Trauma Flashcards
What percent of blood loss will typically not respond to 2 L of LR or NS?
30%
What is the most common complication of massive tranfusion?
Dilutional thrombocytopenia
(Followed by hypothermia and metabolic alkalosis)
What is the best measure of a patient’s resuscitation?
Lactate levels (less than 2.5 mg/dL)
What are the four things indicated SIRS?
HR over 90
WBC less than 4000 or greater than 12000
RRmore than 20 BPM
Tep less than 36 or greater than 38
What are the HR limits for shock classes 2-4?
2: Over 100
3: Over 120
4: Over 140
What is the MOA of TXA?
Competitive inhibitor of plasminogen activation
Motor recovery potential after repair of what nerve has the poorest recovery potential?
Peroneal nerve
What antibiotic for freshwater wound fracture?
Fluoroquinolones (cirpfloxacin)
(Target DNA gyrase, topoisomerase)
What does of ultrasound has been shown effective for healing acute fractures?
30 mW/cm2
Strain less than what percentage results in primary bone healing?
2%
(If it is over 10% it results in no bone formaiton)
What view for SC dislocation?
Serendipity view
What physis is the last to close?
Medial calvicular eiphysis (25 yo)
In PHF, what does Neer define as a part?
1 cm displacement or greater than 45 degrees of angulation
Surgery is indicated for PHF with GT displacement more than what?
5 mm
What is nonop parameters for humeral shaft?
Less than 20 degrees of anterior angulation, less than 30 degrees varus or valgus angulation, or less than 3 cm of shortening
After a radial nerve palsy, what is the first to return?
Brachioradialis followed by the ECRL
What defines the safe zone for ORIF of the radial head/neck?
Radial styloid - Lister’s tubercle (25% along the lateral side)
What are the 4 Bado classes?
- Anterior radial head dislocation with apex anterior proximal third ulna
- Posterior radial head dislocation and apex posterior proximal ulna (Annular ligament is disrupted)
- Lateral radial head dislocation and proximal ulna
- Anterior radial head and proximal third ulna & radius
If there is 3 mm of instability when radius is pulled proximally, what is injured in a monteggia?
Interosseous membrane
For a night stick fracture, when can I consider nonop for distal ulna?
Distal 2/3s, less than 50% displaced, less than 10 degrees of angulation
what pelvic view evaluates anterior or posterior displacement of the SI joint and internal/external rotational deformity?
Inlet
What pelvic view evalutes vertical displacement of SI joint and fixation of hemiplevis?
Outlet view
What class of pelvic fractures have anterior transverse pubic rami fractures?
Lateral compression (LC) fractures
What is normally the primary cause of death in LC pelvic fracture patients?
Brain injury
What is the most common complication of an in-fix?
HO
What are a couple details of sacral dysmorphism?
Prominent mammillary bodies, down sloping S, vestigal disc reminant
What view gives anterior column, posterior wall?
Obturator oblique
What giew is used to ensure that screw is placed in anterior column and does not penetrate into joint?
Obturator oblique
What view profiles the posterior column and anterior wall?
Iliac oblique
`What are the 5 simple types of acetabulum fractures?
Anterior wall, posterior wall, anterior column, posterior column, transverse
What fracture pattern do you see a spur sign?
Associated both column
On XR, both iliopectinal and ilioischial lines are disrupted with intact obturator ring?
Transverse or Transverse/PW
Obturator ring fractured with iliac wing intact, what is the acetabulum fracture?
T-Type
Iliac wing disrupted and obturator ring, what is the acetabulum fracture?
AC/PHT, Both column
What creates the highest acetabular contact pressures?
Getting up from a chair
What travels with the round ligament or spermatic cord through the superficial inguinal ring?
Ilioinguinal nerve
Injury to the obturator nerve will cause hypesthesia where?
The inner thigh
Corona mortis connects what?
External iliac to the obturator arteries
What acetabulum approach has highest rate of HO?
Extended iliofemoral apprach
Postraumatic DJD is seen highest in what acetabulum fracture?
Posterior wall involvement
AVN rate highest for what Pipkin classification?
Type 3
What is the mortality rate after hip fracture at 1 month and 1 year?
6% and 30%
For intertroch fractures, the tip apex distance should be less than what?
25 mm
Distal anterior perforation of a femoral IMN is associated with what starting point?
Posterior
Where does the proximal piece go in subtrochanteric fractures?
Flexion, abduction, external rotation
Use of a IMN for ipsilateral femoral neck and shaft fracture is associated with what?
Increased risk of femoral neck malreduction and AVN
What is the most common complication of a knee dislocation?
Stiffness, arthrofibrosis
Indications for operative treatment of tibial plateau fractures?
3 mm articular step off, 3 mm condylar widening, knee instability, all medial and all bicondylar plateau fractures
What has the highest compressive strength in bone boid?
Calcium phosphate
BMP2 is approved for what type of tibia fracture and what type of fixation?
BMP2 is approved for open tibia fracture with treatment of an IMN
Where are blocking screws in a proximal tibia fracture?
Proximal segment
Posterior and lateral to prevent valgus and apex anterior
What is the acceptable angulation of the radial neck fracture in peds?
20-30 degrees angulation
Less than 45 degrees of rotaiton
Apex dorsal angulation of BBFx in peds shoulder be immobilied in pronation or supination?
Supination
Indications for BBFx in Peds: <10 or >10
<10: 15-20 degrees of angulation
>10: >10 degrees of angulation or bayonet
30 degrees of rotation at any age
Acceptable alignment for DRF in peds
More than 5 years of growth remaining: 30 degrees angulation
Less than 5 years left: 30 - 5 per year less than 5 years of growth remaining
Loss of reduction in peds casting is associated with case index above what?
0.84 (sagittal width/coronal width)
