Trauma Flashcards
What are the risk factors for humeral shaft non-union? (7)
- distraction @ # site;
- open #;
- Vitamin D deficiency;
- segmental fracture;
- infection;
- stiffness;
- patient factors - obesity, smoking, malnutrition,non-compliance
What is the natural history of radial nerve recovery following humeral shaft #s?
- 8-15% incidence;
- 80-90% improve @ 3 months;
- spontaneous recovery @ 7 weeks;
- full recovery @ 6 months
What are the indications for Sx exploration of radial nerve palsy in humeral shaft #s?
- open # with palsy;
- no improvement over 3-6 months;
- fibrications seen @ 3 months - EMG
What is the pathoanatomic cascade of elbow dislocation?
LCL first to MCL last
What are the static stabilizers of the elbow? 1st degree and 2nd degree?
1st degree - UH joint, anterior bundle MCL, LCL complex;
2nd degree - RC joint, capsule, flexor/extensor origins
What are the dynamic stabilizers of the elbow?
- anconeus;
- biceps;
- triceps
What are associated injuries of radial head #s? (7)
- Essex-Lopresti lesions;
- IOM;
- coronoid #s;
- MCL/LCL;
- dislocation;
- terrible Triad;
- carpal #s
Where does the MCL insert on the coronoid specifically?
- 18.4 mm dorsal to tip;
- anterior capsule inserts 6 mm from tip
What is the rate of re-operation for olecranon tension banding?
40-80%
What is the most common nerve injury with Monteggia #s?
PIN
How does one treat malunion of Monteggia #?
ulnar osteotomy + open reduction of radial head
What are the 5 ligaments of the IOM in the forearm?
- central band;
- accessory band;
- distal oblique bundle;
- proximal oblique cord;
- dorsal oblique accessory cord
What are the indications to Tx nightstick # with no op.?
<50% displacement and <10 degrees angulation
What distance from RC joint affects stability in Galeazzi #s?
- <7.5 cm - 55% unstable;
- >7.5 cm <6% unstable
What are the signs of DRUJ injury?
- ulnar styloid #;
- widening of DRUJ;
- volar/dorsal displacement;
- radial shortening >=5 mm;
What are the factors associated with increased mortality with pelvic ring injuries? (4)
- SBP <90;
- age >60;
- increased ISS or RTS;
- need for >= 4 units transfusion
What are the complications of temporary iliac embolization? (2)
- gluteal necrosis;
- impotence
What are the indications for retrograde urethrogram? (3)
- blood @ meatus;
- high riding prostate;
- hematuria
What is the most common distal humerus shaft #?
distal intercondylar #s
What is the Jupiter classification for distal humerus #s?
- High T - above olecranon;
- Low T - below olecranon;
- H (free trochea - increased risk of AVN);
- Y;
- medial lambda (direction of proximal #);
- lateral lambda (direction of proximal #);
- multiplane T
What are the proximal and distal intervals for the medial approach to the elbow?
- Proximal - brachialis/triceps (radial) (MCN);
- Distal - brachioradialis/pronator teres (MED)
When do you go to 1. lateral decubitus; 2. prone; 3. supine for elbow #s?
- LD - isolated single limb trauma;
- prone - spine + contralateral extremity trauma;
- supine - polytrauma
What is the most common dislocation of the elbow?
posterolateral - 80%
What is the Tx algorithm for simple stable elbow?
90% - splint X 7 days with early ROM