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plating Flashcards

1
Q

Biological osteosynthesis principle

A

bridging plate in multifragmentary diaphyseal fracture
- intermediate fragments untouched
- restores length rotation and angulation
- respects biology of fracture

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2
Q

Why leave several holes of bridging plate empty

A

less stress at each hole

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3
Q

Impact of sustained pressure on bone

A

if sustained and not excessive, may lead to osteogenesis

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4
Q

Impact of intermittent pressure on bone

A

bone erosion

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5
Q

Factors affecting stiffness and stability of ex fix

A
  1. shorter distance of rods from bones (the closer to skin, the more stiff)
  2. number of tubes (the more the more stiff)
  3. the separation of tubes on the same pins (the further away the parallel rods from each other, the better)
  4. the number of pins (the more pins the better)
  5. The wider the pins are separated in each fragment the stiffer the construct
  6. the closer the pins to the fracture site, the stiffer the construct
  7. system configuration
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6
Q

System configs for ex fix

A
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7
Q

Stainless teel or titanium stiffness

A

Titanium
- less stiff
- susceptible to weakening if pierced by holes or abraided during insertion

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8
Q

Solid vs hollow nails

A

Solid:
- more stiff
- cannot adapt to curvature mismatch between nail and bone

Hollow:
- provides environment for bacteria to proliferate inside

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9
Q

Factors affecting nail stiffness

A
  • material
  • solid or hollow
  • slotted or unslotted
  • diameter
  • thickness of the wall
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10
Q

Tscherne classification of soft tissue injury

A
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11
Q

Significance of red blisters in fractures

A

indicates deeper dermal injury

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12
Q

When are blisters overlying fractures safe to operate on

A

Clear: 3-7 days
haemorrhagic: 10-14 days

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13
Q

What is wrinkle test

A

squeezing skin over fracture, if wrinkles appear, swelling has settled and safer to operate

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14
Q

What is wrinkle test

A

squeezing skin over fracture, if wrinkles appear, swelling has settled and safer to operate

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15
Q

Compartment syndrome immediate mx

A

Release circumferential dressing
Limb at heart level
Re-assess in 30 mins

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16
Q

Open fracture immediate management

A
  • gross debridement
  • abx
  • pictures
  • splint
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17
Q

Which open fractures need immediate operative mx

A

Vascular compromise
Sewage/farm injury
polytrauma

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18
Q

What to do with bony fragments in open fracture

A

If you can easily remove them (tug test) that means it was devitalised anyway

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19
Q

Guistillo-anderson classification

A
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20
Q

When can you consider internal fixation in trauma

A

if no contamination
And wound could be closed or covered

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21
Q

Plates function and their related stability (absolute vs relative)

A

Absolute:
- neutralisation
- buttress
- compression
- tenson band

Relative: bridging

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22
Q

Function of lag screw technique

A

Compression of fracture site

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23
Q

Which forces does the lag screw technique not protect against

A

Shear
Banding
Torsion
Axial loading

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24
Q

Where are tension band wiring used

A

olecranon
patella

25
Types of pin used in ex fix
Parallel threaded (good fit, no preload) Slightly threaded (certain preload) Markedly threaded (greater radial preload, microfractures at pin-bone interface)
26
What is the working length of a nail
Distance between the 2 locked parts of a nail The longer the working length, the easier for it to bend
27
Positive impacts of reaming before nail insertion
Creates more space, to allow nail insertion Damages the endosteal bloodsupply, stimulating the periosteal blood supply to increase aiding cortical healing
28
Negative impact of reaming before nail insertion
burns the bone
29
Ideal tip apex distance in DHS (
<25mm
30
AO proximal femur A, B, C classification
A- extracapsular B- neck C- head
31
Trochanteric fractures A1-A3
32
Mx of A1 proximal femur #
DHS
33
Why is hip shortened and externally rotated in femoral #
Unopposed pull of ileo-psoas muscle (flexion and ext rotation)
34
Mx of A2 proximal femur #
Depends on stability - reverse oblique - loss of calcar buttress IM nail or DHS
35
Mx of A3 proximal femoral #
IM nail
36
Pauwels' classification
For intracapsular fractures: The more vertical, the more unstable
37
AO intracapsular fracture classification
B1 - subcapital , minimally discplaced B2 - transcervical B3- Subcapital, displaced.
38
Position of casting for distal radius fractures
Neutral flexion Not palmar flexion (risk of median nerve compression) 3 point fixation: - dorsum distal radius - mid forearm on the volar side - proximal point
39
How long does it take for 4 stages of bone healing
40
Non-op mx of distal radius fracture
Cast 4 wks Consider removing cast and starting mobilisation after
41
Reasons for considerations of operative mx of distal radius fracture
1. radial shortening 2. radiocarpal alignment 3. angulation (excessive dorsal or volar) 4. loss of radial height (distance between radial styloid and radial-carpal articular surface)
42
Radial shortening in distal radius #
Causes relative ulnar lengthening and ulnar-carpal impaction
43
What is radiocarpal mal-alignment in the context of distal radius fracture
Distal radius falls into extension -> Loss of radio-carpal co-linearity -> adaptive midcarpal flexion (to allow hand function longitudinal to forearm) Results in stiffness and pain
44
Surgical options of distal radius fracture fixation
K wires vs volar locking plates - similar outcome, but k wire cheaper and quicker to perform (also better for soft tissue) - K wire has risk of pin site infection
45
What 3 features of diaphyseal bone fractures need to be restored before fixation
Length Alignment Rotation
46
3 connections between Ulna and radius
Distal radioulnar joint: triangular fibrocartilage complex (TFCC) Interosseus membrane Proximal radioulnar joint: Radial head (annular ligament)
47
Montegia fracture description
proximal ulnar fracture with radial head dislocation
48
Montegia fracture mx
plate ulna reduce radial head
49
Galeazzi fracture description
Distal radius fracture associated distal radio-ulnar joint dislocation
50
Galeazzi fracture mx
Plate the radius and radio-ulnar joint should reduce But if it doesnt, you could reduce and hold with k wires until it heals, needs to be in plaster as if patient pronates, it will break the wires
50
Galeazzi fracture mx
Plate the radius and radio-ulnar joint should reduce But if it doesnt, you could reduce and hold with k wires until it heals, needs to be in plaster as if patient pronates, it will break the wires
51
Indications of fixation of forearm fractures
open fractures both bone fractures displaced single bone fracture Monteggia or Galeazzi
52
Which forearm single bone fractures are fixed non operatively
Undisplaced <10 degrees angulation <50% displacement
53
Importance of the shape of talus in ankle fracture fixation
Anterior part is wider than posterior Ankle is a mortise joint with talus slotting into the medial/lateral mal gap Fixating the foot in dorsiflexion allows the widest part of the talus inserting in, achieving a much higher stability
54
Importance of the shape of talus in ankle fracture fixation
Anterior part is wider than posterior Ankle is a mortise joint with talus slotting into the medial/lateral mal gap Fixating the foot in dorsiflexion allows the widest part of the talus inserting in, achieving a much higher stability
55
Medial ligaments of ankle joint
Tibionavicular Tibiocalcaneal Posterior tibiotalar
56
Lateral colateral ligaments of ankle joint
Anterior tib fib Anterior talofibular Calcaneoufibular
57
Posterior ligaments of ankle joint
posterior tibiofibular ligament
58
Classification of pelvic fractures

AO (2 decks)

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