random Flashcards
When evaluating for AC joint injury, what xray view should be used along with a shoulder series?
A Zanca view can be taken to better visualize the distal clavicle. This is done with the beam 10 to 15 degrees cephalad
indications for operative management of clavicle fx
- open
- neurovascular injury
- skin tenting
- displacement of > 100%
- shortening of > 2 cm
most brachial plexus injuries are associated with clavicle fx of what location
medial 1/3
Dislocation of medial 1/3 clavicle in what direction is more serious and required operative management along with cardiothoracic surgery consult
posterior displacement
how do pts with glenohumeral anterior dislocation hold their arm
ABducted and external rotation
What view needs to be ordered to catch posterior glenohumeral dislocation?
Axillary view
Regular x-rays may miss posterior glenohumeral dislocations. If evident on radiographs though it may show what?
- internal rotation of the humeral head with a circular appearance (Light bulb sign)
- widened joint space of > 6 mm
- 2 parallel cortical bones lines on the medial aspect of the humeral head (trough line sign)
A HAGL injury is a humeral Avulsion of the Glenohumeral Ligaments, particularly which one?
Inferior glenohumeral ligament
What x-ray view is required for diagnosing a bankart lesion
West Point view
What is a bankart lesion
an avulsion of the labrum off the anteroinferior glenoid rim, generally occurring in the setting of should dislocations . . when this is associated with a glenoid rim fx it is bony bankart
What is Hill-Sachs lesion
defect on the posterolateral head of the humerus caused by chondral impaction on the glenoid
A special Hill-Sach view is used to visualize a hill-sachs lesion . . decribe this view
AP radiograph taken with the shoulder in maximal internal rotation
What classification system can be used on MRI to determine whether surgical intervention would be beneficial in rotator cuff pathology
Goutallier
describe Goutallier classification of rotator cuff pathology
- grade 1: fatty streaks
- Grade 2: fat < muscle
- Grade 3: Fat = muscle
- Grade 4: fat > muscle
What is the rotator interval
- space between the tendons of the supraspinatus and subscapularis
- consists of superior glenohumeral ligament and the caracohumeral ligament
- long head of biceps tendon also contributes to stability to this area
A part in a proximal humerus fx is defined if there is > 1 cm of displacement of 45 degrees of angulation . . what is the exception and why?
- The greater tuberosity, which has a tolerance of 5 mm displacement
- rotator cuff muscles attach there so there may be resultant dysfunction
- the displacement can result in subacromial impingement
In humeral shaft fractures, what are the important acceptable tolerances that will not compromise function or appearance
- 20 degrees AP angulation
- 30 degrees varus-valgus angulation
- 3 cm shortening
In elbow dislocation, the LCL fails first, and then, depending on the degree of injury, the MCL. The capsuloligamentous injury progresses from lateral to medial and is termed what?
the Hori circle
describe the operative approach for Galeazzi fx
- anterior Henry approach
- b/t FCR and BR . . internervous plane (radial and median nerves)
In a distal radius fx, a careful neurovascular assessment should be performed with particular attention to what nerve function
median
The greatest influence on outcome following a distal radius fx is what
carpal alignment
What are the Kanavel cardinal signs which indicate the presence of infectious tenosynovitis of flexor tendon sheaths
- pain with extension of digit
- passive flexion of the digit
- Fusiform (sausage-like) swelling
- Tenderness over the tendon sheath
what is the scaphoid view to catch scaphoid fx
- 30 degrees wrist extension
- 20 degrees ulnar deviation
A scapholunate gap greater than what is a significant finding on x-ray?
What is this called?
- 3 mm
- Terry Thomas sign
The week spot b/t the scaphoid and lunate due to a lack of ligamentoous stability is called what
space of Poirier
The classic appearance of a patient with a posterior hip dislocation is what?
flexion, internal rotation, adduction
what percent of the femoral head is covered by the acetabulum at any position
40%
What muscles insert on the greater trochanter
- piriformis
- glut medius
- glut minimus
- obturator internus
- superior gemellus
Fasciotomy to release the anterior/posterior compartments of the thigh should be done from where?
lateral aspect
medial/adductor compartment fasciotomy is done from what approach
medial
What are the borders of the Adductor Canal (Hunter’s Canal)
- Sartorius
- Vastus medialus
- Adductor longus
Surgical intervention is usually indicated when in patellar fractures
- when there is articular displacement
- gapping > 2 mm
- loss of the extensor mechanism
Describe blumensaat’s line
On lateral x-ray, line projects from the roof of the intercondylar notch anteriorly and should line up with the lower pole of the patella. assessed by a radiograph with the knee flexed at 30 degrees
normal Q angle
13 to 18 degrees
Which tibial plateau fx would you consider an angiogram
medial . . Schatzker IV
Describe the parameters of tibial plateau fx that are consider non-displaced and a knee brace or cast can be implemented
< 3 mm step off or < 5 mm gapping
The structures passing posterior to the medial malleolus are important to understand, especially during ORIF procedures. What is the mnemonic and structures
- Tom Dick And Nervous Harry
- Tibialis posterior
- Flexor digitorum longus
- posterior tibial Artery
- Tibial Nerve
- Flexor Hallucis longus
The common peroneal nerve runs where in relation to the lateral malleolus
12 cm proximal
what is a Tillaux fracture
an avulsion fracture of the distal tibia by the AITFL
what is a LeForte-Wagstaffe fx
avulsion fx to distal fibula
What is a curbstone fx
avulsion fx of posterior malleolus
What are the 2 important attachments to the fibular head
- LCL
- biceps femoris
fx of lateral process of talus
snowboarder’s fx
What is the normal boehler’s angle
20-40 degrees
Normal Gissane (crucial) angle
130-145 degrees
Lisfranc injury (tarsometatarsal fx-dislocation) is a condition characterized by what?
disruption b/t the medial cuneiform and the base of the 2nd metatarsal
x-ray findings in Lisfranc injury
> 2 mm space b/t 2nd metatarsal base and cuneiform
- this is an indication for surgical fixation
- A fleck sign may also be noticed on radiograph, which is a small bony fragment in the space, indicating an avulsion of the Lisfranc ligament
The Lisfranc ligament tightens with what movement of forefoot
pronation and abductiond
where does an achilles tendon rupture typically occur
about 3 cm above insertion . . . watershed area
Radiograph to look at Hill-Sachs lesion
-Stryker notch or Axillary lateral
describe stryker notch view
hand on head, 10 degrees cephalic tilt
radiograph to look for bony bankart
-West point
describe a west point view of shoulder
- Prone, beam to axilla
- looks at anterior inferior glenoid
describe supraspinatus outlet view and what it looks for
- Scapular Y with 10 degrees caudal tilt
- Acromion morphology
methods for reducing anterior shoulder dislocation
- Stimson
- Milch
- Hippocratic
Describe the stimson maneuver for reducing anterior shoulder dislocation
- patient prone on table with affected limb hanging freely over edge
- 10-15 lb weight suspended from wrist
- gradual traction overcomes muscle spasm and in most cases achieves reduction in 20-25 minutes
Describe milch maneuver for reducing anterior shoulder dislocation
- patient supine
- steady downward traction applied at elbow
- combined with slow, gradual external rotation and abduction of limb
describe hippocratic maneuver for reducing anterior shoulder dislocation
- patient supine on table
- examiner places sole of foot (shoe removed) against patients axillary fold for countertraction, grasps patient’s wrist with both hands, and applies steady longitudinal traction.
Borders of triangular space?
- Teres minor
- Teres major
- Long head of triceps
structures in Triangular space?
-circumflex scapular artery
borders of quadrangular space?
- Teres minor
- Teres major
- long head of triceps
- Medial border of humerus
Structures in quadrangular space?
- Axillary nerve
- Posterior circumflex artery
- Humeral artery
Borders of triangular interval?
- Teres major
- Triceps (long head)
- Triceps (lateral head)
Structures in triangular interval?
- Radial nerve
- Deep artery of arm
