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Ortho-Rheum > Orthopaedic Trauma Day 4 > Flashcards

Orthopaedic Trauma Day 4 Flashcards

1
Q

what is the most common long bone fracture?

A

tibia shaft fracture

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2
Q

what must be done when a patient presents with a tibia shaft fracture? (3)

A

investigate for open wounds
evaluate for compartment syndrome
NV exam

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3
Q

what is the treatment for a tibia shaft fracture? (2)

A

immediate reduction at bedside
intermedullary nail

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4
Q

what are 4 risks for tibia shaft fractures?

A

open
compartment syndrome
fat emboli
nonunion

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5
Q

identify

A

tibia shaft fracture

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6
Q

very common injury that occurs with twisting

A

ankle fractures

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7
Q

what is the lateral malleolus ankle fracture classification based on?

A

based on fracture site at the distal fibula

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8
Q

lateral malleolus fracture that occurs below the syndesmosis and is typically non-operative

A

weber A

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9
Q

lateral malleolus fracture that occurs at the level of the syndesmosis and treatment depends on stability

A

weber B

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10
Q

lateral malleolus fracture that occurs above the syndesmosis and is typically operative due to instability and disruption of he syndesmosis

A

weber C

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11
Q

what classification of lateral malleolus ankle fracture is most important and why?

A

weber B
need to determine whether surgery is needed

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12
Q

fracture that occurs below the syndesmosis and is usually an isolated stable fracture without instability

A

lateral malleolus fracture weber A

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13
Q

a patient presents with swelling, ecchymosis, and pain to their lateral ankle over the distal fibula. Dx?

A

lateral malleolus fracture weber A

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14
Q

what is the treatment for a lateral malleolus fracture weber A?

A

immobilization in high boot (WBAT) x 6-8 weeks

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15
Q

what surgical treatment may be needed for a lateral malleolus fracture weber A depending on displacement?

A

ORIF (open reduction internal fixation)

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16
Q

identify fracture and treatment

A

lateral malleolus fracture weber A
immobilization in high boot (WBAT) x 6-8 weeks

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17
Q

identify fracture and treatment

A

lateral malleolus fracture weber A + displacement
ORIF

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18
Q

fracture that occurs at the level of syndesmosis and must be evaluated for stability with gravity or manual stress exam

A

lateral malleolus fracture weber B

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19
Q

how do you know if a lateral malleolus fracture weber B is stable?

A

no medial or lateral clear space widening with stress exam

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20
Q

an increased medial clear space >5mm in a lateral malleolus fracture weber B indicates injury to what?

A

deltoid ligament injury

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21
Q

an increased lateral clear space or decreased tibiofibular overlap in a lateral malleolus fracture weber B indicates injury to what?

A

syndesmosis injury

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22
Q

what is the treatment for a stable lateral malleolus fracture weber B? (2)

A

high fracture boot +WBAT
f/u w/ WB xrays to confirm stability

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23
Q

what is the treatment for an unstable lateral malleolus fracture weber B? (2)

A

splint NWB
+ ORIF (open reduction internal fixation)

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24
Q

identify

A

lateral malleolus fracture weber B

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25
Q

identify

what is the possible associated injury?

A

lateral malleolus fracture weber B
+ medial clear space widening

possible deltoid ligament injury

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26
Q

identify
stable or unstable?
what is the possible associated injury?

A

lateral malleolus fracture weber C
unstable
possible deltoid ligament injury (d/t medial clear space widening)

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27
Q

identify
stable or unstable?

A

lateral malleolus fracture weber B
stable

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28
Q

fracture that occurs above the syndesmosis and is commonly associated with disruption of the syndesmosis

A

lateral malleolus facture weber C

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29
Q

what is the treatment for a lateral malleolus fracture weber C? (2)

A

splint NWB
ORIF (open reduction internal fixation)

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30
Q

identify

A

lateral malleolus fracture weber C

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31
Q

a medial malleolus and fibula fracture

A

bimalleolar ankle fracture

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32
Q

identify

A

bimalleolar ankle fracture

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33
Q

what is the treatment for a bimalleolar ankle fracture? (2)

A

splint NWB
ORIF (open reduction internal fixation)

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34
Q

medial malleolus + fibula + posterior malleolus fracture

A

trimalleolar fracture

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35
Q

what is the treatment for a trimalleolar fracture? (2)

A

splint NWB
ORIF (open reduction internal fixation)

36
Q

identify

A

trimalleolar fracture

37
Q

involves the proximal 1/3 fibula and is associated with a medial malleolus fracture or deltoid ligament injury

A

maisonneuve fracture

38
Q

what should an isolated medial malleolus fracture raise suspicion for?

A

maisonneuve’s injury (1/3 proximal fibula fracture)

39
Q

a patient presents with medial ankle pain and proximal leg pain. what are they suspicious for?

A

maisonneuve fracture

40
Q

identify

A

maisonneuve fracture

41
Q

identify
stable or unstable?
treatment?

A

lateral malleolus fracture weber C
unstable
reduce, splint NWB, ORIF

42
Q

weight bearing articular surface of the distal tibia in which the talus gets forced into the distal tibia causing an intra-articular fracture

A

pilon fracture

43
Q

what are the 2 treatment options for a pilon fracture?

A

ORIF
OR
External fixation with delayed ORIF

+ NWB x 12 weeks

44
Q

what should we evaluate for in a pilon fracture? (3)

A

low back pain (L1 fx)
post traumatic arthritis
compartment syndrome

45
Q

identify

A

pilon fracture

46
Q

midfoot injury with disruption of lisfranc ligament leading to disruption of TMT joint complex

A

lisfranc fracture

47
Q

a patient presents with plantar bruising, swelling throughout midfoot, TTP over TMT joints, and inability to BW. what are they suspicious for?

A

lisfranc fracture

48
Q

what is the treatment for a lisfranc fracture? (2)

A

splint NWB
ORIF (open reduction internal fixation)

49
Q

how are lisfranc fractures misdiagnosed?

A

as foot sprain

50
Q

identify

A

lisfranc fracture

51
Q

identify

A

lisfranc fracture

52
Q

what imaging is helpful to identify extent of lisfranc injury and for surgical planning?

53
Q

what should we look for in a negative xray/subtle lisfranc fracture?

A

fleck sign from 2nd metatarsal

54
Q

identify

A

fleck sign indicating lisfranc fracture

55
Q

what is the most common tarsal fracture?

A

calcaneus fracture

56
Q

what should we assess if a patient has a calcaneus fracture? (3)

A

lumbar spine
femur
pelvis

57
Q

calcaneus fracture fragment usually displaces with variable comminution, resulting in heel shortening and valgus deformity

A

intra-articular fracture of calcaneus

58
Q

what is a common occurrence with calcaneus fractures?

A

fracture blisters

59
Q

what is the treatment for a calcaneus fracture? (2)

A

well padded splint NWB
ORIF

60
Q

a patient presents with swelling and bruising on his hindfoot and has difficulty with WB. what is the patient suspicious for?

A

calcaneus fracture

61
Q

identify

A

calcaneus fracture

62
Q

extra-articular fracture of the calcaneus, that results from avulsion of bifurcate ligament

A

anterior process fracture

63
Q

what is the treatment for a calcaneus anterior process fracture?

A

WBAT in fracture boot x 4 weeks

64
Q

identify

A

anterior process fracture

65
Q

what does a tongue type fracture require?

A

Urgent ortho eval

66
Q

Achilles and calcaneus avulsion with strong contraction of the gastroc-soleus muscles

A

tongue type fracture

67
Q

a patient presents with a posterior heel with skin breakdown/tenting. what are they suspicious for?

A

tongue-type fracture

68
Q

what is the treatment for a tongue type fracture? (3)

A

split in plantar flexion position
NWB
ORIF

69
Q

identify

A

tongue type fracture

70
Q

what is the most common fractured metatarsal in adults?

A

5th metatarsal

71
Q

what is the least common fractured metatarsal in adults?

A

1st metatarsal

72
Q

in which metatarsal are stress fractures most common? what imaging detects it?

A

2nd metatarsal

MRI

73
Q

which zone/fracture is one that occurs in the articular surface for metatarso-cuboid joint?

A

zone 1 / avulsion fracture

74
Q

which zone/fracture is one that occurs in the articulation of 4th and 5th MT?

A

zone 2 / jones fracture

75
Q

which zone/fracture is one that extends 1.5cm distal to the tuberosity?

A

zone 3 / dancer’s (stress) fracture

76
Q

what are 2 treatment options for a zone 1 5th metatarsal fracture? (2)

A

fracture boot x 4-6 weeks
OR
hard soled shoe WBAT x 4-6 weeks

77
Q

identify

A

5th metatarsal zone 1 fracture

78
Q

why is there poor healing in a zone 2 5th metatarsal fracture? (jones)

A

blood supply in area

79
Q

what is the conservative treatment for a zone 2 5th metatarsal fracture (jones)?

A

fracture boot NWB x 6-8 weeks, then WBAT in boot x 4 weeks

80
Q

what is the operative treatment for a zone 2 5th metatarsal fracture (jones)?

A

surgical screw with 2 weeks NWB, then WB in boot x 4-6 weeks

81
Q

identify

A

zone 2 5th metatarsal fracture (jones)

82
Q

commonly associated with stress fracture, has a length healing time of 20 weeks, and can cause a cavus foot (high arch)

A

zone 3 5th metatarsal fracture

83
Q

what is the conservative treatment for a zone 3 5th metatarsal fracture (stress/dancer)?

A

NWB x 6-8 weeks, then WB

84
Q

what is the surgical treatment for a zone 3 5th metatarsal fracture (stress/dancer)?

A

surgical screw + 2 weeks NWB, then WB in boot x 4-6 weeks

85
Q

identify

A

zone 3 5th metatarsal fracture (stress/dancers)

Ortho-Rheum (27 decks)

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