Trauma Flashcards
can lose this amount of blood before there are vital sign changes
15%
clinical picture of 15-30% blood loss
decreased BP and increased HR (still less than 120)
once HR is over 120, this amount of blood loss is present. why is that important
> 30%, at which point you need to replace blood products as well as volume
how much blood loss does it take to stop making urine
> 40%
motor recovery after nerve repair is best with this nerve
radial, MC, femoral
motor recovery after nerve repair is worst with this nerve
peroneal
proximal 1/3 tibia coverage flap
gastroc
middle 1/3 tibia coverage flap
soleus
distal 1/3 tibia coverage flap
fasciocutaneous
volume of strain as it relates to bone healing
strain as it relates to the mechanics of a fracture
change in the fracture gap, divided by the length of the fracture gap. this decreases as the callus matures
effect of load-bearing devices as it relates to the biomechanics
these cause stress-shielding
effect of plate length on biomechanics
affects bending stability
effect of screw position on biomechanics
affects the torsional stability of a construct
in what motion are unicortical locking screws particularly more weak than bicortical locking screws
torsion
resistance to what force do the interlocks of an IMN provide
compression and torsion
in this age group, medial SC dislocations are actually more likely to be a SH injury
under the age of 25, since it hasn’t fused yet
nonunion rates for midshaft clavicle fxs are higher in these groups
women, the elderly, and fxs that are shortened, displaced, or comminuted
scapulothoracic dissociation mortality rate
10%
functional outcome in scap thoracic dissocn related to
the severity of the initial injruy
anterior pins in the CRPP of a proximal humerus fx risk these
biceps tendon, cephalic vein, MC nerve
most common complication of proximal humeral locking plate
screw cut out
loss of active shoulder elevation after a proximal humeral fx
possible nonunion of GT
concern in shoulder dislocn >45
RTC tear
inferior shoulder dislocn position
abducted, 100-160*
WB status after ORIF humerus
WBAT
humerus fx, IMN vs plate
complication rate is higher with nail, as is the shoulder pain rate
nerve complications after IMN humerus
radial nerve with the Lat to Med screw, MC nerve with the A to P screw
order that things return after radial n palsy in humerus fxs
BR first, then ERCL. EPL and EIP are last
these pts get TEA if they have distal humeral fx
over 65, especially if RA or osteoporotic
second most common complication, after stiffness, of distal 2 column humeral fx
loss of elbow muscle strength in 25%
the only capitellar fx that isn’t just excised if displaced
coronal shear fxs get ORIF, through a lateral approach
lactate for adequate resuscitation
wire position in tension band of olecranon fx
dorsal to the midaxis
this is an option for low demand pt with nonreconstructable olecranon fx
excision and triceps advancement
only possible coronoid fx that gets nonop treatment
Type I in a pt that is STABLE after elbow reduction. Otherwise it gets sutured down, and type 2-3 get ORIF
when are adult radial head fxs non-op’d
if nondisplaced, or at least stable, with no mechanical block
exception to the rule that all operative radial head fxs get fixed or replaced
only if elderly and low-demand can you excise a radial head
plate safe zone for radial head fxs
arc of 110*, or 25%. From lister’s to the radial styloid
complication fixing radial head fx and how to avoid
PIN injury, pronate during the exposure
what is the importance of recognizing a complex elbow dislocation
pretty much they all need SOME type of surgery
typical location of LCL injury in terrible triad elbows
usually avulsion of the ligament from the distal humerus
progression of mgmt in terrible triad elbow
fix coronoid, then address radial head (repair or replace), then LCL repair to the humerus. Check stability. If unstable, repair the MCL.
progression of mgmt in monteggia fx
fix the ulna, this should reduce the radial head. if not, either revise the ulna, or if it is AFT then repair the annular ligament
natural history of PIN injury in monteggia fxs
usually resolves after 3 months. may explore after that
risk of taking plates off BBFA
refx if taken off before 12-18 months
this is associated with single incision BBFA fixation
synostosis
radial shortening of this magnitude assoc c DRUJ injury
> 5mm
surgical options after assessing DRUJ during DR fx ORIF and finding it to be disrupted
if it has large ulnar styloid can try to ORIF it. if not, pin it in supination
this may block reduction of the DRUJ during DR fx ORIF and finding it to be disrupted
ECU tendon can get trapped
necessary condition for APC II
sacrotuberous, sacrospinous, and anterior SI ligaments have to be out
necessary condition for APC III
in addition to the ligaments required for APC II injury, the posterior SI ligaments are injured
why is this type of sacral fx a concern
vertical shear fxs at risk for loss of fixation
while performing CRPP of sacrum, this view provides protection to the S1 foramen
outlet view
while performing CRPP of sacrum, this view provides protection to the L5 nerve root
lateral view, which shows the sacral alar slope
this is the only tab fx that gets ilioinguinal approach routinely
anterior column, PHT. if there is limited PW involvement, some T types can get it
risk with delay in ORIF of a tab
malreduction (probably in addition to mortality of waiting…)
this injury is double the incidence of AVN after hip dislocation
meniscal injury, 30%
pipkin
below, above, with a neck, with a tab
main benefit of hemi over THA in fem neck fx
lower dislocation rate
two instances where piriformis start nails should not be used
peds, and if the piriformis is disrupted by fx, whether subtroch or whatever
risk with placing piriformis nail starting point too anterior
hoop stress, can pop the neck
what happens if you use a straight nail with a troch start
medial shaft comminution
how long can you wait to convert an ex fix femur to an IMN and have the same union and infxn rates
3 weeks
malrotation with lateral position femur IMN
ER
malrotation with supine position femur IMN
IR
malrotation with fx table femur IMN
IR
hoffa fragment
usually LATERAL, 40% present, 80% missed
delayed femoral union after IMN, exchange vs dynamize
dynamization is less successful
distal femur ORIF: blade (4) vs LCP (1)
blades have more torsional strength, fewer complications, less ULTIMATE strength, greater subsidence. LCP is better thought for coronal fxs
disadvantage of DCS for distal femoral ORIF
removes bone
most common knee dislocn
KD III
this ABI indicates intact vessels after KD
> 0.9
vascular injury is most common in this KD
4
besides vascular injury, these are common after knee dislocn
peroneal n injury, which commonly resolves. Stiffness is most common though
natural history of quad tendon rupture
half lose strength, half can’t return to activity
this occurs in half of tibial plateau fxs
mensical injuries (Sch II lateral, IV medial), most of which are peripheral
calc phos vs ICBG for tibial plateau ORIF
calc phos has highest compressive strength, but autograft has lowest subsidence
difference bt G-A 2 and 3 injuries
3 is contaminated and has periosteal stripping
gustilo type 3
no flap, flap, vascular repair
this bmp is used in type II open tibias
bmp -2
this bmp is used for tibial IMN nonunions
bmp 7
LISS plate for tibial shaft risk
13 hole plates risk SPN (10-13th holes)
concern with malunion of tibial shaft
ankle arthrosis
common malreduction in distal tibial ORIF
malrotation
risk factors for reoperation for nonunion of tibia within first year
open, transverse, cortical contact
utility of WVAC in infection of open tibia
doesn’t change the numbers?
happens in 30% of IMN tibias
anterior knee pain. goes away in half if you take nail out
location and connections to typical pilon fragments
medial is the deltoid, posterolateral (volkmann) is the anterior talofibular ligament, anterolateral (chaput) is the posterior tibiofibular ligament
how long to expect clinical improvement in pilon fxs
for up to 2 yrs
this is more common in hybrid fixation of pilon
metaphyseal nonunion
normal ankle talocrural angle
83*
bosworth fx-dislocation
distal fibula gets trapped behind tibia, caught on the posterolateral ridge
posterior vs lateral plate for ORIF fibula
posterior is more stable but has more peroneal tendon irritation
location of fx concerning for syndesmotic disruption
fibular fxs more than 6mm from the joint
medial comminution in talus fxs
varus malunion
90% of talar dislocations have these
associated tarsal fxs
medial irreducible talus
EBD, capsule
lateral irreducible talus
posterior tibial interposition
typical open fxs of calcaneus wound location
usually medial
powers ratio
distance from the front of the foramen to the posterior arch, over the distance from the back of the foramen to the anterior arch. If this is more than 1, this indicates atlantoaxial instability
ADI indicative of transverse ligament rupture
> 3mm
ADI indicative of transverse and alar ligament rupture
> 5mm
C2 fx mgmt
can treat this in halo if the transverse ligament is intact, C1-C2 fusion if not
type III odontoid mgmt
ORIF if > 5mm displaced
halo control of cervical motion
not good at controlling axial distraction, best controlling rotation
flexion vs extension injuries in lower cervical spine fxs
flexion injuries are more unstable
implications if you miss child abuse
33% further abuse, 10% mortality
physeal fxs occur here
zone of provisional calcification in the zone of hypertrophy
threshold for doing physeal bar resection after growth arrest from fracture
if there are more than 2cm growth remaining and less than 50% of the physis is involved
at what age can you start IMN for femurs
conservative age is probably 14
deforming forces in peds prox humerus
pec major and the deltoid
nerve injury with extension type peds SC humerus
AIN neuropraxia
nerve injury with flexion type peds SC humerus
ulnar nerve injury, which can also be injured with medial pinning
this is not needed in the mgmt of pale pulseless hand in peds SC humerus
you know where there is vessel injury, so don’t need arteriography
etiology of cubitus varus after peds SC humerus
malunion, rather than growth arrest
this is important when fixing peds type III distal humeral lateral condyle fxs
disruption of the posterior blood supply can lead to AVN
half of medial epicondyle fxs in peds are assoc c this
elbow dislocn
peds indications radial head/neck
> 30* angulation, >45* rotation, or >4mm translation
reduction for nursemaids
thumb pressure, then flexion/supination
splint position for apex dorsal peds BBFA
since MOI is pronation for this injury, splint in supination
splint position for apex volar peds BBFA
since MOI for this injury is supination, splint in pronation
risk of AVN in basicervical peds femoral neck
relatively low, increases as you come up the neck
rate of growth arrest in distal femoral peds salter injury
30-50%
peds fx with equivalent mechanism to ACL injury
tibial eminence fxs, from valgus, hyperextension often with rotational component
mgmt of peds tibial eminence fxs
if it reduces in extension you can nonop it. if not it needs fixed. you can use screws, but if it extends into you the joint you have to confirm reduction visually (scope or arthrotomy)
cozen fx
proximal tibial metaphyseal fx that leads to genu valgum; usually resolves spontaneously
this should be in differential for red painful distal tibia in young peds
toddlers fx, often normal xrays. cast for 2 wks, repeat films
location of the tillaux fragment in peds SH III injury
anterolateral
where is the thurston-holland fragment in a triplane fx
posterolateral tibia. may not be evident on the AP films
if a peds tibial eminence fx won’t reduce, what is most likely interposed
medial meniscus usually
