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OITE > Trauma > Flashcards

Trauma Flashcards

1
Q

How does the Sickness Impact Profile relate to lower extremity injuries?

A

The psychosocial subset does not improve with time.

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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

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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

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4
Q

What is the cause of death in the first minutes of injury?

A

50% die from massive blood loss or neurologic injury

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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

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6
Q

What is the cause of death days to weeks following injury?

A

multi system organ failure and infection are leading causes

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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

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8
Q

What is the incidence of PTSD after traumatic event involving orthopedic injuries?

A

50%; women are 4x more likely to develop PTSD

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9
Q

What is the incidence of depression after traumatic event involving orthopedic injuries?

A

33%

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10
Q

What is class I hemorrhagic shock?

A

<15% of EBL; HR, BP, pH, are normal; UOP >30ml/hr

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11
Q

What is class II hemorrhagic shock?

A

15-30% EBL; HR >100 bpm, UOP 20-30 ml/hr; BP and HR are normal

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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

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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

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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

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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

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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

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17
Q

What antibiotic is used in grade I and II Gustilo open fractures?

A

1st gen cephalosporin (eg cefazolin)

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18
Q

When is penicillin added to open fractures?

A

Farm injury

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19
Q

What antibiotics are used in Grade III open injuries?

A

1st gen cephalosporin (Gm+ coverage) + aminoglycoside (eg gentamicin) (Gm- coverage)

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20
Q

What antibiotic is used for open fresh water wounds/salt water wounds?

A

Fluoroquinolones (ciprofloxacin); Doxycycline and 3rd or 4th-generation cephalosporin (e.g. ceftazidime) can be used for salt water wounds

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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

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22
Q

An ISS of what should be treated with DCO?

A

ISS >40 without thoracic injury; ISS >20 with thoracic trauma

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23
Q

Which three patient-factors increase the mortality associated with geriatric fractures?

A

Increased ISS
Need for mechanical ventilation at admission
Head injury

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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

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25
Q

What is the most sensitive exam finding for compartment syndrome?

A

Pain with passive stretch; most sensitive prior to onset of ischemia

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26
Q

What are the five most common locations of septic arthritis in descending order?

A

Knee (>50% of cases) > hip > shoulder > elbow > ankle

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27
Q

What are 4 risk factors for gram-negative bacillus septic arthritis?

A

neonates
IV drug users
elderly
immunocompromised patients with diabetes

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28
Q

What is the most common organism in septic olecranon bursitis?

A

most common cultured organism in the setting of septic olecranon bursitis is Staphylococcus aureus (S. aureus), appearing as gram positive cocci in pairs and clusters.

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29
Q

What deformity occurs in a Chopart amputation and how is this prevented?

A

Equinovarus; prevented with transfer of tib ant to talar neck and perform achilles tendon lengthening.

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30
Q

What are the common flexors in the forearm? And where do they originate?

A

Pronator teres, Palmaris longus, FCR, FDS, FDP; medial epicondyle

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31
Q

What are the common extensors of the forearm and where do they originate?

A

Aconeus, EDC, ECRL ECRB, EDM, ECU; lateral epicondyle

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32
Q

Where does the anterior bundle of the medial collateral ligament originate and insert?

A

Originates from the distal medial epicondyle and inserts on the sublime tubercle

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33
Q

What is the primary function of the medial collateral ligament of the elbow?

A

Primary restraint to valgus stress from 30-120 degrees

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34
Q

When is the medial collateral ligament of the elbow tight? Pronation or supination?

A

Pronation

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35
Q

Where does the lateral collateral ligament of the elbow originate and insert?

A

originates from distal lateral epicondyle and
inserts on crista supinatorus

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36
Q

What is the primary function of the lateral collateral ligament of the elbow?

A

stabilizer against posterolateral rotational instability

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37
Q

When is the lateral collateral ligament of the forearm tight? Pronation or supination?

A

Supination

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38
Q

How far proximal from the triceps aponeurosis can the radial nerve be found?

A

3.9 cm (2 FBs)

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39
Q

How far proximal from the elbow articular surface is the radial nerve found?

A

15 cm can be found in the spiral groove

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40
Q

When does the radial nerve branch into the PIN and superficial radial nerve?

A

At the level of the radial head

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41
Q

Just proximal to the elbow, the radial nerve can be found running between what two muscles?

A

Brachioradialis and brachialis

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42
Q

In the setting of a distal humerus fracture in an adult, when is an olecranon osteotomy contraindicated?

A

If the patient needs a total elbow arthroplasty (distal bicolumnar elderly patient)

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43
Q

What nerve complication can occur with an olecranon osteotomy?

A

AIN palsy, check FPL in recovery

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44
Q

What are the indications for a total elbow arthroplasty in the setting of distal humerus fractures?

A

communited articular fractures in osteoporotic bone
inflammatory conditions (e.g. RA)

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45
Q

When performing a hemiarthroplasty for a proximal humerus fracture, how far below the articular surface do you place the greater tuberosity?

A

8 mm (head to tuberosity distance = HTD)

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46
Q

Nonanatomic placement of the tuberosities in a shoulder hemiarthroplasty results in what impairment?

A

nonanatomic placement of tuberosities results in impairment in external rotation kinematics with an 8-fold increase in torque requirements

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47
Q

When performing a shoulder hemiarthoplasty for a proximal humerus fracture, the height of the prosthesis is best determined by what?

A

The superior edge of the pec major tendon; 5.6cm between top of humeral head and superior edge of tendon

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48
Q

Why is repair of the greater tuberosity recommended when performing a RSA?

A

It improves shoulder ROM

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49
Q

What is the most common complication following periarticular locking plating fixation for a proximal humerus fracture?

A

Screw cut out (up to 14%)

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50
Q

What surgical approach increases the risk of axillary nerve injury in surgical fixation of proximal humerus fractures?

A

Anterolateral (deltoid-split) approach

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51
Q

How far below the acromion is the axillary nerve found?

A

axillary nerve is usually found ~5-7cm distal to the tip of the acromion

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52
Q

Weakness in what exam testing is found when a patient has a lesser tuberosity nonunion?

A

lesser tuberosity nonunion leads to weakness with lift-off testing

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53
Q

What are the greatest risk factors for proximal humerus fracture nonunions?

A

Smoking and age

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54
Q

What nerve innervates Latissimus dorsi?

A

Thoracodorsal nerve

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55
Q

What position is the upper extremity in when a radial head fracture occurs?

A

FOOSH - arm extended and in pronation (allows more force to be transmitted through the radius)

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56
Q

What is the most common ligamentous injury in a radial head fracture?

A

Lateral collateral ligament injury

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57
Q

What are the characteristics of an Essex-Lopresti injury?

A

Radial head fracture, IOM injury, DRUJ injury

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58
Q

What part of the radial head lacks subchondral bone?

A

The anterolateral 1/3 lacks subchondral bone (makes it an easily fractured area)

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59
Q

What percent of load transfer across the elbow occurs through the radiocapitellar joint?

A

60%

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60
Q

Where does the lateral ulnar collateral ligament attach insert?

A

Supinator crest on the ulna

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61
Q

What is the primary stabilizer to valgus stress of the elbow?

A

medial (ulnar) collateral ligament, specifically the anterior bundle; radial head is the second

62
Q

What are contraindications to radial head excision?

A

presence of destabilizing injuries:
forearm interosseous ligament injury (>3mm translation with radius pull test),
coronoid fracture,
MCL deficiency

63
Q

What is the interval for the Kocher approach to the elbow?

A

ECU (PIN) and anconeus (radial n)

64
Q

When performing the Kocher approach to the elbow, you want to incise the capsule where? And why?

A

incise capsule in mid-radiocapitellar plane;
anterior to crista supinatoris to avoid damaging LUCL

65
Q

What position should the forearm be in when performing the Kaplan or Kocher approach to the elbow to protect PIN?

A

in both Kocher and Kaplan approaches, the forearm should be pronated to protect PIN

66
Q

What is the interval for a Kaplan approach to the elbow?

A

EDC (PIN) and ECRB (radial n)

67
Q

When plating for radial head/neck fractures, what is the distal extent for plate placement?

A

bicipital tuberosity is the distal limit of plate placement; anything distal to that will endanger PIN

68
Q

What are risk factors for humeral shaft nonunion?

A

vitamin D deficiency (most common), open fractures, segmental injuries, smoking and obesity

69
Q

In patients with scapular fractures, what other fracture is MOST commonly observed?

A

Rib fractures are the most commonly observed fractures associated with scapular fractures.

70
Q

What are the risk factors for mid-shaft clavicle fracture nonunions?

A

shortening (<2cm), comminution (z-deformity), female gender, advancing age, smoking

71
Q

What are the complications of non-operative management of midshaft clavicle nonunions?

A

nonunion (10-15%), malunion, deformity/poor cosmoses, decreased shoulder strength and endurance

72
Q

What is the posterior approach to the scapula? And what is the inter-nervous plane?

A

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).

73
Q

What is the criteria for nonoperative (conservative) treatment of humeral shaft fractures?

A

<20 deg of angulation on AP, <30 deg varus/valgus angulation, and <3 cm of shortening

74
Q

What are the LaFontaine Criteria?

A

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

75
Q

Of the LaFontaine criteria, what is the most predictive of instability?

A

Radial shortening < 5 mm (followed by dorsal comminution)

76
Q

How any LaFontaine criteria need to be met in order to predict loss of reduction?

A

3

77
Q

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?

A

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

78
Q

How far below the superior border of the humeral head does the pectoralis major tendon insert?

A

pectoralis major tendon inserts 5.6 cm distal to the superior aspect of the humeral head

79
Q

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?

A

Screw cut out/penetration

80
Q

In fixation of proximal humerus fracture with plates and screws, a neck shaft angle of what predicts failure?

A

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.

81
Q

What are the absolute indications for operative management of humeral shaft fractures?

A

Absolute indications of operative management include open fracture with severe soft tissue injury, vascular injury requiring repair, and a coexisting brachial plexus injury.

82
Q

What is the treatment for post-traumatic elbow stiffness?

A

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.

83
Q

What nerve is at risk when placing the AP distal interlocking screw for humeral nailing? The lateral to medial?

A

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.

84
Q

What is the main blood supply to the humeral head?

A

Recent evidence has demonstrated that the posterior humeral circumflex artery is likely the main blood supply to the humeral head

85
Q

What are the predictors of fracture-induced humeral head ischemia

A

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.

86
Q

What is a Monteggia fracture

A

proximal third ulna fracture with associated radial head dislocation

87
Q

What is a Bado I Monteggia fracture?

A

Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (most common in children and young adults)

88
Q

What is a Bado II Monteggia fracture?

A

Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (70 to 80% of adult Monteggia fractures)

89
Q

What is the most common nerve injury in a Monteggia fracture?

A

PIN

90
Q

What is a Galeazzi fracture?

A

Distal third radial shaft fracture with associated DRUJ injury.

91
Q

What is the incidence of DRUJ instability in in radial shaft fractures?

A

55% if radius fracture is <7.5 cm from articular surface; 6% if radius fracture is >7.5 cm from articular surface.

92
Q

What are the primary stabilizing ligaments of the DRUJ?

A

Volar and Dorsal radioulnar ligaments

93
Q

What position is the DRUJ most stable?

A

Supination

94
Q

What are the radiographic signs of DRUJ instability?

A

ulnar styloid fx, widening of joint on AP view, dorsal or volar displacement on lateral view, Radial shortening >5 mm

95
Q

In what position, and for how long, should the wrist/forearm be splint for treatment of the DRUJ?

A

Wrist/forearm in supination; immobilized for 6 weeks.

96
Q

If closed reduction of the DRUJ is blocked, what interposition should be suspected?

A

interposition of the ECU tendon

97
Q

How do you prevent refracture after fixation of a Galeazzi fracture?

A

Do not remove plate before 18 months; 4.5 mm plates increase risk of refracture (use smaller plate); comminuted fractures increase risk

98
Q

What is the incidence of sacral fractures in pelvic ring injuries?

A

30-45%

99
Q

What is the rate of neurologic injury in sacral fractures?

A

25%

100
Q

What sacral nerve roots carry a higher rate of injury in sacral fractures?

A

S1 and S2

101
Q

What Denis classification of sacral fractures has the highest incidence of nerve injury?

A

Zone 3 (medial to sacral foramina into the spinal canal); 60% rate of nerve injury; bowel/bladder/sexual dysfunction;

102
Q

What is the most common fracture classifcation/pattern of sacral fractures?

A

Denis I - 50%

103
Q

What nerve is most commonly injured in Denis I sacral fractures?

A

Nerve injury is rare, but if it occurs, it is most commonly L5 nerve root

104
Q

What fixation technique is shown to have the greatest stiffness for when used for unstable sacral fractures?

A

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

105
Q

What are the iatrogenic causes of nerve injury in percutaneous sacral fixation for sacral fractures?

A

Over-compression, Mal-placement of implants

106
Q

What is the dose of Vitamin C given for CRPS?

A

500 mg for 50 days

107
Q

What is the most common mode of failure of the lateral ulnar collateral ligament associated with an elbow dislocation?

A

The lateral ulnar collateral ligament (LUCL) is often injured with elbow dislocations, and is most commonly injured at the proximal origin.

108
Q

How long should a simple elbow dislocation be immobilized?

A

Less than 2 weeks; anything beyond 2 weeks portends greater stiffness

109
Q

Anteromedial coronoid facet fractures risks what type of instability?

A

Varus posteromedial rotatory instability

110
Q

What is primary bone healing?

A

direct healing by internal remodeling; intramembranous ossification

111
Q

What ligament is a key stabilizer of the DRUJ and tested with the “shuck test” ?

A

Radioulnar ligaments of the TFCC

112
Q

What is the essential lesion that results in the most instability in a terrible triad injury of the elbow?

A

lateral collateral ligament. Repair of this lesion results in the greatest increase in elbow rotatory stability.

113
Q

What is the in-hospital mortality rate of geriatric femoral neck fractures?

A

6%

114
Q
A
115
Q

What is a Segond sign?

A

Lateral tibial plateau avulsion fracture (associated with ACL tear)

116
Q

What is a Segond sign indicative of?

A

ACL rupture

117
Q

Which meniscal tears are more common in tibial plateau fractures overall?

A

Lateral meniscal tears (associated with Schatzker II, >10 mm depression, >6mm widening)

118
Q

Medial meniscal tears are most commonly associated with which Schatkzer pattern?

A

Schatkzer IV

119
Q

The ACL is most commonly injured in which Schatkzer patterns?

A

IV and VI

120
Q

What is the most common malunion deformity in proximal third tibial shaft fractures?

A

valgus, procurvatum

121
Q

What are the indications for treating a proximal third tibia shaft fracture non-operatively?

A

< 5 degrees varus-valgus angulation; < 10 degrees anterior/posterior angulation; > 50% cortical apposition; < 1 cm shortening; < 10 degrees rotational alignment

122
Q

In subtalar dislocations, medial or lateral dislocations are more likely to be open?

A

lateral dislocations more likely to be open

123
Q

With subtalar dislocations, which fractures are associated with a medial subtalar dislocation?

A

dorsomedial talar head, posterior process of talus, navicular

124
Q

Which fractures are associated with lateral subtalar dislocations?

A

cuboid, anterior calcaneus, lateral process of talus, fibula

125
Q

What is the most important and main blood supply to the talus?

A

posterior tibial artery via the artery of the tarsal canal. (supplies the majority of the taller body)

126
Q

The anterior tibial artery supplies what portion of the talus?

A

The talar head and neck

127
Q

The perforating perineal arteries supply what portion of the talus?

A

The talar head and neck via the artery of the tarsal sinus.

128
Q

What surgical approach is used in medial talus dislocations?

A

Sinus tarsi approach (lateral based approach), to remove lateral structures blocking reduction

129
Q

What surgical approach is used in a lateral talus dislocation?

A

medial based approach between tib ant and posterior tib; removes medial based structures blocking reduction

130
Q

In talus dislocations, poorer outcomes are associated with which factors?

A

Lateral dislocations, open fractures, concomitant fractures, high energy mechanisms

131
Q

What is the malunion deformity seen in mid shaft tibia fractures with an intact fibula?

A

varus defmority

132
Q

What is the antibiotic treatment for Grade IIIB open tibia shaft fractures?

A

cephalosporins + aminoglycoside added in Grade IIIB injuries

133
Q

What is a normal tib/fib overlap on an AP ankle XR?

A

> 6 mm; if less than that consider syndesmotic injury

134
Q

What is a normal tib/fib overlap on a mortise ankle XR?

A

> 1 mm; if less than that consider syndesmotic injury

135
Q

In ankle fractures, when does proper braking response time return to baseline?

A

proper braking response time (driving) returns to baseline at 9 weeks after surgery

136
Q

What techniques can be used to overcome the malalignment of apex anterior and valgus deformities in proximal third tibia shaft fractures?

A
  • 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
137
Q

What is the most common complication following a talar neck fracture?

A

post-traumatic arthritis; subtalar joint being the most common

138
Q

In subtalar dislocations, which type (medial or lateral) is more likely to be:
a) common
b) open
c) associated with fracture?

A

a) common - medial
b) open - lateral
c) associated with fracture - lateral

139
Q

Which factors lead to an increased risk of complications for unstable ankle fractures?

A

skin integrity, smoking status, diabetes, peripheral neuropathy; age does not have an effect on complication rate

140
Q

How long do you maintain nonweightbearing status in patients with operatively fixed diabetic ankle fractures?

A

maintain nonweightbearing 8-12 weeks post op; instead of 4-8 weeks in normal patients

141
Q

What are the common deformities seen in malunions of conservatively managed calcaneus fracture?

A

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

142
Q

What are the attachment sites for the bifurcate ligament?

A

anterior process of the calcaneus and bifurcates to the navicular and cuboid

143
Q

What ligament is responsible for an avulsion fracture of the anterior process of the calcaneus?

A

bifurcate ligment

144
Q

What is the mechanism of injury for an avulsion fracture of the anterior process of the calcaneus?

A

plantar flexion and inversion

145
Q
A
146
Q

Treating a femoral shaft fracture on a fracture table increases the risk for what deformity?

A

Internal rotation; fracture table has been shown to induce an internal mal rotation deformity when used to treat femoral shaft fractures.

147
Q

Is fixation of the fibula in associated tibial plafond fractures associated with higher or lower complication rates?

A

Higher

148
Q

When is the most optimal time to repair a nerve transected from a GSW?

A

1-3 weeks

149
Q

A sliding hip screw had lower reoperation rates in which patient cohort?

A

Displaced basicervical femoral neck fractures in current smokers

150
Q
A

OITE (13 decks)

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