Trauma Flashcards
At least how many views are needed to confirm the diagnosis of a fracture?
2
Does fracture location in cancellous vs. cortical bone affect healing? Discuss.
yes- cancellous bone has better healing potential- better osteogenic properties, large fx surfaces, good soft tissue support
Describe the sequence for closed reduction.
exagerrate
distract
reverse the deformity
immobilize
The principles of closed reduction were described by who?
Charnley
What is the purpose of increasing the deformity when performing closed reduction?
allows for soft tissue that may be interposed between the fragments to be released
What is the clasification system for nail bed injuries?
(Rosenthal)
Zone 1- distal to the distal phalanx
Zone 2- distal to the lunula
Zone 3- proximal to the distal end of the lunula
Healing by secondary intention would be appropriate for which Rosenthal zone of injury?
Zone 1- may consider STSG or FTSG
As a general rule, when should a nail plate be removed if there is a subungual hematoma?
> 25% nail plate involvement
How do you differentiate between a fractured sesamoid and bipartite sesamoid?
fractured sesamoid will have jagged edges
bipartite sesamoid typically is divided in proximal/distal halves while a fx is divided into medial/lateral halves
What is the most common direction for a dislocated 1st MTPJ?
dorsal dislocation of the hallux
what is the radiographic sign that is pathognmonic for non-union?
sclerotic fracture ends
How do you test the stability of the ankle syndesmosis intra-operatively?
cotton test
Hook test
How do you perform the cotton test?
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.
how can you close reduce an ankle fx (SER) mechanism? what is this called?
Quigley maneuver- pull up on the hallux, this causes the foot to naturally invert while the leg externally rotates
what is the classifications sytem for medial mall fx?
Mueller
which foot bones have highest incidence of stress fx?
2nd met, followed by 3rd met
what is the most common fx type of the 5th met?
avulsion fx of the 5th met tuberosity (Stewart 3)
an electric bone stimulator would be most useful for which type of nonunion?
hypertrophic (vascular)
how is atrophic nonunion treated?
surgery to debride fracture ends and a bone graft is inserted with fixation
what is the most common compartment in the leg involved in compartment syndrome?
anterior compartment (followed by deep posterior compartmnet)
what compartment pressures is concerning and should consider fasciotomy?
30-45 mmgHg
what are secondary complications of compartment syndrome?
Volkman’s contractures
myoglobinuria (secondary to muscle necrois)
what is the most commonly involved articular surface affected in calc fx?
posterior facet
there is an avulsion fx at the medial aspect of the medial cuneiform, what is the most likely cause of injury?
tibialis anterior
what structure is most commonly avulsed in anterior process calc fx?
bifurcate ligament
what is a Shephard’s fx?
(aka Steida’s fx) fx of posterior lateral process of the talus
Describe the classification system for peroneal tendon dislocation.
(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
When should a Volkman’s fracture be fixated?
if the fx invovles >25% of the articular surface
