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ABOS PART ONE > Trauma > Flashcards

Trauma Flashcards

1
Q

can lose this amount of blood before there are vital sign changes

A

15%

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2
Q

clinical picture of 15-30% blood loss

A

decreased BP and increased HR (still less than 120)

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3
Q

once HR is over 120, this amount of blood loss is present. why is that important

A

> 30%, at which point you need to replace blood products as well as volume

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4
Q

how much blood loss does it take to stop making urine

A

> 40%

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5
Q

motor recovery after nerve repair is best with this nerve

A

radial, MC, femoral

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6
Q

motor recovery after nerve repair is worst with this nerve

A

peroneal

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7
Q

proximal 1/3 tibia coverage flap

A

gastroc

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8
Q

middle 1/3 tibia coverage flap

A

soleus

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9
Q

distal 1/3 tibia coverage flap

A

fasciocutaneous

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10
Q

volume of strain as it relates to bone healing

A
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11
Q

strain as it relates to the mechanics of a fracture

A

change in the fracture gap, divided by the length of the fracture gap. this decreases as the callus matures

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12
Q

effect of load-bearing devices as it relates to the biomechanics

A

these cause stress-shielding

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13
Q

effect of plate length on biomechanics

A

affects bending stability

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14
Q

effect of screw position on biomechanics

A

affects the torsional stability of a construct

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15
Q

in what motion are unicortical locking screws particularly more weak than bicortical locking screws

A

torsion

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16
Q

resistance to what force do the interlocks of an IMN provide

A

compression and torsion

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17
Q

in this age group, medial SC dislocations are actually more likely to be a SH injury

A

under the age of 25, since it hasn’t fused yet

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18
Q

nonunion rates for midshaft clavicle fxs are higher in these groups

A

women, the elderly, and fxs that are shortened, displaced, or comminuted

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19
Q

scapulothoracic dissociation mortality rate

A

10%

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20
Q

functional outcome in scap thoracic dissocn related to

A

the severity of the initial injruy

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21
Q

anterior pins in the CRPP of a proximal humerus fx risk these

A

biceps tendon, cephalic vein, MC nerve

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22
Q

most common complication of proximal humeral locking plate

A

screw cut out

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23
Q

loss of active shoulder elevation after a proximal humeral fx

A

possible nonunion of GT

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24
Q

concern in shoulder dislocn >45

A

RTC tear

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25
Q

inferior shoulder dislocn position

A

abducted, 100-160*

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26
Q

WB status after ORIF humerus

A

WBAT

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27
Q

humerus fx, IMN vs plate

A

complication rate is higher with nail, as is the shoulder pain rate

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28
Q

nerve complications after IMN humerus

A

radial nerve with the Lat to Med screw, MC nerve with the A to P screw

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29
Q

order that things return after radial n palsy in humerus fxs

A

BR first, then ERCL. EPL and EIP are last

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30
Q

these pts get TEA if they have distal humeral fx

A

over 65, especially if RA or osteoporotic

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31
Q

second most common complication, after stiffness, of distal 2 column humeral fx

A

loss of elbow muscle strength in 25%

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32
Q

the only capitellar fx that isn’t just excised if displaced

A

coronal shear fxs get ORIF, through a lateral approach

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33
Q

lactate for adequate resuscitation

A
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34
Q

wire position in tension band of olecranon fx

A

dorsal to the midaxis

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35
Q

this is an option for low demand pt with nonreconstructable olecranon fx

A

excision and triceps advancement

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36
Q

only possible coronoid fx that gets nonop treatment

A

Type I in a pt that is STABLE after elbow reduction. Otherwise it gets sutured down, and type 2-3 get ORIF

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37
Q

when are adult radial head fxs non-op’d

A

if nondisplaced, or at least stable, with no mechanical block

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38
Q

exception to the rule that all operative radial head fxs get fixed or replaced

A

only if elderly and low-demand can you excise a radial head

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39
Q

plate safe zone for radial head fxs

A

arc of 110*, or 25%. From lister’s to the radial styloid

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40
Q

complication fixing radial head fx and how to avoid

A

PIN injury, pronate during the exposure

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41
Q

what is the importance of recognizing a complex elbow dislocation

A

pretty much they all need SOME type of surgery

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42
Q

typical location of LCL injury in terrible triad elbows

A

usually avulsion of the ligament from the distal humerus

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43
Q

progression of mgmt in terrible triad elbow

A

fix coronoid, then address radial head (repair or replace), then LCL repair to the humerus. Check stability. If unstable, repair the MCL.

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44
Q

progression of mgmt in monteggia fx

A

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

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45
Q

natural history of PIN injury in monteggia fxs

A

usually resolves after 3 months. may explore after that

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46
Q

risk of taking plates off BBFA

A

refx if taken off before 12-18 months

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47
Q

this is associated with single incision BBFA fixation

A

synostosis

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48
Q

radial shortening of this magnitude assoc c DRUJ injury

A

> 5mm

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49
Q

surgical options after assessing DRUJ during DR fx ORIF and finding it to be disrupted

A

if it has large ulnar styloid can try to ORIF it. if not, pin it in supination

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50
Q

this may block reduction of the DRUJ during DR fx ORIF and finding it to be disrupted

A

ECU tendon can get trapped

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51
Q

necessary condition for APC II

A

sacrotuberous, sacrospinous, and anterior SI ligaments have to be out

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52
Q

necessary condition for APC III

A

in addition to the ligaments required for APC II injury, the posterior SI ligaments are injured

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53
Q

why is this type of sacral fx a concern

A

vertical shear fxs at risk for loss of fixation

54
Q

while performing CRPP of sacrum, this view provides protection to the S1 foramen

A

outlet view

55
Q

while performing CRPP of sacrum, this view provides protection to the L5 nerve root

A

lateral view, which shows the sacral alar slope

56
Q

this is the only tab fx that gets ilioinguinal approach routinely

A

anterior column, PHT. if there is limited PW involvement, some T types can get it

57
Q

risk with delay in ORIF of a tab

A

malreduction (probably in addition to mortality of waiting…)

58
Q

this injury is double the incidence of AVN after hip dislocation

A

meniscal injury, 30%

59
Q

pipkin

A

below, above, with a neck, with a tab

60
Q

main benefit of hemi over THA in fem neck fx

A

lower dislocation rate

61
Q

two instances where piriformis start nails should not be used

A

peds, and if the piriformis is disrupted by fx, whether subtroch or whatever

62
Q

risk with placing piriformis nail starting point too anterior

A

hoop stress, can pop the neck

63
Q

what happens if you use a straight nail with a troch start

A

medial shaft comminution

64
Q

how long can you wait to convert an ex fix femur to an IMN and have the same union and infxn rates

A

3 weeks

65
Q

malrotation with lateral position femur IMN

A

ER

66
Q

malrotation with supine position femur IMN

A

IR

67
Q

malrotation with fx table femur IMN

A

IR

68
Q

hoffa fragment

A

usually LATERAL, 40% present, 80% missed

69
Q

delayed femoral union after IMN, exchange vs dynamize

A

dynamization is less successful

70
Q

distal femur ORIF: blade (4) vs LCP (1)

A

blades have more torsional strength, fewer complications, less ULTIMATE strength, greater subsidence. LCP is better thought for coronal fxs

71
Q

disadvantage of DCS for distal femoral ORIF

A

removes bone

72
Q

most common knee dislocn

A

KD III

73
Q

this ABI indicates intact vessels after KD

A

> 0.9

74
Q

vascular injury is most common in this KD

A

4

75
Q

besides vascular injury, these are common after knee dislocn

A

peroneal n injury, which commonly resolves. Stiffness is most common though

76
Q

natural history of quad tendon rupture

A

half lose strength, half can’t return to activity

77
Q

this occurs in half of tibial plateau fxs

A

mensical injuries (Sch II lateral, IV medial), most of which are peripheral

78
Q

calc phos vs ICBG for tibial plateau ORIF

A

calc phos has highest compressive strength, but autograft has lowest subsidence

79
Q

difference bt G-A 2 and 3 injuries

A

3 is contaminated and has periosteal stripping

80
Q

gustilo type 3

A

no flap, flap, vascular repair

81
Q

this bmp is used in type II open tibias

A

bmp -2

82
Q

this bmp is used for tibial IMN nonunions

A

bmp 7

83
Q

LISS plate for tibial shaft risk

A

13 hole plates risk SPN (10-13th holes)

84
Q

concern with malunion of tibial shaft

A

ankle arthrosis

85
Q

common malreduction in distal tibial ORIF

A

malrotation

86
Q

risk factors for reoperation for nonunion of tibia within first year

A

open, transverse, cortical contact

87
Q

utility of WVAC in infection of open tibia

A

doesn’t change the numbers?

88
Q

happens in 30% of IMN tibias

A

anterior knee pain. goes away in half if you take nail out

89
Q

location and connections to typical pilon fragments

A

medial is the deltoid, posterolateral (volkmann) is the anterior talofibular ligament, anterolateral (chaput) is the posterior tibiofibular ligament

90
Q

how long to expect clinical improvement in pilon fxs

A

for up to 2 yrs

91
Q

this is more common in hybrid fixation of pilon

A

metaphyseal nonunion

92
Q

normal ankle talocrural angle

A

83*

93
Q

bosworth fx-dislocation

A

distal fibula gets trapped behind tibia, caught on the posterolateral ridge

94
Q

posterior vs lateral plate for ORIF fibula

A

posterior is more stable but has more peroneal tendon irritation

95
Q

location of fx concerning for syndesmotic disruption

A

fibular fxs more than 6mm from the joint

96
Q

medial comminution in talus fxs

A

varus malunion

97
Q

90% of talar dislocations have these

A

associated tarsal fxs

98
Q

medial irreducible talus

A

EBD, capsule

99
Q

lateral irreducible talus

A

posterior tibial interposition

100
Q

typical open fxs of calcaneus wound location

A

usually medial

101
Q

powers ratio

A

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

102
Q

ADI indicative of transverse ligament rupture

A

> 3mm

103
Q

ADI indicative of transverse and alar ligament rupture

A

> 5mm

104
Q

C2 fx mgmt

A

can treat this in halo if the transverse ligament is intact, C1-C2 fusion if not

105
Q

type III odontoid mgmt

A

ORIF if > 5mm displaced

106
Q

halo control of cervical motion

A

not good at controlling axial distraction, best controlling rotation

107
Q

flexion vs extension injuries in lower cervical spine fxs

A

flexion injuries are more unstable

108
Q

implications if you miss child abuse

A

33% further abuse, 10% mortality

109
Q

physeal fxs occur here

A

zone of provisional calcification in the zone of hypertrophy

110
Q

threshold for doing physeal bar resection after growth arrest from fracture

A

if there are more than 2cm growth remaining and less than 50% of the physis is involved

111
Q

at what age can you start IMN for femurs

A

conservative age is probably 14

112
Q

deforming forces in peds prox humerus

A

pec major and the deltoid

113
Q

nerve injury with extension type peds SC humerus

A

AIN neuropraxia

114
Q

nerve injury with flexion type peds SC humerus

A

ulnar nerve injury, which can also be injured with medial pinning

115
Q

this is not needed in the mgmt of pale pulseless hand in peds SC humerus

A

you know where there is vessel injury, so don’t need arteriography

116
Q

etiology of cubitus varus after peds SC humerus

A

malunion, rather than growth arrest

117
Q

this is important when fixing peds type III distal humeral lateral condyle fxs

A

disruption of the posterior blood supply can lead to AVN

118
Q

half of medial epicondyle fxs in peds are assoc c this

A

elbow dislocn

119
Q

peds indications radial head/neck

A

> 30* angulation, >45* rotation, or >4mm translation

120
Q

reduction for nursemaids

A

thumb pressure, then flexion/supination

121
Q

splint position for apex dorsal peds BBFA

A

since MOI is pronation for this injury, splint in supination

122
Q

splint position for apex volar peds BBFA

A

since MOI for this injury is supination, splint in pronation

123
Q

risk of AVN in basicervical peds femoral neck

A

relatively low, increases as you come up the neck

124
Q

rate of growth arrest in distal femoral peds salter injury

A

30-50%

125
Q

peds fx with equivalent mechanism to ACL injury

A

tibial eminence fxs, from valgus, hyperextension often with rotational component

126
Q

mgmt of peds tibial eminence fxs

A

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)

127
Q

cozen fx

A

proximal tibial metaphyseal fx that leads to genu valgum; usually resolves spontaneously

128
Q

this should be in differential for red painful distal tibia in young peds

A

toddlers fx, often normal xrays. cast for 2 wks, repeat films

129
Q

location of the tillaux fragment in peds SH III injury

A

anterolateral

130
Q

where is the thurston-holland fragment in a triplane fx

A

posterolateral tibia. may not be evident on the AP films

131
Q

if a peds tibial eminence fx won’t reduce, what is most likely interposed

A

medial meniscus usually

ABOS PART ONE (11 decks)

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