Trauma Flashcards
1
Q
In the Sickness Impact Profile related to lower extremity injuries, the […] subset does not improve with time.
A
psychosocial
2
Q
In regards to the Sickness Impact Profile, women score lower on these things at a 10 year follow up.
A
decreased quality-of-life scores
increased PTSD rates
increased absentee sick days when compared to males
3
Q
What are the variables of the SIRS criteria?
A
heart rate > 90 beats/min,
WBC count <4000cells/mm³ OR >12,000 cells/mm³,
respiratory rate > 20 or PaCO2 < 32mm (4.3kPa),
temperature less than 36 degrees or greater than 38 degrees
4
Q
What is the cause of death in the first minutes of injury?
A
50% die from massive blood loss or neurologic injury
5
Q
What is the cause of death within hours of arrival to the hospital after injury?
A
most commonly from shock, hypoxia, or neurologic injury
6
Q
What is the cause of death days to weeks following injury?
A
multi system organ failure and infection are leading causes
7
Q
Use of an airbag in a head-on collision significantly decreases the rate of what?
A
closed head injuries
facial fractures
thoracoabdominal injuries
need for extraction
8
Q
What is the incidence of PTSD after traumatic event involving orthopedic injuries?
A
50%
9
Q
What is the incidence of depression after traumatic event involving orthopedic injuries?
A
33%
10
Q
What is class I hemorrhagic shock?
A
<15% of EBL; HR, BP, pH, are normal; UOP >30ml/hr
11
Q
What is class II hemorrhagic shock?
A
15-30% EBL; HR 100-120 bpm, UOP 20-30 ml/hr; BP and pH are normal
12
Q
What is class III hemorrhagic shock?
A
30-40% EBL; HR >120 bpm, BP decreased, UOP 5-15 ml/hr; pH decreased; treat with blood and fluids
13
Q
What is class IV hemorrhagic shock?
A
> 40% EBL; HR >140 bpm; UOP negligible, pH decreased; BP decreased; treat with blood and fluids
14
Q
What is the estimated circulating blood volume in an average adult?
A
average adult (70 kg male) has an estimated 4.7 - 5 L of circulating blood
15
Q
What is the estimated circulating blood volume in an average child?
A
average child (2-10 years old) has an estimated 75 - 80 ml/kg of circulating blood
16
Q
What are the parameters for moving forward with early appropriate care?
A
lactate of < 4.0 mmol/L,
pH ≥ 7.25,
base excess ≥ -5.5 mmol/L
17
Q
What antibiotic is used in grade I and II Gustilo open fractures?
A
1st gen cephalosporin (eg cefazolin)
18
Q
Open fractures with farm injury require what additional antibiotic?
A
Penicillin (anaerobic coverage for clostridium)
19
Q
What antibiotics are used in Grade III open injuries?
A
1st gen cephalosporin (Gm+ coverage) + aminoglycoside (eg gentamicin) (Gm- coverage)
20
Q
What antibiotic is used for open fresh water wounds?
A
Fluoroquinolones (ciprofloxacin) or 3rd or 4th-generation cephalosporin
21
Q
What are the risk factors for elder abuse?
A
increasing age,
functional disability,
child abuse within the regional population,
cognitive impairment,
gender is NOT a risk factor
22
Q
An ISS of what should be treated with DCO?
A
ISS >40 without thoracic injury; ISS >20 with thoracic trauma
23
Q
Which three patient-factors increase the mortality associated with geriatric fractures?
A
Increased ISS
Need for mechanical ventilation at admission
Head injury
24
Q
What are the three main benefits of performing an adductor myodesis during an AKA?
A
improves clinical outcomes,
creates dynamic muscle balance (otherwise have unopposed abductors),
provides soft tissue envelope that enhances prosthetic fitting
25
What is the most sensitive exam finding for compartment syndrome?
Pain with passive stretch; most sensitive prior to onset of ischemia
26
What are the five most common locations of septic arthritis in descending order?
Knee (>50% of cases) > hip > shoulder > elbow > ankle
27
What are 4 risk factors for gram-negative bacillus septic arthritis?
neonates
IV drug users
elderly
immunocompromised patients with diabetes
28
What is the most common organism in septic olecranon bursitis?
Staphylococcus aureus (S. aureus), gram positive cocci in pairs and clusters.
29
What deformity occurs in a Chopart amputation and how is this prevented?
Equinovarus; prevented with transfer of tib ant to talar neck and perform achilles tendon lengthening.
30
What are the common flexors in the forearm? And where do they originate?
Pronator teres, Palmaris longus, FCR, FDS, FDP; medial epicondyle
31
What are the common extensors of the forearm and where do they originate?
Aconeus, EDC, ECRL ECRB, EDM, ECU; lateral epicondyle
32
Where does the anterior bundle of the medial (ulnar) collateral ligament originate and insert?
Originates from the distal medial epicondyle and inserts on the sublime tubercle
33
What is the primary function of the medial collateral ligament of the elbow?
Primary restraint to valgus stress from 30-120 degrees
34
When is the medial collateral ligament of the elbow tight? Pronation or supination?
Pronation
35
Where does the lateral collateral ligament of the elbow originate and insert?
originates from distal lateral epicondyle and
inserts on crista supinatorus
36
What is the primary function of the lateral collateral ligament of the elbow?
stabilizer against posterolateral rotational instability
37
When is the lateral collateral ligament of the elbow tight? Pronation or supination?
Supination
38
How far proximal from the triceps aponeurosis can the radial nerve be found?
3.9 cm (2 FBs)
39
How far proximal from the elbow articular surface is the radial nerve found?
15 cm can be found in the spiral groove
40
When does the radial nerve branch into the PIN and superficial radial nerve?
At the level of the radial head
41
Just proximal to the elbow, the radial nerve can be found running between what two muscles?
Brachioradialis and brachialis
42
In the setting of a distal humerus fracture in an adult, when is an olecranon osteotomy contraindicated?
If the patient needs a total elbow arthroplasty (distal bicolumnar elderly patient)
43
What nerve complication can occur with an olecranon osteotomy?
AIN palsy, check FPL in recovery
44
What are the indications for a total elbow arthroplasty in the setting of distal humerus fractures?
communited articular fractures in osteoporotic bone
inflammatory conditions (e.g. RA)
45
When performing a hemiarthroplasty for a proximal humerus fracture, how far below the articular surface do you place the greater tuberosity?
8 mm (head to tuberosity distance = HTD)
46
When performing a shoulder hemiarthoplasty for a proximal humerus fracture, the height of the prosthesis is best determined by what?
The superior edge of the pec major tendon; 5.6cm between top of humeral head and superior edge of tendon
47
Why is repair of the greater tuberosity recommended when performing a RSA?
It improves shoulder ROM
48
What is the most common complication following periarticular locking plating fixation for a proximal humerus fracture?
Screw cut out (up to 14%)
49
What surgical approach increases the risk of axillary nerve injury in surgical fixation of proximal humerus fractures?
Anterolateral (deltoid-split) approach
50
How far below the acromion is the axillary nerve found?
axillary nerve is usually found ~5-7cm distal to the tip of the acromion
51
Weakness in what exam testing is found when a patient has a lesser tuberosity nonunion?
lesser tuberosity nonunion leads to weakness with lift-off testing
52
What are the greatest risk factors for proximal humerus fracture nonunions?
Smoking and age
53
What nerve innervates Latissimus dorsi?
Thoracodorsal nerve
54
What position is the upper extremity in when a radial head fracture occurs?
FOOSH - arm extended and in pronation (allows more force to be transmitted through the radius)
55
What is the most common ligamentous injury in a radial head fracture?
Lateral collateral ligament injury
56
What are the characteristics of an Essex-Lopresti injury?
Radial head fracture, IOM injury, DRUJ injury
57
What part of the radial head lacks subchondral bone?
The anterolateral 1/3 lacks subchondral bone (makes it an easily fractured area)
58
What percent of load transfer across the elbow occurs through the radiocapitellar joint?
60%
59
Where does the lateral ulnar collateral ligament attach insert?
Supinator crest on the ulna
60
What is the primary stabilizer to valgus stress of the elbow?
medial (ulnar) collateral ligament, specifically the anterior bundle; radial head is the second
61
What are contraindications to radial head excision?
presence of destabilizing injuries:
forearm interosseous ligament injury (>3mm translation with radius pull test),
coronoid fracture,
MCL deficiency
62
What is the interval for the Kocher approach to the elbow?
ECU (PIN) and anconeus (radial n)
63
When performing the Kocher approach to the elbow, you want to incise the capsule where? And why?
incise capsule in mid-radiocapitellar plane;
anterior to crista supinatoris to avoid damaging LUCL
64
What position should the forearm be in when performing the Kaplan or Kocher approach to the elbow to protect PIN?
in both Kocher and Kaplan approaches, the forearm should be pronated to protect PIN
65
What is the interval for a Kaplan approach to the elbow?
EDC (PIN) and ECRB (radial n)
66
When plating for radial head/neck fractures, what is the distal extent for plate placement?
bicipital tuberosity is the distal limit of plate placement; anything distal to that will endanger PIN
67
What are risk factors for humeral shaft nonunion?
vitamin D deficiency (most common), open fractures, segmental injuries, smoking and obesity
68
In patients with scapular fractures, what other fracture is MOST commonly observed?
Rib fractures are the most commonly observed fractures associated with scapular fractures.
69
What are the risk factors for mid-shaft clavicle fracture nonunions?
shortening (<2cm), comminution (z-deformity), female gender, advancing age, smoking
70
What are the complications of non-operative management of midshaft clavicle nonunions?
nonunion (10-15%), malunion, deformity/poor cosmoses, decreased shoulder strength and endurance
71
What is the posterior approach to the scapula? And what is the inter-nervous plane?
Surgical fixation of a scapular neck fracture is performed via the Judet approach, a posterior approach to the scapula/glenoid. The internervous plane is between the infraspinatus (suprascapular nerve) and the teres minor (axillary nerve).
72
What is the criteria for nonoperative (conservative) treatment of humeral shaft fractures?
<20 deg of angulation on AP, <30 deg varus/valgus angulation, and <3 cm of shortening
73
What are the LaFontaine Criteria?
radial shortening (most predictive of instability, followed by dorsal comminution),
severe osteoporosis,
associated ulnar fracture,
dorsal comminution,
dorsal angulation > 20°,
initial displacement > 1cm
initial radial shortening > 5mm
74
Of the LaFontaine criteria, what is the most predictive of instability?
Radial shortening < 5 mm (followed by dorsal comminution)
75
How any LaFontaine criteria need to be met in order to predict loss of reduction?
3
76
The superior border of the pectoralis major tendon can be used to determine accurate restoration of what when performing an arthroplasty for a proximal humerus fracture?
the superior border of the pectoralis major insertion (PMI) has been shown to be the most reliable instrument to assess humeral prosthesis height and retroversion
77
How far below the superior border of the humeral head does the pectoralis major tendon insert?
pectoralis major tendon inserts 5.6 cm distal to the superior aspect of the humeral head
78
In patients over 60 years of age with a proximal humerus fracture, what is the most common complication of ORIF of the proximal humerus fracture?
Screw cut out/penetration
79
In fixation of proximal humerus fracture with plates and screws, a neck shaft angle of what predicts failure?
varus malreduction (head-shaft angle<120 degrees); Agudelo et al retrospectively reviewed 153 patients at a level-one trauma center treated with proximal humerus locking plates, investigating modes of failure for the implant. They determined that varus malreduction (head-shaft angle<120 degrees) was the most common mode of failure in their group.
80
What are the absolute indications for operative management of humeral shaft fractures?
Absolute indications of operative management include open fracture with severe soft tissue injury, vascular injury requiring repair, and a coexisting brachial plexus injury.
81
What is the treatment for post-traumatic elbow stiffness?
Supervised exercise therapy with static or dynamic progressive elbow splinting over a 6 month period has shown to have the greatest improvement on DASH scores and functional range of motion (ROM) in patients with post-traumatic elbow stiffness. Treatment is usually maintained over a period of 6-12 months. Surgery is considered when nonoperative therapy fails.
82
What nerve is at risk when placing the AP distal interlocking screw for humeral nailing? The lateral to medial?
The musculocutaneous nerve is at risk with anterior to posterior distal locking screw placement. The radial nerve is at risk with lateral to medial screw placement.
83
What is the main blood supply to the humeral head?
Recent evidence has demonstrated that the posterior humeral circumflex artery is likely the main blood supply to the humeral head
84
What are the predictors of fracture-induced humeral head ischemia
Hertel et al. reported that the highest predictors of humeral head ischemia, from most accurate to least accurate, were calcar length <8mm, disruption of the medial hinge, fracture pattern, displacement of the humeral head >45 degrees, displacement of the tuberosities >10 mm, glenohumeral fracture-dislocation and head-split fractures. They concluded that the most relevant predictors of ischemia were the length of the posteromedial calcar, the integrity of the medial hinge, and the basic fracture type.
85
What is a Monteggia fracture
proximal third ulna fracture with associated radial head dislocation
86
What is a Bado I Monteggia fracture?
Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (most common in children and young adults)
87
What is a Bado II Monteggia fracture?
Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (70 to 80% of adult Monteggia fractures)
88
What is the most common nerve injury in a Monteggia fracture?
PIN
89
What is a Galeazzi fracture?
Distal third radial shaft fracture with associated DRUJ injury.
90
What is the incidence of DRUJ instability in in radial shaft fractures?
55% if radius fracture is <7.5 cm from articular surface; 6% if radius fracture is >7.5 cm from articular surface.
91
What are the primary stabilizing ligaments of the DRUJ?
Volar and Dorsal radioulnar ligaments
92
What position is the DRUJ most stable?
Supination
93
What are the radiographic signs of DRUJ instability?
ulnar styloid fx, widening of joint on AP view, dorsal or volar displacement on lateral view, Radial shortening >5 mm
94
In what position, and for how long, should the wrist/forearm be splint for treatment of the DRUJ?
Wrist/forearm in supination; immobilized for 6 weeks.
95
If closed reduction of the DRUJ is blocked, what interposition should be suspected?
interposition of the ECU tendon
96
How do you prevent refracture after fixation of a Galeazzi fracture?
Do not remove plate before 18 months; 4.5 mm plates increase risk of refracture (use smaller plate); comminuted fractures increase risk
97
What is the incidence of sacral fractures in pelvic ring injuries?
30-45%
98
What is the rate of neurologic injury in sacral fractures?
25%
99
What sacral nerve roots carry a higher rate of injury in sacral fractures?
S1 and S2
100
What Denis classification of sacral fractures has the highest incidence of nerve injury?
Zone 3 (medial to sacral foramina into the spinal canal); 60% rate of nerve injury; bowel/bladder/sexual dysfunction;
101
What is the most common fracture classifcation/pattern of sacral fractures?
Denis I - 50%
102
What nerve is most commonly injured in Denis I sacral fractures?
Nerve injury is rare, but if it occurs, it is most commonly L5 nerve root
103
What fixation technique is shown to have the greatest stiffness for when used for unstable sacral fractures?
Iliosacral and lumbopelvic fixation - pedicle screw fixation in lumbar spine,
iliac screws parallel to the inclination angle of outer table of ilium, longitudinal and transverse rods
104
What are the iatrogenic causes of nerve injury in percutaneous sacral fixation for sacral fractures?
Over-compression, Mal-placement of implants
105
What is the dose of Vitamin C given for CRPS?
500 mg for 50 days
106
What is the most common mode of failure of the lateral ulnar collateral ligament associated with an elbow dislocation?
The lateral ulnar collateral ligament (LUCL) is often injured with elbow dislocations, and is most commonly injured at the proximal origin.
107
How long should a simple elbow dislocation be immobilized?
Less than 2 weeks; anything beyond 2 weeks portends greater stiffness
108
Anteromedial coronoid facet fractures risks what type of instability?
Varus posteromedial rotatory instability
109
What is primary bone healing?
direct healing by internal remodeling; intramembranous ossification
110
What ligament is a key stabilizer of the DRUJ and tested with the "shuck test" ?
Radioulnar ligaments of the TFCC
111
What is the essential lesion that results in the most instability in a terrible triad injury of the elbow?
lateral collateral ligament. Repair of this lesion results in the greatest increase in elbow rotatory stability.
112
What is the in-hospital mortality rate of geriatric femoral neck fractures?
6%
113
114
What is a Segond sign?
Lateral tibial plateau avulsion fracture (associated with ACL tear)
115
What is a Segond sign indicative of?
ACL rupture
116
Which meniscal tears are more common in tibial plateau fractures overall?
Lateral meniscal tears (associated with Schatzker II, >10 mm depression, >6mm widening)
117
Medial meniscal tears are most commonly associated with which Schatkzer pattern?
Schatkzer IV
118
The ACL is most commonly injured in which Schatkzer patterns?
IV and VI
119
What is the most common malunion deformity in proximal third tibial shaft fractures?
valgus, procurvatum
120
What are the indications for treating a proximal third tibia shaft fracture non-operatively?
< 5 degrees varus-valgus angulation; < 10 degrees anterior/posterior angulation; > 50% cortical apposition; < 1 cm shortening; < 10 degrees rotational alignment
121
In subtalar dislocations, medial or lateral dislocations are more likely to be open?
lateral dislocations more likely to be open
122
With subtalar dislocations, which fractures are associated with a medial subtalar dislocation?
dorsomedial talar head, posterior process of talus, navicular
123
Which fractures are associated with lateral subtalar dislocations?
cuboid, anterior calcaneus, lateral process of talus, fibula
124
What is the most important and main blood supply to the talus?
posterior tibial artery via the artery of the tarsal canal. (supplies the majority of the taller body)
125
The anterior tibial artery supplies what portion of the talus?
The talar head and neck
126
The perforating perineal arteries supply what portion of the talus?
The talar head and neck via the artery of the tarsal sinus.
127
What surgical approach is used in medial talus dislocations?
Sinus tarsi approach (lateral based approach), to remove lateral structures blocking reduction
128
What surgical approach is used in a lateral talus dislocation?
medial based approach between tib ant and posterior tib; removes medial based structures blocking reduction
129
In talus dislocations, poorer outcomes are associated with which factors?
Lateral dislocations, open fractures, concomitant fractures, high energy mechanisms
130
What is the malunion deformity seen in mid shaft tibia fractures with an intact fibula?
varus defmority
131
What is the antibiotic treatment for Grade IIIB open tibia shaft fractures?
cephalosporins + aminoglycoside added in Grade IIIB injuries
132
What is a normal tib/fib overlap on an AP ankle XR?
>6 mm; if less than that consider syndesmotic injury
133
What is a normal tib/fib overlap on a mortise ankle XR?
>1 mm; if less than that consider syndesmotic injury
134
In ankle fractures, when does proper braking response time return to baseline?
proper braking response time (driving) returns to baseline at 9 weeks after surgery
135
What techniques can be used to overcome the malalignment of apex anterior and valgus deformities in proximal third tibia shaft fractures?
- lateral parapatellar approach
- proximal and lateral starting point
- suprapatellar nailing (apex anterior correction only)
- Poller screw in lateral aspect of the proximal segment (concavity of deformity)
- femoral distractor or temporary plating
136
What is the most common complication following a talar neck fracture?
post-traumatic arthritis; subtalar joint being the most common
137
In subtalar dislocations, which type (medial or lateral) is more likely to be:
a) common
b) open
c) associated with fracture?
a) common - medial
b) open - lateral
c) associated with fracture - lateral
138
Which factors lead to an increased risk of complications for unstable ankle fractures?
skin integrity, smoking status, diabetes, peripheral neuropathy; age does not have an effect on complication rate
139
How long do you maintain nonweightbearing status in patients with operatively fixed diabetic ankle fractures?
maintain nonweightbearing 8-12 weeks post op; instead of 4-8 weeks in normal patients
140
What are the common deformities seen in malunions of conservatively managed calcaneus fracture?
most common deformities associated with calcaneal fracture malunion are:
-decreased calcaneal height
-increased calcaneal width
-hindfoot varus
-lateral exostosis secondary to lateral wall blow-out
dorsiflexion of the talus resulting in ankle impingement
141
What are the attachment sites for the bifurcate ligament?
anterior process of the calcaneus and bifurcates to the navicular and cuboid
142
What ligament is responsible for an avulsion fracture of the anterior process of the calcaneus?
bifurcate ligment
143
What is the mechanism of injury for an avulsion fracture of the anterior process of the calcaneus?
plantar flexion and inversion
144
145
Treating a femoral shaft fracture on a fracture table increases the risk for what deformity?
Internal rotation; fracture table has been shown to induce an internal mal rotation deformity when used to treat femoral shaft fractures.
146
Is fixation of the fibula in associated tibial plafond fractures associated with higher or lower complication rates?
Higher
147
When is the most optimal time to repair a nerve transected from a GSW?
1-3 weeks
148
A sliding hip screw had lower reoperation rates in which patient cohort?
Displaced basicervical femoral neck fractures in current smokers
149
Women are [...] more likely to develop PTSD after sustaining a traumatic orthopedic injury.
4x
150
Pregnant women should be placed in the [...] position to limit positional hypotension
left lateral decubitus
151
What is the risk of contracting HBV through a blood transfusion?
1 in 205,000
152
In open fractures, studies show increased infection rate when antibiotics are delayed for more than [...] from time of injury.
3 hours
153
What antibiotics are used for open salt water wounds?
doxycycline + ceftazidime or a fluoroquinolone
154
In the Masquelet technique, optimal time frame for bone grafting is [...] weeks after placement of cement spacer
4-6
155
What is the antibiotic regimen for an open fracture with a farm injury/bowel contamination?
1st generation cephalosporin + aminoglycoside + PCN (for clostridia)
156
A temperature of less than [...] degrees is considered unstable and shoulder undergo DCO in a polytraumatized patient.
35
157
A platelet count of less than [...] is considered unstable and shoulder undergo DCO in a polytraumatized patient.
90,000
158
A gastric mucosal pH greater than [...] is associated with restoration of tissue oxygenation/adequate resuscitation.
7.3
159
A HR greater than [...] bpm meets SIRs criteria
90
160
A RR greater than [...] meets SIRs criteria
20
161
Syme amputations have a [...] percent increase in metabolic demands.
15
162
Traumatic transtibial amputations have an average of [...] percent increase in metabolic demands.
25
163
Vascular transtibial amputations have an average of [...] percent increase in metabolic demands.
40
164
Transfemoral traumatic amputations have a [...] percent increase in metabolic demands.
68
165
Vascular transfemoral amputations have a [...] percent increase in metabolic demands.
100
166
Wound healing following an amputation increases with an albumin level of greater than [...]
3.0
167
Wound healing following an amputation is increased with a TCO2 greater than [...], ideally greater than [...].
30; 45
168
A total lymphocyte count of greater than [...] increases the rate of wound healing following an amputation.
1500
169
When performing a transradial amputation, the [...] of forearm amputation maintains length and is ideal
middle third
170
When performing a transhumeral amputation, ideal level is [...] cm proximal to elbow joint
4-5
171
When performing a transfemoral amputation, ideal cut is [...] cm above knee joint to allow for prosthetic fitting
12
172
Patients with a through-knee amputation have [...] self-selected walking speeds than BKA
slower (LEAP study)
173
Patients with a through-knee amp have [...] amounts of pain compared to AKA and BKA
similar (LEAP study)
174
Patients with a through knee amp have [...] performance on the Sickness Impact Profile (SIP) than BKA and AKA.
worse (LEAP study)
175
When performing a below knee amputation,
[...] cm below knee joint is ideal
12-15
176
When performing a Syme amputation, a patent [...] artery is required
tibialis posterior
177
A Syme amputation is [...] energy efficient than midfoot amps.
more
178
What is the most important factor for outcomes of a Syme amputation?
stable heel pad
179
A Syme amputation is used to successfully treat [...]
forefoot gangrene in diabetics
180
What is a Chopart (or Boyd) amputation?
a partial foot amputation through the talonavicular and calcaneocuboid joints
181
A Chopart amputation occurs through [...] and [...] joints
talonavicular; calcaneocuboid
182
What is the primary complication of a Chopart amputation?
equinus deformity
183
In order to avoid an equinus deformity following a Chopart amputation, lengthen the Achilles tendon and transfer the [...] to the talar neck
tibialis anterior
184
Following a Lisfranc (midfoot) amp, [...] deformity is common
equinovarus
185
What is the cause of equinovarus deformit following a midfoot amputation?
unopposed pull of tibialis posterior and gastroc/soleus
186
In order to prevent an equinovarus deformity following a midfoot amp, maintain the insertion of [...] and perform achilles lengthening
peroneus brevis
187
When performing great toe amputations, preserve [...] cm at base of proximal phalanx
1
188
When performing great toe amputations, preserve 1 cm at base of [...]
proximal phalanx
189
Trauma-related amputation have an infection rate of around [...] percent.
34
190
What is the most common complication following a pediatric amputation?
bony overgrowth
191
What has the highest impact on decision-making process to amputate a limb due to traumatic injury?
soft tissue injury
192
SIP (sickness impact profile) and return to work [...] significantly different between amputation and reconstruction at 2 years in limb-threatening injuries
not
193
Mangled foot and ankle injuries requiring free tissue transfer have a [...] SIP than BKA
worse
194
When looking at amp vs reconstruction for lower ext trauma, most important factor to determine patient-reported outcome is the [...]
ability to return to work
195
According to the METALS study (military amp study), there
were [...] rates of return to vigorous activity in the amputation group
higher
196
What are the muscles of the deep posterior leg compartment?
FHL, FDL, Tib post
197
What are the muscles of the superficial posterior leg compartment?
Gastroc, soleus, plantaris
198
What is the most sensitive physical exam finding for compartment syndrome?
pain with passive stretch
199
What joint is most commonly affected by septic arthritis?
Knee
200
In septic arthritis of the SC joint, [...] should be obtained preoperatively to rule out retrosternal abscess or chest w
advanced imaging (CT/MR)
201
What is the most common pathogen in septic arthritis?
S aureus
202
Which two pathogens are commonly associated with septic arthritis in sickle-cell disease?
salmonella and strep pneumo
203
In a saline load test of a knee, [...] mL of saline is needed to reach 95% sensitivity
155
204
In a saline load test of a knee, [...] mL of saline is needed to reach 99% sensitivity.
175
205
[...] is the most common hematogenous site for osteomyelitis in adults
Vertebrae
206
During the planktonic stage of osteomyelitis bacteria attach to an inert substrate and undergo [...] to create a matrix for biofilm
apoptosis
207
A [...] is devitalized bone that serves as a nidus for infection
sequestrum
208
A [...] is formation of new bone around an area of bony necrosis
involucrum
209
In an antibiotic-impregnated acrylic (PMMA) Intramedullary nail, peak antibiotic elution is [...] after placement
24 hours
210
In an antibiotic-impregnated acrylic (PMMA) Intramedullary nail, duration of antibiotics elution is generally up to [...] months
4
211
Preganglionic brachial plexus injuries may show [...] of innervation to cervical paraspinals on EMG.
loss
212
A [...] is gold standard for defining level of nerve root injury in a brachial plexus injury.
CT Myelogram
213
In an Oberlin transfer, the [...] nerve is used for upper trunk injury for biceps function.
ulnar
214
Recovery of reconstructed brachial plexus can take up to [...]
3 years
215
What is the first bone to ossify and last physis to close?
medial clavicle
216
The [...] capsular ligament is the most important structure for anterior-posterior stability of the SC joint.
posterior
217
What is the most common complication of ORIF mid-shaft clavicle fractures?
supraclavicular nerve injury
218
What percentage of operatively treated mid-shaft clavicle fractures undergo plate removal?
8-30%
219
What is the nonunion rate of operatively treated mid-shaft clavicles?
1-5%
220
In patients with scapular fractures, what other fracture is MOST commonly observed?
Ribs (53%)
221
The fibrocartilaginous labrum deepens glenoid fossa by [...] percent to increase stability
50
222
The acromion is formed by [...] ossification centers
3
223
The coracoid is formed by [...] ossification centers.
2
224
What muscles attach to the coracoid?
coracobrachialis, short head of biceps, pec minor
225
Which ligaments provide horizontal stability to the AC joint?
acromioclavicular ligaments
226
Which ligaments provide vertical stability to the AC joint?
Coracoclavicular (CC) ligaments
227
Greater than [...] widening of space between medial scapular border and spine indicates possible scapulothoracic dissociation
1 cm
228
What is a normal glenopolar angle?
30 - 45 deg
229
An Os Acromiale is unfused secondary [...] and [...] ossification centers
meso- and meta-acromion
230
Scapular body fractures with a glenopolar angle of [...] have poorer outcomes with nonoperative management
less than 20 deg
231
Scapular neck fractures can be managed nonoperatively if translation is less than [...]; glenopolar angle is [...] and angulation is less than [...].
1 cm; greater than 20 deg; 40 deg
232
Intra-articular glenoid fractures can be managed non-operatively if less than [...] mm step-off and less than [...] percent glenoid involvement
4; 25
233
Acromion fractures can be managed non-op if displacement is less than [...]
1 cm
234
What are indications for non-op management of coracoid fractures?
<1 cm displacement; coracoid tip fractures distal to insertion of coracoclavicular (CC) ligaments
235
Scapular body fractures with medialization of lateral boarder greater than [...] is a relative indication for surgery.
20 mm
236
Scapular body fractures with GPA less than [...] deg is a relative indication for surgery.
20-22
237
Scapular body fractures with angulation greater than [...] deg is a relative indication for surgery.
40
238
The Judet approach to the scapular utilizes internervous plane between [...] and [...].
infraspinatus (suprascapular nerve); teres minor (axillary nerve)
239
What is the intermuscular plane of the Judet approach to the scapula?
infraspinatus (suprascapular n) and teres minor (axillary n)
240
What is the innervation of teres major?
lower subscapular nerve (posterior cord)
241
What is the innervation to the trapezius musclee?
spinal accessory nerve (CN XI)
242
In proximal humerus fractures, vascularity of articular segment is more likely to be preserved if greater than [...] mm of calcar is attached to articular segment
8
243
In proximal humerus fractures, [...] nerve injury is the most nerve common
axillary
244
The [...] artery is the terminal branch of the anterior humeral circumflex artery and main supply to greater tuberosity
arcuate
245
Greater tuberosity fractures with less than [...] mm of displacement can be managed non-operatively
5
246
Greater tuberosity fractures with greater than [...] displacement will result in impingement with loss of abduction and external rotation
5 mm
247
In proximal humerus fractures managed non-op, immediate physical therapy results in [...] recovery.
faster
248
In ORIF of proximal humerus fractures, [...] screw placement critical to decrease varus collapse of head
calcar
249
In ORIF of proximal humerus fractures, calcar screw placement critical to decrease [...] deformity/collapse of head
varus
250
IMN of proximal humerus fractures is biomechanically [...] with torsional stress compared to plates
inferior
251
IMN of proximal humerus fractures has [...] rates of fracture healing and ROM compared to ORIF
favorable
252
When performing rTSA for proximal humerus fractures, humeral height is best judged from the [...]
superior border of the pectoralis major insertion
253
In rTSA for proximal humerus fractures, there are poorer outcomes if humeral component is retroverted greater than [...] deg.
40
254
In ORIF of proximal humerus fractures, [...] is the most common complication following ORIF with a periarticular locking plates
screw cut-out (up to 14%)
255
In ORIF of proximal humerus fractures, place plate lateral to the bicipital groove and pectoralis major tendon to avoid injury to the [...] artery
ascending branch of anterior humeral circumflex
256
In IMN of humerus, [...] nerve is at risk with lateral to medial distal screw
radial
257
In iMN of humerus, [...] nerve at risk with anterior to posterior distal screw
musculocutaneous
258
In surgical management of proximal humerus fractures, nonanatomic placement of tuberosities results in impairment in [...] ROM with an 8-fold increase in torque requirements
external rotation
259
In a hemiarthroplasty for a proximal humerus fracture, the height of the prosthesis is best determined off the superior edge of the pectoralis major tendon with [...] between top of humeral head and superior edge of tendon
5.6 cm
260
In a rTSA for PHF, repair of the greater tuberosity is always recommended despite ability of RSA design to compensate for non-functioning tuberosities/rotator cuff as it improves [...]
range of motion
261
axillary nerve is usually found [...] cm distal to the tip of the acromion
~5-7
262
Consider a [...] dislocation in all patients with lesser tuberosity fracture
posterior
263
The humeral intramedullary canal
terminates [...] cm proximal to the olecranon fossa
2 to 3
264
The radial nerver exits axilla [...] to
the brachial artery
posterior
265
Less than [...] deg of anterior angulation is acceptable for non-op management of humeral shaft fractures
20
266
Less than [...] deg varus/valgus angulation is acceptable for non-op management of humeral shaft fractures
30
267
Less than [...] cm of shortening is acceptable for non-op management of humeral shaft fractures
3
268
The average union rate of non-op humeral shaft fractures is [...] percent
93.5
269
The average time to union for non-op humeral shaft fractures is [...] weeks
10.7
270
About [...] percent of patients with non-op humeral shaft fractures will lose external rotation
40
271
In an ex fix of the humerus, most distal pin is just proximal to [...]
olecranon fossa
272
What is the innervation of the brachialis muscle?
radial n (lateral); musculocutaneous (med)
273
What are the predictors of humeral non-union after trial of non-operative treatment?
no callous on radiograph and gross motion at the fracture site at 6 weeks
274
Iatrogenic radial nerve palsy is most common following ORIF via a [...] approach
lateral (20%)
275
Surgical exploration of radial nerve palsy in the setting of a humeral shaft fracture is indicated if palsy fails to improve over [...] months
~4-6
276
In setting of chronic radial n injury, [...] to EPL tendon transfer can be used for thumb extension
palmaris longus
277
In the setting of chronic radial n injury, [...] to EDC tendon transfer can be used for finger extension
FCR/FCU
278
During an open reduction internal fixation of a humerus fracture using the posterior approach, which nerve can be identified and traced back to the radial nerve?
Posterior antebrachial cutaneous nerve
279
In patients > 65 years old with a distal humerus fracture, functional outcomes were higher with TEA than ORIF at [...]-year follow-up
2
