Trauma

Question 1

What is the eponym for an anterior lateral avulsion off the tibia?

Answer 1

Tillaux-Chaput (AITFL avulsion off the tibia)

Question 2

What is the eponym for an anterior medial avulsion off teh fibula?

Answer 2

Wagstaffe (AITFL off the fibula)

Question 3

What is the eponym for an avulsion fx of the posterior malleolus (posterior lip of the tibia)?

Answer 3

Volkmann fx (PITFL avulsion off the tibia)

Question 4

If you saw an avulsion of the anterior lateral tibia, what fracture classification pathologies would you suspect?

Answer 4

(AITFL avulsion)
PAB stage 2
SER stage 1
PER stage 2

Question 5

If you see a posterior malleolar fx, what fracture classifications/pathologies would you suspect?

Answer 5

(PITFL avulsion)
PAB stage 2
SER stage 3
PER stage 4

Question 6

What is the classification system for anterior process of the calcaneus fx?

Answer 6

Degan
type 1- nondisplaced fx of the tip of anterior process
type 2- displaced extra-articular fx
type 3- large displaced intra-articular fragment, involving CC-joint

Question 7

What is a Cotton’s fx?

Answer 7

trimalleolar fx

Question 8

What is another name for a fracture of the posterior process of the talus?

Answer 8

Steida’s process , Shepard’s Fx; involves the lateral tubercle of the posterior process

Question 9

What clinical exam should you perform if you suspect a fx of the posterior process of the talus?

Answer 9

(toe test of Jack)- dorsiflex the hallux, which will elicit pain in a fracture due to the FHL which courses between the medial and lateral posterior talar processes

Question 10

What is the classification system for a tibial plafond (Pilon fx)?

Answer 10

Ruedi and Allgower
Type 1- distal tibial fx w/o displacement
Type 2- distal tibial fx with significant displacement
Type 3- distal tibial fx with sig. displacement and comminution

Question 11

Describe the classification system for peroneal subluxation/dislocation.

Answer 11

Eckert and Davis
Grade 1- retinaculum separates from fibrous ridge of fibula
Grade 2- retinaculum separates from fibrous ridge, which has ALSO detached from the fibula
Grade 3- invovles an avulsion fx of the fibula

Question 12

where is the zone of avascularity to the achilles tendon?

Answer 12

2-6 cm proximal to insertion

Question 13

where is the zone of avascularity to the posterior tibial tendon?

Answer 13

1.5 cm distal to medial malleolus

Question 14

what is “trench foot”?

Answer 14

caused by prolonged immersion in cool/cold water or mud resulting in blackening and death of superficial tissue

Question 15

what is the correct angle for insertion for throwing syndesmotic screws across the tib-fib joint?

Answer 15

30 deg from the coronal plane inserted from posterolateral in the fibula to anteromedial in the tibia

Question 16

how many screws are used for syndesmotic screws?

Answer 16

1 OR 2 3.5mm screws engaging 4 cortices (removed at 3 months) placed 2cm above the ankle joint

Question 17

what is the normal tib-fib overlap seen on ankle MORTISE view?

Answer 17

> 1mm

>10mm on AP view

Question 18

what is normal medial clear space?

Question 19

what structure do you worry about damaging with a syndesmotic screw?

Answer 19

perforating peroneal artery (as it traverses thru the IO mb)

Question 20

how do you clinically and intra-operatively assess the stability of the syndesmosis?

Answer 20

clinically: frog leg maneuver or squeeze test
intraoperatively: Hook’s test/cotton test or external stress test

Question 21

what is the name of the maneuver to close reduce a SER type injury?

Answer 21

Quigley maneuver- supinate adduct the foot by hanging the foot from an IV