trauma Flashcards
SIRS criteria
HR > 90, WBC <4 or >12, RR >20 w/ PaCO2<32, T <36 or >38
antibiotics for GA III open fracture
cephalosporin and aminoglycoside (gent)
antibiotic added for heavily contaminated wound or farm wound
penicillin
antibiotics for freshwater wounds
fluoroquinolone (cipro or levo) or 3/4th generation cephalosporin (ceftazidime)
antibiotics for saltwater wounds
doxy and ceftazidime or a fluoroquinolone
flap and blood supply for middle third tibial wound
soleus flap, posterior tib artery
radiation dose for HO ppx
600-700 cGy 24 hours before up to 72 hours after surgery
main findings of LEAP study
absence of plantar sensation is not predictive of function, no difference in outcomes between limb salvage and amputation
operative indications for scapula fracture
angulation > 40 degrees, glenopolar angle < 20 degrees
Rockwood classification of AC injuries
1 - AC sprain, 2 - AC torn/CC sprain, 3 - AC and CC torn, 4 - clavicle through trap posteriorly, 5 - trap and deltoid detached (>100% displacement), 6 - clavicle beneath coracoid
operative indication for greater tuberosity. fracture
> 5 mm displacement
most common complication of periarticular locking plate for proximal humerus fracture
screw cutout
most reliable landmark. for judging humeral height
superior border of pec major insertion
acceptable alignment for non op treatment of humeral shaft fracture
<20 degrees anterior angulation, <30 degrees varus/valgus, <3 cm shortening
which nerves are at risk with distal interlocks in humeral nail?
radial nerve with lateral to medial, musculocutaneous with AP
first and last muscles to return in radial nerve injury
first - BR, ECRL. last - EPL and EIP
radial fracture at what distance from the articular surface is suggestive of DRUJ injury?
DRUJ unstable in 55% when radial fracture <7.5 cm from articular surface
most common cause of irreducible DRUJ
interposition of ECU tendon
factors most predictive of loss of reduction in distal radius fractures
radial shortening, dorsal comminution
APC 1
symphysis < 2.5 cm, anterior SI ligaments stretched
APC 2
symphysis > 2.5 cm, rupture of anterior SI ligaments, sacrotuberous, sacrospinous
APC 3
symphysis > 2.5 cm, rupture of anterior and posterior SI ligaments, sacrotuberous, and sacrospinous
LC classification
all have pubic rami fracture, 1 - sacral compression fracture. 2 - posterior iliac wing fracture. 3 - contralateral APC
main cause of death in LC injuries
brain injury
strongest pins for pelvic ex fix
AIIS > iliac wing, but iliac wing tolerated better
Denis classification
1 - lateral to foramen, 2 - involves foramen, 3 - medial to foramen
best view to see S1 foramen for SI screw placement
outlet
xray view to make sure anterior column screw doesn’t penetrate joint
obturator oblique
simple acetabulum fractures
posterior wall, posterior column, anterior wall, anterior column, transverse
associated acetabulum fractures
posterior wall posterior column, transverse posterior wall, T-type, anterior column posterior hemitransverse, associated both column
approach that provides best access to quadrilateral surface
modified stoppa
what is the corona mortis
vascular communication between external iliac and obturator artery system
which approach to the tab has the highest rate of HO
extended iliofemoral
what is the spur sign and what view is it seen on
obturator oblique, represents intact portion of iliac wing in associated both column
ilioinguinal medial window
medial to external iliac artery and vein
ilioinguinal middle window
between external iliac vessels and iliopsoas
ilioinguinal lateral window
lateral to iliopsoas (iliopectineal fascia)
pipkin classification
femoral head. 1 - below fovea, 2 - above fovea, 3 - +femoral neck fracture, 4 - +acetabular fracture
garden classification
femoral neck. 1 - valgus impacted. 2 - complete, nondisplaced. 3 - complete, partially displaced. 4 - complete, displaced
what factor correlates most with satisfactory clinical outcome in tibial plateau fractures
maintenance of mechanical axis
what bone void filler used for plateaus has highest compressive strength
calcium phosphate cement
what factor has the highest impact on need for amputation in tibial shaft fractures
severity of muscle injury
which BMP is approved in acute tibial shaft fractures? nonunion?
BMP-2 in acute with IMN, BMP-7 in nonunion
angulation common in proximal third tibia fractures
valgus and apex anterior
starting point for tibial nail
medial border of lateral spine
preferred treatment for midshaft tibial nonunions
reamed exchange nailing
zone of physis damage in physeal fracture
zone of provisional calcification within zone of hypertrophy
pediatric blood volume
75-80 ml/kg
order of elbow ossification centers
CRI(M)TOE(L) - 1, 3, 5, 7, 9, 11
xray view for lateral condyle
internal oblique
bado classification
Monteggia. 1 - anterior. 2 - posterior. 3 - lateral. 4 - radial head fracture dislocation + proximal ulna fx
acceptable angulation in peds distal radius fracture with >5 years growth remaining
30 degrees sagittal plane, 10-15 degrees coronal plane
ASIS avulsion
sartorius
AIIS avulsion
rectus
iliac crest avulsion
abdominals and TFL
delbet classification
peds fem neck. 1 - transphyseal (almost 100% risk AVN). 2 - transcervical. 3 - basicervical. 4 - IT (10-15% risk of AVN)
Meyers and McKeever tibial spine fx classification
1 - nondisplaced. 2 - minimally displaced w/ intact posterior hinge. 3 - completely displaced. 4 - completely displaced and rotated
tibial plateau and tubercle physis closure
posterior to anterior, medial to lateral, proximal to distal
tillaux fracture
SH 3 avulsion of AITFL
distal tibial physis order of closure
central -> anteromedial -> posteromedial -> lateral
triplane fracture
SH 4. sagittal plane through epiphysis. axial plane through physis. coronal plane through metaphysis (SH 2 on lateral, SH 3 on coronal)
what is the ISS
sum of square of 3 highest AIS scores. correlates w/ morbidity, mortality, LOS
what structure travels with the round ligament or spermatic cord through superficial inguinal ring
ilioinguinal nerve
best imaging to view U-type sacral fracture
lateral of sacrum or sagittal reformatted CT
border between middle and lateral windows
iliopectineal fascia
common nerve injured in hindfoot nail
lateral plantar nerve (numbness over lateral plantar midfoot)
last muscle to recover with a peroneal nerve injury at fibular neck
EHL
