Principles

Question 0

What is the antibiotic coverage of Gustillo & Anderson grading of open fractures?

Answer 0

Type 1: 1st generation cephalosporin
Type 2: +- add aminoglycoside
Type 3: add aminoglycoside
Farm injuries: add penicillin and an aminoglycoside

ALL GET TETANUS PROPHYLAXIS

Question 1

Describe the Gustillo & Anderson classification of open fractures:

Answer 1

Type 1: clean wound 1cm long with extensive soft tissue damage
Type 3: usually >10cm laceration with high contamination
3A: adequate bone coverage
3B: extensive soft tissue injury with periosteal stripping and bone exposure requiring grafting to close
3C: associated vascular injury requiring repair

Question 2

What is the Tscherne classification used for? Describe it:

Answer 2

Used to describe soft tissue integrity in fracture.

• Grade 0: minimal soft tissue damage, indirect trauma to limb (torsion injury), simple fracture pattern
• Grade 1: superficial contusion or abrasion. Mild trauma pattern
• Grade 2: deep abrasion, skin or muscle contusion, seve fracture pattern, direct trauma to limb
• Grade 3: extensive skin contusion or muscle damage, crush injury, severe damage to underlying muscle, compartment syndrome, subcutaneous avulsion

Question 4

Define compartment syndrome in terms of compartment pressure:

Answer 4

Absolute pressure of 30mmHg
Within 30mmHg of diastolic pressure

New studies show 18-19mmHg starts to occlude capillary pressure and can lead to compartment syndrome. = Pre-compartment syndrome

Question 5

How far proximally do you have to go to release the deep posterior compartment?

Answer 5

High enough to release soleus from tibia.

This releases soleal bridge and the possibility of the 5th compartment

Question 6

Describe the 2 incision technique for lower leg fasciotomy:

Answer 6

Anterolateral: halfway between fibula and tibial crest
- Allows access to anterior and lateral compartments

Posteromedial: 1-2cm posterior to lateral aspect of tibia
- Allows access to superficial and deep posterior compartments

Question 7

Describe the fasciotomy technique for the forearm:

Answer 7

True Volar Henry approach allows release of the superficial and deep anterior compartments

Thompson approach allows release of the mobile wad

Question 8

What x-rays constitute a trauma series?

Answer 8

Lateral c-spine
CXR
AP Pelvis

Question 9

Describe the Injury Severity Score:

Answer 9

Sum of the square of the abbreviated injury score (AIS) of the 3 most injured body regions
Score >18 suggests multiply injured patients and indicates transfer to the trauma department

Question 12

How much pressure is released by univalving a cast? Bivalving?

Answer 12

Univalve: 30% pressure drop
Bilvalve: 60% pressure drop
Cut cast padding to release more pressure

Question 13

What is the position of function for the ankle?

Answer 13

Neutral (no dorsiflexion)

Question 14

What is the position of function of the hand?

Answer 14

Intrinsic plus position

MCP flexed 70-90 degrees, IP joints extended

Question 15

How much weight can be applied to skin traction?

Answer 15

10lbs

Question 16

What is the maximum weight that can be applied to skeletal traction?

Answer 16

20% of body weight for the lower extremity

Question 17

What size pin should you use for skeletal traction?

Answer 17

Largest available (5-6mm)

Question 18

What is the location for tibial traction pin? What are the dangers?

Answer 18

1cm distal and 2cm posterior to the tibial tubercle.
Placed from lateral to medial, away from common peroneal nerve
Try to stay out of the anterior compartment

Question 19

What is the location of a femoral traction pin? What are the dangers?

Answer 19

At the adductor tubercle, 2 fingerbreadths proximal to the femoral condyle (in metaphyseal bone), in the middle of the femur (AP direction).
Use the proximal edge of patella in an extended knee as your landmark
Go medial to lateral to avoid neurovascular bundle

Question 20

What needs to be done after delayed reperfusion (>6hrs) of any vascularly damaged extremity?

Answer 20

Prophylactic fasciotomies

Question 21

What is the location of a calcaneal traction pin? The dangers?

Answer 21

2cm posterior and inferior to the medial malleolus

Go medial to lateral to avoid the neurovascular bundle

Question 22

What is the location for olecranon traction?

Answer 22

1.5cm from the tip of the olecranon.
Go medial to lateral to avoid ulnar nerve
Rarely used

Question 23

What are the principles of tendon transfers?

Answer 23

SEACOAST
Synergistic transfers
Expendable donor muscle
Adequate strength
Contractures need releasing
One tendon, one function
Adequate amplitude (length)
Straight line of pull
Tissue equilibrium

Question 24

Risk factors for non-union:

Answer 24

Infection
Diabetes
Smoking
Vascular disease
Steroids
Immunosuppressed

Question 25

What are 3 risk factors to failure of arthrodesis?

Answer 25

Poor blood supply:
- Smoking
- Diabetes
- Avascular necrosis
Other
- Failure of previous fusion
- Too much motion through the joint
- Adjacent joint fusion

Question 26

Name 5 indications for surgery on any fracture:

Answer 26

Open fracture
Unacceptable displacement or deformity
Polytrauma
Failure of closed reduction
Unstable fracture
Failed non-operative management

Question 27

What is the Seddon classification of nerve injuries?

Answer 27

Neuropraxia
Axontmesis
Neurontmesis

Question 28

What is the most common endocrine abnormality in nonunion?

Answer 28

Vitamin D deficiency (for all comers)