignment, rotation of fibula fx?

A

1-reduction of talus
2-buttress to talar motion (if incompetent deltoid)
3-allow syndesmotic ligs to heal with appropriate tension

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36
Q

Stress fx appearance on MRI?

A

Decreased signal on T1

Increased signal on T2

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37
Q

Structure most at risk with antero-lateral acromial approach?

A

Axillary nerve

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38
Q

Distance of axillary nerve from GT prominence?

A

35 mm

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39
Q

Subcapital neck fx, optimal cannulated screw config?

A

1-Inverted triangle

2-Inferior screw posterior to midline and adjacent to calcar

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40
Q

Which structure most important to pelvic ring stability, anterior or posterior SI ligaments?

A

Posterior

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41
Q

Difference between APC 2 and APC 3 injuries?

A

Posterior SI-ligaments spared in APC 2, injured in APC 3

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42
Q

Best predictor of improved patient outcome post acetab fx orif?

A

Post-op hip strength, regardless of surgical approach

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43
Q

BTT (brake travel time) after LE fx, increases or decreases?

A

Increases up to 6 weeks after initiation of weight bearing (both long bone and articular fx) of Right LE.

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44
Q

BTT returns to normal when post long-bone or articular LE fx?

A

By 9 weeks after initiation of weight bearing.

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45
Q

3 principles needed for tension band construct?

A

1-Eccentrically loaded bone
2-Construct applied to tensile side
3-Opposite cortex must withstand compressive forces

46
Q

Deforming forces on proximal fragment in subtroch hip fx?

A

1-Flexion (iliopsoas)
2-Abducted (TFL, glut med)
3-ER (piriformis)

47
Q

Reduction maneuver for proximal fragment displacement in sub-troch hip fx?

A

Extension, ADDuction, internal rotation

48
Q

Which tendon can be used to adequate assess humeral height in shoulder arthroplasty?

A

1-Pec Major tendon

49
Q

Distance between top of humeral head, and superior edge of pec major tendon?

A

5.6 cm

50
Q

Classification for femoral head fx?

A

Pipkin classification

51
Q

What is a Pipkin II femoral head fx?

A

Supra-foveal

Needs surgical fixation

52
Q

Crescent fx of iliac wing, what type of pelvic injury?

A

LC type 2 (Young-Burgess classification)

53
Q

Most common position of talar neck mal-union?

A

Varus, leading to diminished subtalar and forefoot motion

54
Q

Exam under anaesthesia for post-wall fx instability, what is the best xray view?

A

Obturator oblique view

55
Q

Tibial IMN insertion technique to ensure perfect alignment?

A

Critical that nail is parallel to lateral and anterior cortex

56
Q

Where do blocking (Poller) screws go in tibial IMN?

A
  • Concave side of deformity

- i.e. where you don’t want the nail to go

57
Q

Flexion procurvatum deformity is typically a result of what?

A

Extensor mechanism of the knee

58
Q

What is the semi-extended nailing technique?

A

-Patella subluxed, allowing access to insertion site at 15 deg knee oflexion

59
Q

What leg position exerts lease intraneural pressure (stretch) on sciatic nerve in Kocker-Langenback approach?

A

Extend the hip

Flex the knee

60
Q

Ileopectineal disrupted?

A

Anterior column

61
Q

Ilioischial line disrupted?

A

Posterior column

62
Q

IOWA mnemonic?

A

Iliac oblique wall anteior

63
Q

What correlates most closely with good outcome post ORIF of posterior wall fx?

A

Quality of reduction

and degree of displacement on post op Pelvic CT scan

64
Q

Pelvic spur sign is pathognomonic for what injury?

A

Both column fx

=dissociation of articular surface from innominate bone / axial skeleton

65
Q

What is the actual spur, in the spur sign?

A

Intact portion of the ilium , still attached to axial skeleton
(seen postero-superior to displaced acetabulum)

66
Q

What is the Lauge-Hanser classification short form?

A

PA/PER/SA/SER
Pro/adduction
Pro/external rotation

67
Q

Vertical shear component of medial mal ankle fx, is pathognomonic for which L-H class?

A

Supination adduction (SA) injury

68
Q

Comminuted fibula fx more likely in which L-H ankle fx?

A

Pronation abduction (PA) ankle injury

69
Q

1 mm shift of talus lateral decreaess tibio-talar contact area by how much?

A

42%

70
Q

Syndesmosis instability is greatest in which plane?

A

A to P plane (rather than M-L)

71
Q

Antegrade femoral IMN nail with fx table rather than manual traction leads to what?

A
  • Higher percentage of internal rotation deformities
  • longer OR time
  • more fluoro time
72
Q

What is the most common femoral shaft deformity with IMN via piriformis fossa, patient SUPINE?

A

Internal rotation deformity

73
Q

What is the most common femoral shaft deformity with IMN via piriformis fossa, patient LATERAL?

A

External rotation deformity

74
Q

What 2 factors tend to increase rotational mal-alignmnent in femoral shaft IMN?

A
  • night time surgery

- increased fx communition

75
Q

What are 2 iatrogenic fx etiologies in fem shaft IMN?

A
  • Failure to overream canal by atleast 0.5mm

- Antegrade starting point that is >6mm anterior to the intramedullary axis

76
Q

Incidence of concomitant proximal femur neck fx, with ipsilateral femur shaft fx?

A

Ipsilateral femoral neck-shaft combo in upto 9%

77
Q

Incidence of osteonecrosis with femoral neck fx? Increased risk with?

A

10-45%

High risk with - non-anatomic reduction, increased time to reduction, increased initial displacement

78
Q

What has a higher dislocation rate THA or hemiarthroplasty for femoral neck fx?

A

7x higher than with THA (10%)

79
Q

What kind of malreduction most closely correlates with failure of fixation after reduction and cannulated screw fixation, of fem neck fx?

A

Varus mal-reduction

Non-union rate 5-30%

80
Q

Indications for THA for femoral neck fx?

A

-Older ACTIVE pt with pre-existing hip OA

more predictable pain relief and better function

81
Q

Outlet view allows viewing?

A
  • Avoid S1 exiting foramina

- Vertical displacement, SI joint widening

82
Q

Inlet view

A
  • Avoid L5 nerve root

- AP displacement

83
Q

Lateral sacral view allows?

A
  • Most important intra-op view for SI screw
  • Avoid alar slope
  • Transverse sacral fx
84
Q

Benefit of outlet obturator oblique (O-O-O) image?

A

Supra-acetabular pin placement

-starting point is the confluence running from ASIS to AIIS

85
Q

Markers of adequate fluid resuscitation?

A

Most important :

-Base deficit 60, UOP 0.5-1 ml/kg/hr, HR

86
Q

What does compensated shock mean?

A 
Underresuscitated patient (beware)
Increased IL-6 levels
87
Q

What percentage of normal circulating blood loss is needed for a patient to become tachycardic with a narrowed pulse pressure?

A

Class 2 to Class 3 hemorrhagic shock is when you being having HD instability, needs (15-30% blood loss)

88
Q

What triad in a polytrauma patient is bad?

A
  • Head injury
  • Femur fx
  • Hypotension
89
Q

Two key technical points in shoulder hemi-arthroplasty (for prox hum fx)?

A

-restore head height & retroversion

reference sup border of pec major, 5.6cm

90
Q

What are 2 possible technical problems with shoulder hemi-arthroplasty?

A

-Tuberosity mal-position (KEY concept) restricts motion/rotation
10mm below articular surface
If too high, decreased abduction & elevation
-Tuberosity non-union (restricts overhead motion)

91
Q

Acceptable parameters for humeral shaft fx, for non-op mgt?

A

20 deg a-p angulation

30 deg V/V

92
Q

What would you consider if >6cm non-union in humeral shaft fx?

A

Plate & graft with vascularized free fibula

93
Q

Recovery of radial nerve palsy/neuropraxia in hum shaft fx?

A

70% recover within 3 mos, 95% within 4 months

94
Q

What kind of radial nerve injury:

a) Transverse humeral shaft fx ?
b) Distal 1/3 spiral

A

a) neuropraxia

b) laceration / entrapment (Holstein-Lewis fragment)

95
Q

How do you interpret EMG/NCV at 6 weeks for radial nerve palsy?

A

Fasciculations –> continued observation

Denervation (fibrillations) –> exploration

96
Q

Non-op mgt of ulna fx?

A

Distal 2/3rd fx,

97
Q

When is grafting indicating in ORIF for BBFA?

A

Grafting if only failure of bone contact/gap. Not comminution

98
Q

Tension band construct for olecranon fx, indications?

A

Stable and not comminuted.

If comminuted –> excision upto 50% and reattach triceps

99
Q

If olecranon fx that is comminuted or unstable, with extension into the coronoid, mgt?

A

ORIF + plate (not tension band)

100
Q

In a medial compartment fasciotomy, what must you ensure to do with soleus?

A

Medially, must take down soleus insertion to access deep compartment

101
Q

Risk with proximal peri-fibular approach in fasciotomy, SPN or CPN?

A

CPN

SPN is at risk more distally (and lateral)

102
Q

Is early mobilization a risk for non-union for ORIF clavicle?

A

NO, no effect.

103
Q

What type Schatzker classification has the highest rate of meniscal and vascular injury?

A
  • Type 4

- acts like knee dislocation

104
Q

What type Schatzker are ACL injuries most common?

A

Type 5 and 6

105
Q

What variable is most important preidctor of long term outcomes with Tib plateau ORIF?

A

Restoration of joint stability (limb mechanical axis)

106
Q

In talar neck fx, varus malunion, how is the subtalar ROM altered?

A
  • residual decreased subtalar eversion

- Stands on the lateral border of the foot

107
Q

What can lead to varus malunion in talar neck fx? Tx?

A

Medial comminution, or over-compressing the medial side

Tx with triple arthrodesis

108
Q

Dorsal impingment post tx of talar neck fx, what kind of malunion?

A

Dorsal malunion

109
Q

Caphut fragment in tibial plafond fx?

A

Anterior-inferior tib-fib ligament

110
Q

Volkmann’s fragment?

A

Posterior-inferior tib-fib ligament

111
Q

Sliding hip compression screw is contra-indicated in what type of IT hip fx?

A

Reverse obliquity fracture

112
Q

What is the most frequent intra-op complication with ante-grade nailing of subtroch fem fx?

A 
Varus 
and procurvatum (or flexion) malreduction

Orthobullets (6 decks)

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