Retino Qs - Fracture Conference Flashcards
Martin-Gruber anastamoses
Anomalous anatomy in 15% of population where axons of AIN may cross over and connect to ulnar nerve and innervate other muscle groups
Track of AIN in forearm
AIN splits off the median nerve 4-6cm distal to medial epicondyle
Travels between FDS and FDP initially
Then between FDP and FPL
Then on ant surface of IO membrane
Motor nerve with no cutaneous involvement
Feeds FDP (index /middle fingers), FPL and PQ
Which muscles on the hand have no cross innervation
Extensor indices (radial) Abductor digiti minimi (ulnar) Opponens policis (median)
Globus
Transition between the smooth volar skin and the rough/wrinckly skin of the fingers. Marks the location of the neurovascular structures of the digits
Shape of perc fem neck screws in CRPP
Inverted triangle unless posteromedial comminution is present, then square construct is better
Forearm fracture indications for surgery
Distal 2/3 ulnar shaft if >50% displacement or >10 degrees angulation
All proximal 1/3 isolated ulna fxs
All radial shaft fxs (even if nondisplaced)
All both bone fxs
All open fractures
Only fxs that are non op are distal 2/3 ulnar shaft if
Leadbetter technique
Technique to reduce femoral neck fracture
- Flex hip to 90 degrees with slight adduction (relaxes surrounding muscles)
- Pull traction in line with femur
- Internally rotate 45 degrees (relaxes Y lig)
- Slowly bring hip into slight abduction and full extension while maintaining traction and int rot
Teardrop fracture of the spine
Flexion teardrop fx - anterior column fx in flexion/compression and posterior column failure in tension
Unstable and requires surgery, a/w SCI
Extension teardrop fx - opposite mechanism with small fleck of bone avulsed off anterior inferior endplate
Stable and tx with C-collar
Growth plate yearly rates
Growth continues until 16 yrs in boys and until 14 yrs in girls
Leg grows 23 mm/year, with most of that coming from the knee (15 mm/yr)
-Proximal femur - 3 mm / yr (1/8 in)
-Distal femur - 9 mm / yr (3/8 in)
-Proximal tibia - 6 mm / yr (1/4 in)
-Distal tibia - 5 mm / yr (3/16 in)
Complication of tibial tubercle fracture
Compartment syndrome due to anterior tibial recurrent artery
Wards triangle
Radiolucent area between principle compressive, secondary compressive and primary tensile trabeculae in the neck of femur
Avoid per pin placement into this area as the purchase will be compromised
Order of fixation of triplane fracture
Triplane fx - epiphysis with sagital split (AP film), metaphysis with coronal split (lat film) and physis split in axial plane
Presence of fracture in the metaphysis in the coronal plane distinguishes this fracture from a triplane injury
To fix triplane
- First convert to Tillaux fx by fixing coronal split
- Then treat like Tillaux by fixing epiphysis and then metaphysis
Miserable malalignment syndrome
Femoral anteversion
External tibial torsion
Genu valgum
Dejour classification
Type A: normal shape of trochlea, but shallow trochlear groove
Type B: markedly flattened or even convex trochlea
Type C: trochlear facet asymmetry, with too high lateral facet, and hypoplastic medial facet
Type D: type C features and vertical link between facets (‘cliff pattern’)
Mason classification
Type I: non-displaced radial head fractures
Type II: partial articular fractures with displacement (>2mm)
Type III: comminuted fractures involving the entire radial head
IIIa: fracture of the entire radial neck, with the head completely displaced from the shaft
IIIb: articular fracture involving the entire head, consisting of more than two large fragments
IIIc: fracture with a tilted and impacted articular segment
Type IV: fracture of the radial head with dislocation of the elbow joint
