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Millers > Trauma 2 > Flashcards

Trauma 2 Flashcards

1
Q

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

A

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

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2
Q

What is the gull sign

A

On obturator oblique
Superomedial dome impaction
Think post wall frx

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3
Q

What is operative threshold for post wall frx

A

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

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4
Q

What is the corona mortis? What approach

A

Anastomosis between ext iliac + obturator systems
Ant ilioinguinal

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5
Q

What visceral injury is associated with traumatic hip dislocation?

A

Thoracic aorta rupture

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6
Q

Surgical approaches for femoral head fracture

A

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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7
Q

Name Pipkin classification + trt

A

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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8
Q

What is normal NSA and version femoral neck

A

NSA – 130 (123-137)
AV 10deg (3-17)

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9
Q

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

A

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

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10
Q

Summarize FAITH findings
- RF for poor outcomes

A

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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11
Q

FAITH finding for smokers

A

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

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12
Q

Why does the data support cemented hemis

A

Decreased short + long term mortality

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13
Q

Cons of acute THA for FNF

A

Increased OR time
Higher EBL
Higher risk of dislocation

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14
Q

What is the TUG test

A

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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15
Q

What is FRAX score

A

Bone mineral density at the fem neck
Clinical risk factors

= 10 yr probability of fracture risk

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16
Q

Treat FNF nonunion in varus in good bone

A

Valgus IT osteotomy

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17
Q

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

A

Decreased 1 yr mortality rate

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18
Q

Criteria for unstable IT frx

A

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

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19
Q

Treat stable IT / criteria for appropriate implant positioning

A

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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20
Q

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

A

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

21
Q

Blade or screw w/ CMN

A

SCREW
Blade = higher incidence of medial migration

22
Q

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

A

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

23
Q

Hallmarks of a biphos femur frx

A

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

24
Q

What is the risk if troch nail start too lateral

A

Varus
Why do trochiformis start

25
Q

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

A

Supine: IR
Lateral: ER

26
Q

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

A

ABI > .9
Next step = agram
Agram if signs of ischemia post reduction (“soft signs”

Hard signs of ischemia – direct to OR for revasc

27
Q

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

A

Anterior

28
Q

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

What ligamentous injury is common?

A

Schz 2 = lat split depression
Meniscocapsular avulsion
ACL

29
Q

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

A

Early ROM + delayed WB

30
Q

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

A

Ca PO4
Mech: osteoclast degradation

31
Q

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

A

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

32
Q

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

A

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

33
Q

What is most important factors for surgical outcomes of plateau frx

A

Restore joint stability + mechanical axis

34
Q

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

A

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

35
Q

What malunion is at risk with a midshaft tibia intact fibula

A

Intact fibula – VARUS

36
Q

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

A

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

37
Q

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

A

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

38
Q

When do declare tibial shaft nonunion? Treat?

A

> 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

39
Q

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

A

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

40
Q

3 parts to plafond fracture

A

Med mal
Chaput = AITFL
Volkmann = PITFL

41
Q

LH classification
SER
PAD
PER
SAD

A

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

42
Q

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

A

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

43
Q

Indications to fix post mal

A

> 25% of articular surface
2mm step off

44
Q

Treat lateral talus process frx

A

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

45
Q

Primary BS to talar body

A

Post tib art -> art tarsal canal

46
Q

Treat varus malunion of a talar neck frx

A

Medial opening wedge osteotomy

47
Q

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

A

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

48
Q

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

A

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

49
Q

Where does LF ligament go

A

Base 2nd MT to medial cuneiform

Millers (29 decks)

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