Trauma

Question 1

At least how many views are needed to confirm the diagnosis of a fracture?

Answer 1

2

Question 2

Does fracture location in cancellous vs. cortical bone affect healing? Discuss.

Answer 2

yes- cancellous bone has better healing potential- better osteogenic properties, large fx surfaces, good soft tissue support

Question 3

Describe the sequence for closed reduction.

Answer 3

exagerrate
distract
reverse the deformity
immobilize

Question 4

The principles of closed reduction were described by who?

Answer 4

Charnley

Question 5

What is the purpose of increasing the deformity when performing closed reduction?

Answer 5

allows for soft tissue that may be interposed between the fragments to be released

Question 6

What is the clasification system for nail bed injuries?

Answer 6

(Rosenthal)
Zone 1- distal to the distal phalanx
Zone 2- distal to the lunula
Zone 3- proximal to the distal end of the lunula

Question 7

Healing by secondary intention would be appropriate for which Rosenthal zone of injury?

Answer 7

Zone 1- may consider STSG or FTSG

Question 8

As a general rule, when should a nail plate be removed if there is a subungual hematoma?

Answer 8

> 25% nail plate involvement

Question 9

How do you differentiate between a fractured sesamoid and bipartite sesamoid?

Answer 9

fractured sesamoid will have jagged edges

bipartite sesamoid typically is divided in proximal/distal halves while a fx is divided into medial/lateral halves

Question 10

What is the most common direction for a dislocated 1st MTPJ?

Answer 10

dorsal dislocation of the hallux

Question 11

what is the radiographic sign that is pathognmonic for non-union?

Answer 11

sclerotic fracture ends

Question 12

How do you test the stability of the ankle syndesmosis intra-operatively?

Answer 12

cotton test

Hook test

Question 13

How do you perform the cotton test?

Answer 13

after fibular fixation is compelte, place a clamp around the fibula at the level of the syndesmosis. place lateral traction and see if there is any widening of the syndesmosis under fluoro.

Question 14

how can you close reduce an ankle fx (SER) mechanism? what is this called?

Answer 14

Quigley maneuver- pull up on the hallux, this causes the foot to naturally invert while the leg externally rotates

Question 15

what is the classifications sytem for medial mall fx?

Answer 15

Mueller

Question 16

which foot bones have highest incidence of stress fx?

Answer 16

2nd met, followed by 3rd met

Question 17

what is the most common fx type of the 5th met?

Answer 17

avulsion fx of the 5th met tuberosity (Stewart 3)

Question 18

an electric bone stimulator would be most useful for which type of nonunion?

Answer 18

hypertrophic (vascular)

Question 19

how is atrophic nonunion treated?

Answer 19

surgery to debride fracture ends and a bone graft is inserted with fixation

Question 20

what is the most common compartment in the leg involved in compartment syndrome?

Answer 20

anterior compartment (followed by deep posterior compartmnet)

Question 21

what compartment pressures is concerning and should consider fasciotomy?

Answer 21

30-45 mmgHg

Question 22

what are secondary complications of compartment syndrome?

Answer 22

Volkman’s contractures

myoglobinuria (secondary to muscle necrois)

Question 23

what is the most commonly involved articular surface affected in calc fx?

Answer 23

posterior facet

Question 24

there is an avulsion fx at the medial aspect of the medial cuneiform, what is the most likely cause of injury?

Answer 24

tibialis anterior

Question 25

what structure is most commonly avulsed in anterior process calc fx?

Answer 25

bifurcate ligament

Question 26

what is a Shephard’s fx?

Answer 26

(aka Steida’s fx) fx of posterior lateral process of the talus

Question 27

Describe the classification system for peroneal tendon dislocation.

Answer 27

(Eckert and Davis)
Grade 1- superior peroneal retinaculum ruptured and fibular periosteum is avulsed from fibrocartilaginous lip
Grade 2- fibrous lip is elevated along with the retinaculum
Grade 3- thin fragment of bone is avulsed from retinaculum

Question 28

When should a Volkman’s fracture be fixated?

Answer 28

if the fx invovles >25% of the articular surface