Trauma

Question 1

measures of resuscitation

Answer 1

Lactate <2.5 mmol/L, <45 mg/dL
Urine output >0.5-1 ml/kg/hr (30 cc/hr)
Base deficit -2 to 2
Gastric mucosal pH

Question 2

Give blood in what order for resuscitaition

Answer 2

1:1:1 blood, platelets, plasma

Question 3

what tear associated with scatzker IV

Answer 3

medial meniscus tear, ACL tear

Question 4

Which plateau has high rate of NV and ligamenotus injuries

Answer 4

TYpe IV

Question 5

varus/valgus instability testing for plateaus

Answer 5

any laxity >10 degrees in full exgtension

Question 6

incidence of ipsilateral FN fxs afeter fem shaft fractures

Answer 6

2-6% incidence, basicervical, vertical, and nondisplaced

Question 7

Pauwels classification

Answer 7

….

Question 8

Winquist and Hansen classification

Answer 8

Winquist and Hansen Classification
Type 0
No comminution
Type I
Insignificant amount of comminution
Type II
Greater than 50% cortical contact
Type III
Less than 50% cortical contact
Type IV
Segmental fracture with no contact between proximal and distal fragment

Question 9

Benefits of femoral shaft nailing within 24 hours

Answer 9

stabilization within 24 hours is associated with
decreased pulmonary complications (ARDS)
decreased thromboembolic events
improved rehabilitation
decreased length of stay and cost of hospitalization

Question 10

reamed nailing superior to unreamed nailing

Answer 10

increased union rates

decreased time to union
no increase in pulmonary complications

Question 11

antegrade nails pros
98-99% union rate
low complication rate
infection risk 2%

Answer 11

pros
98-99% union rate
low complication rate
infection risk 2%

Question 12

cons to antegrade femoral nailing

Answer 12

cons
not indicated for use with ipsilateral femoral neck fracture
increased rate of HO in hip abductors with antegrade nailing
increased rate of hip pain compared with retrograde nailing
mismatch of the radius of curvature of the femoral shaft and intramedullary nails can lead to anterior perforation of the distal femur

Question 13

Pros and cons of retrograde femoral nailing

Answer 13

pros
technically easier
allows for addressing other injuries surgically without changing patient position
allows for direct comparison of rotation and leg length to nonoperative extemity
union rates comparable to those of antegrade nailing
no increased rate of septic knee with retrograde nailing of open femur fractures
cons
knee pain
increased rate of interlocking screw irritation

cartilage injury
cruciate ligament injury with improper starting point

Question 14

Why did you do retrograde nailing in this case?

Answer 14

I did retrograde nailing because it allowed me to use the same skin incision for my tibial nail, the same positioning…and floating knee injuries have been described as an indication to use retrograde nails.

Question 15

risk factor for iatrogenic proximal femur fracture with nailing

Answer 15

antegrade starting point 6 mm or more anterior to the intramedullary axis

Question 16

risk factor for anterior cortical performation

Answer 16

Too posterior of a starting point. (it’s all relative to the shaft)

Question 17

don’t forget kellgren lawrence

Question 18

Femoral shaft fracture Fracture table deformity

Answer 18

use of a fracture table increases risk of internal rotation deformities when compared to manual traction
ry

Question 19

deformities of subtroch fracture

Answer 19

abduction, flexion, external rotation of proximal fragment. Adduction adn shortening of distal fragment. May need to abduct leg to get it lined up. I guess distal is also externally rotated too??

Question 20

read up on meta tan!!

Answer 20

127 degree neck shaft angle

Question 21

Post suergery deformity

Answer 21

Varus and Procurvatum…I did a good job.

Question 22

why cant u use standard troch locking for subtrochs

Answer 22

because the canal is wide proximally and the nail can toggle. Reconstruciton nails going into the femoral neck and head allows for more secure fixation

Question 23

Which nail positionign start point is more dangerous

Answer 23

Anterior start of the nail increases hoop stress that can lead to comminution and bursting the proximal fragment. nail won’t reduce the fracture.

Question 24

I reamed out medially to allow for me to place the nail more medial to avoid varus.

Question 25

why did your subtroch take so much time

Answer 25

Because I wanted to ensure a good reduction to avoid nonunion

Question 26

metatan vs intertan

Answer 26

metatan is narrower for younger patients.

Question 27

why lock subtroch screw

Answer 27

turn it into a fixed angle device.

Question 28

components of syndesmosis

Answer 28

AITFL, PITFL, interosseous ligamen, interosseous memebarane, inferior transverse ligament

Question 29

Fragment on the ankle

Answer 29

Chaput is anterolateral, Volkman is posterolateral, medial fragment, wagstaff is anterior fibula

Question 30

during dorsiflexion fibula does what

Answer 30

ER and moves laterally