Trauma 2 Flashcards by Lo Kola

Spur sign is pathognomonic for what
What XR do you see it on?

Both columns tab frx
- Spur sign = the stable part of the iliac wing
- Articular surface medializes
Obturator oblique

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What is the gull sign

On obturator oblique
Superomedial dome impaction
Think post wall frx

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What is operative threshold for post wall frx

> 40%
Non op is <20%, so in theory 20-40 is gray

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What is the corona mortis? What approach

Anastomosis between ext iliac + obturator systems
Ant ilioinguinal

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What visceral injury is associated with traumatic hip dislocation?

Thoracic aorta rupture

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Surgical approaches for femoral head fracture

Ant (Smith Pete)
- If head fracture is anterior
- IV plane: sup glut / femoral
- No increased risk AVN
Troch flip for Pip 4

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Name Pipkin classification + trt

1 – infra fovea (not WB aspect), TTWB
2 – above the fovea, ORIF with countersunk screws
3 – w/ fem neck (worst prognosis 2/2 AVN)
Young: ORIF
Old: THA
4 – w/ tab frx (post wall), ORIF

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What is normal NSA and version femoral neck

NSA – 130 (123-137)
AV 10deg (3-17)

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Where should you put a 4th screw for FNF perc screws if needed?

Post inf
Improved fixation if you capture this for post comminution/osteoporotic bone

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Summarize FAITH findings
- RF for poor outcomes

Lag screws vs SHS for FNF
>5mm shortening = poorer outcomes
Factors associated w/ revision:
F
High BMI
Displacement
Poor implant positioning

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FAITH finding for smokers

FNF w/ screws fail more in smokers
Reason to do SHS for smokers

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Why does the data support cemented hemis

Decreased short + long term mortality

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Cons of acute THA for FNF

Increased OR time
Higher EBL
Higher risk of dislocation

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What is the TUG test

Time to risk from a chair, walk 3 meters, turn around and sit back down (nml <12sec)
Predicts need for assistive aid / fall risk

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What is FRAX score

Bone mineral density at the fem neck
Clinical risk factors

= 10 yr probability of fracture risk

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Treat FNF nonunion in varus in good bone

Valgus IT osteotomy

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What is the benefit to operating on FNF/IT frx within 48hrs

Decreased 1 yr mortality rate

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Criteria for unstable IT frx

Lateral wall blow out
Sub troch ext (>3cm)
Reverse oblique

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Treat stable IT / criteria for appropriate implant positioning

SHS: No diff 2 vs 4 hole
TAD = AP dist + lat dist = <25mm
Baumgartner tip-apex distance >25 mm risk of femoral head cut-out
>45mm = 60% failure

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What is an important consideration for using SHS in left sided frx?

As you insert the lag screw, you mal reduce the fracture through screw torque

Blade or screw w/ CMN

SCREW
Blade = higher incidence of medial migration

What is the malreduction risk of using a IMN with subtroch frx

GT/trochiformis start
Varus + flexion
Need to be perfectly reduced before reaming (vs shaft more forgiving)

Hallmarks of a biphos femur frx

Subtroch
Transverse
No comminution
Minimal trauma
Thick lat cortex or incomplete lateral frx
+/- prodoromal pain

What is the risk if troch nail start too lateral

Varus
Why do trochiformis start

What is the malrotation - Supine femoral nail - Lateral femoral nail

Supine: IR Lateral: ER

What is a normal ABI – what is next step if abnormal What is the indication for an arteriogram

ABI > .9 Next step = agram Agram if signs of ischemia post reduction (“soft signs” Hard signs of ischemia – direct to OR for revasc

If you do a partial patellectomy, where should you reattached the patellar ligament?

What Schatzker is most common to get meniscus tear? What type of tear? What ligamentous injury is common?

Schz 2 = lat split depression Meniscocapsular avulsion ACL

What is a key for non op treatment of articular knee frx (distal fem, plateau, etc)

Early ROM + delayed WB

What has the highest compressive strength to fill metaphyseal defects in plateau frx? Mechanism

Ca PO4 Mech: osteoclast degradation

What is the difference in how you use a plate for unicondylar vs bicondylar plateaus?

Unicond – non locking screws bc acting as a buttress plate and intact far cortex Bicond – locking

How far should K wires be from the joint for plateau frx

14mm - most distal extent of the knee capsule aka prevent septic arthritis

What is most important factors for surgical outcomes of plateau frx

Restore joint stability + mechanical axis

What is the risk of proximal third tibial shaft with IMN How move start point to accommodate if not using blocking screws

Prox 1/3 – VALGUS + procurvatum - Prevent with post + lat blocking screws (PoLler) Move start point slightly lateral

What malunion is at risk with a midshaft tibia intact fibula

Intact fibula – VARUS

What are the parameters for acceptable alignment tibial shaft V/V Sagittal Cortical apposition Shortening Rotation

V/V < 5deg Sagittal < 10deg Cortical apposition >50% Shortening <1cm Rotation 10deg

LEAP - Relative indication for amp - Most imp factor for eventual amp - Most impt predictor of infection

Relative indication amp: - Warm ischemia >6hrs - Bad soft tissue injury Predictor of eventual amp = ipsi ST inj Predictor of infection = time to transfer to definitive trauma center

When do declare tibial shaft nonunion? Treat?

>9mo If >5mm of persistent frx gap, will likely fail dynamization and exchange nail Think direct grafting and nailing Concomitant fibular osteotomy = decreased healing time

Tibial shaft random - Stainless steel or titanium - BMP2 for what - BMP 7 for what

Titanium > stainless steel - Think flexible so fracture sees better stress BMP 2 = open tibia BMP 7 = long bone nonunion

3 parts to plafond fracture

Med mal Chaput = AITFL Volkmann = PITFL

LH classification SER PAD PER SAD

SER = short oblique fib at plafond, trans MM PER = spiral above plafond, trans MM SAD = vertical MM, lat mal below plafond PAD = comminuted lat mal (abdC), avulsion MM

Lat mal frx X mm lat talar shift = X% drop in tibtal contact area Xmm lat mal displacement well tolerated with intact mortise

1 mm lat talar shift = 42% drop in tibtal contact area 3mm lat mal displacement well tolerated with intact mortise Aka talar displacement more important than lat mal

Indications to fix post mal

>25% of articular surface >2mm step off

Treat lateral talus process frx

ND = NWB Disp = ORIF (large), excise (small)

Primary BS to talar body

Post tib art -> art tarsal canal

Treat varus malunion of a talar neck frx

Medial opening wedge osteotomy

Subtalar dislocations – what is blocking you for irreducible dislocations Medial Lateral

Medial – head of talus broken, interposed EDB Lateral – interposed PT or FHL

Calc malunion - How does look on XR? - What soft tissue issues associated? - Trt

XR: lose height, varus Peroneals 2/2 subfibular impingement from height loss Trt: distraction bone block

Where does LF ligament go

Base 2nd MT to medial cuneiform

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Trauma 2 Flashcards

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