Trauma Flashcards
What are the common fracture problems?
Transverse Greenstick torus Oblique/Spiral Comminuted
What fracture pattern is most commonly stable?
Transverse!
What is Vassal’s Principle?
Initial fixation of a primary fracture will assist stabilization of the secondary fractures.
“Ligamentotaxis”
What are the possible complications of fractures?
Delayed union Non-union Pseudoarthrodesis OA AVN
What is the most common cause of non-healing for a bone fracture?
Improper immobilization
Who was Lisfranc?
A field surgeon in Napoleans army
Are dorsal or plantar lis franc dislocations more common?
Dorsal
The plantar ligaments are stronger than the dorsal
What stages of Berdnt and Hardy are often associated with lateral ankle injuries?
2,3,4
Describe DIAL a PIMP
Dorsiflexion Inversion leading to an Anterior Lateral OCD lesion of the talar dome. (Unstable, shallow, wafer-shaped lesion)
Plantarflexion Inversion leading to a Medial Posterior OCD lesion (Deep, Cup-shaped lesion)
What is Hawkins Sign?
Presence of subchondral talar dome osteopenia seen 6-8 weeks after talar fracture signifying intact vascularity.
Absence of sign implies AVN,.
What is the Sneppen classification?
Talar body fractures!
What percentage of fractures of the talus involve the calcaneus?
Of these fractures, how many involve the joint?
60%
Of these fractures 75% of them involve the STJ.
What is mondors sign?
Plantar, rearfoot ecchymosis that is pathognomonic for calcaneal fractures
How is Bohler angle affected by calcaneal fractures?
Bohlers angle is decreased.
norm is 20-40 degrees
How is gissane angle affected by a calcaneal fracture?
Increases with intra-articular calcaneal fracture.
90-105 is normal
What fractures are commonly associated with calcaneal fractures?
Vertebral fractures specifically at the L1
Femoral neck fractures
tibial plateau fxs
What is the mechanism of injury of an anterior calcaneal process fracture?
Inversion with plantarflexion
Rowe IA
When can you tell the ATF is ruptured on the anterior drawer test?
When there is a 5-8 mm drawer
When can you tell the calcaneofibular ligament is ruptured on the anterior drawer test?
When the anterior drawer is 10-15 mm
When can you tell the ATF, Cf, and posterior talofibular ligaments are rupturd?
Anterior drawer test of >15 mm
what angulation of the talar tilt test is pathologic?
What does it tell you?
More than 10 degrees of talar tilt is pathologic
It tells you that there is a rupture of the calcaneo fibular ligament.
Describe the stress inversion test
checks the lateral ankle for tears of the CFL and ATFL
5 degrees of inversion = rupture of ATFL
10-30 degrees of inversion = rupture of ATFL + CFL
What is the thompson test?
A positive test results when squeezing of the calf muscle does not plantarflex the foot.
What is the Hoffa sign?
Increased dorsiflexion compared to the contralaterasl side with the inability to do a single leg heel raise.
Indicates an achilles tendon rupture.
What is seen radiographically with an achilles tendon rupture?
Disruption of Kagers triangle
Where in the achilles tendon is it most likely to rupture?
1.5-4 cm proximal to the calcaneal insertion.
Pott fracture
bimalleolar ankle fracture
Cotton fracture
Trimalleolar fracture
Cedell fracture
Fracture of posterior medial process of the tibia
Shepard fracture
Fracture of the posterior lateral process of the tibia
What is a Foster fracture?
Entire posterior process of the talus
What is a Bosworth fracture?
Lateral malleolar fracture with ankle displacement
What is the most common mechanism of injury causing an ankle fracture?
SER
What mechanism of action causes a transverse lateral malleolar fracture?
Supination Adduction
What is the mechanism of action that causes a short oblique medial malleolar fracture?
SAD II
What is the mechanism of action causing a short oblique lateral mal fracture? (AP view)
PAB III?
What is the MOI causing a spiral, lateral malleolar fracture with a posterior spike?
SER II
What is the MOI of a high ankle fracture?
PER III Maisonneuve fracture
What is a Lauge Hansen type V?
Pronation dorsiflexion!! 1 Vertical tibial malleolar tip fracture 2 Anterior tibial lip fracture 3 supramalleolar fib fracture 4 Transverse posterior tibia fracture level with proximal aspect of anterior tibial fracture.
What is the indication for posterior malleolar fixation?
If the posterior malleolar fracture is greater than 255 of the articular surface area then it needs to be ORIF.
What direction should syndesmotic screws be placed?
Approximately 30 degrees from the sagittal plane from posterior lateral to anterior medial
Should transsyndesmotic screws be inserted with lag technique?
NO!!
These screws are to provide stability, not compression.
Insert the fully threaded cortical screws without overdrilling/underdrilling here across both cortices of the fibula and the lateral cortex of the tibia.
What is a thurston holland sign?
Epiphysis is separated from the physis with the fracture extending into the metaphysis resulting in a triangular fracture fragment.
this is also known as the flag sign.
