Trauma Flashcards
How do you treat a Galeazzi fracture?
- Consider closed treatment if stable after closed reduction
- Usually have to do ORIF radius with pinning of DRUJ. Most common bloack to reduction is interposed ECU.
pin in supination if unstab;e
Repeated visits to ER is a red flag for what?
Domestic abuse
What percentage of the humeral head does the posterior humeral circumflex artery provide?
64%
3 ways to treat HO?
which has evidence supporting it?
NSAIDs (indomethacin)
Bisphosphonates
radiation (700cGy x 1 dose)
None have good evidence
3 indicators HO is mature
Mature, thickened cortex
Distinct separation/demarcation from soft tissue
Presence of a trabecular pattern
*bone scan plays no role now
*Labs (ALP, CRP etc help with diagnosis, but not maturity)
Most important technical step of transfemoral amputation?
Addductor myodesis
Components of TFCC (5)?
central articular disc
meniscal homologue
volar and dorsal radioulnar ligaments
ulnolunate and ulnotriquetral ligament origins
ECU subsheath
It is safer for a proximal A-P locking screw to be proximal or distal to the lesser troch?
Proximal
Ideal length of BKA?
12-15 cm
What is the time cutoff after which you lose the improved outcomes with early repair of miltiligamentous knee injury?
3 weeks
What approach is indicated for open reduction of a) anterior and b) posterior hip dislocations?
Anterior dislocation anterior (Smith-Petersen) approach
Posterior dislocation posterior (Kocher-Langenbeck) approach
What types of plexus injuries does innervation to cervical paraspinal muscles on EMG differentiate between?
Pre and post ganglionic injury (brachial plexus)
What are the only two strong or moderate reccomendations for osteoporotic spinal compression fractures?
Strong recommedation AGAINST vertebraoplasty
(cement without baloon expansion)
Intermediate recommendation FOR 4 weeks of calcitonin if presentation is within 5 days of onset of symptoms
Summarize BMP’s role in tibia fractures
Open tibia fracutres only
Increased union in all open tibia fractures
Decreased infection in grade II open tibias only
(risk of tumour?)
Elderly patient presents 3 days after fall.
Diagnosed with femoral neck fracture.
What is the most relevant non-orthopedic investigation that is required?
Doppler ultrasound
Higher risk of DVT of presentation > 2 days from injury
This was a orthobullets question
Blocks to reduction of lateral subtalar dislocation:
MEDIAL structures
- posterior tibialis tendon
- flexor hallucis longus
- flexor digitorum longus
- Talonavic joint capsule - talar head can buttonhole thru it
- tibial nv bundle
Indications for surgery with a GSW to the lumbar spine include? (3)
1) spinal instability
2) a neurologic deficit is present that correlates with radiographic findings of neurologic compression by the missile.
3) Lead missile is in contact with the cerebrospinal fluid (CSF)
Which pelvic fractures can be treated with WBAT?
APC 1 (no posterior diasthasis)
LC 1 (no crescent fracture)
Four risk factors for AVN in proximal humerus fractures?
- 4 part fracture
- head split
- short calcar segment
- disrupted medial hinge
Mechanism of Bado 1?
Hyperextension
Should you use routine preop traction in elderly patients with hip fracture?
No
JAAOS CPG
What nerve roots are more likely to be injured with sacral fractures?
S2-3 because they occupy a large amount of their foramina comparatively. Injury to S2-S5 will cause impairment of urinary/anal and sexual systems.
Is the saline load test sensitive for traumatic knee arthrotomies?
Unacceptable low sensitivity, even with addition of methylene blue.
Name 5 risk factors for HO (all scenarios)
TBI (worse with decubitus ulcers)
SCI (worse with decubitus ulcers)
Amputation through a zone of injury (worse with blast mechanism)
High ISS
THA
- psoas tenotomy
- cementless
- Smith-pete
TKA
- Anterior femoral notching
- quad trauma
- MUA post-op
Antegrade femoral nail (piriformis start worse)
Distal femoral traction pins (rare)
What do you have to order in addition to standard things when someone has a delayed presentation for hip fracture?
Duplex doppler of bilateral lower extremities
Most common complication of elbow ORIF?
Elbow stiffness
post-discharge hip fracture in elderly, what should you prescribe (or at least set up) for patients (3)
PT: strong evidence for intensive PT
Interdisciplinary care for mild-mod dementia: strong evidence
Multimodal analgesia: strong evidence
Nutritional supplementation/dietetics consult: moderate evidence
Calcium/Vit D: moderate evidence
Osteoporosis evaluation and treatment: moderate
What is needed to consider a SYme?
Post. Tib Pulse and a stable heel pad
What are the benefits of fixing femur fractures within 24 hours?
decreased pulmonary complications (ARDS)
decreased thromboembolic events improved rehabilitation
decreased length of stay and cost of hospitalization
What is the Jean mart method?
Using the angle between a line drawn tangential to the femoral condyles and a line drawn through the axis of the femoral neck to determine if there is rotational malalignment after fixation of a femur
How do you splint/cast medial or lateral epicondyle elbow fractures?
Medial in pronation, Lateral in supination
**** Thumb towards the injury.
Indications for glenoid fixation (fracture characteristics - 3)
- > 25% invovlement with subluxation of humerus
- > 5 mm step
- excessive medialization of glenoid (+1 cm)
How can use you flouro to get proper rotation of a tibial fracture?
Obtain perfect lateral of knee and then rotate c-arm internal by 105-120 degrees and this should give you a mortise view.
Think: From a lateral of knee to AP of ankle you would go internal 90 degrees so to get mortise you add another 15 (105).
In femoral IMN, is it safer for a proximal A-P locking screw to be proximal or distal to the lesser troch?
Proximal
distal=stress riser
What is the union rate of bisphosphonate fractures compared to conventional fractures when treated with IMN?
1:2 (54% v. 98%)
Also have higher complication rate.
What is the most proximal amp. that gives children equivalent walking speeds?
Through knee amputation
Most common impediment to closed reduction of DRUJ?
Tendon of ECU
What differentiates a Milch 1 from a Milch 2 fracture?
Whether or not the lateral intercondylar ridge is intact.
What finding indicates an adequate inlet view?
Overlap of S1 and S2 sacral bodies
Negative prognostic indicators for tibia fractures
high energy fractures
stainless steel nails vs titanium nails
fracture gaps
full postoperative weight bearing
open fractures treated with reamed nailing (?is this correct)
(SPRINT)
What is the difference between the type of nec fasc seen in healthy vs. immunocompromised patients?
immuno = polymicrobial, much more common
healthy = beta hemo GAS, less common (S.Pyogenes)
What is the activity that causes lateral process of talus fractures?
Snowboarding
Name an antibiotic to add for the presence of:
a) fresh water contamination
b) salt water contamination
Fluoroquinolines: add if fresh or salt water injury
Can also use if allergy to cephalosporins
Doxycycline + ceftazidime: Can use for salt water wounds
When comparing operative to nonoperative management of displaced intra-articular calcaneus fractures, what 2 groups of people had better outcomes with surgery?
What was found with all comers?
Women
All-comers NOT on WSIB
All-comers: Equivalent outcomes
What is the significance of roof arc measurements?
Show intact weight bearing dome if > 45 degrees on AP, obturator, and iliac oblique
Need for surgery or not.
Not useful for posterior wall fractures.
For a Lisfranc amputation what deformity is feared and how to avoid it?
- equinovarus
- preserve soft tissue around the base of the fifth MT
Initial abx for nec fasc (4)?
penicillin, clindamycin, metronidazole, and an aminoglycoside then tailor based on cultures
Wound Healing: Ischemic index should be greater than … ?
0.5
Calc fractures:
what is the constant fragment
what makes it constant?
Superomedial fragment (sustentaculum)
This remains “constant” due to medial talocalcaneal and interosseous ligaments (ie it’s attachments to the talus)
Is pregnancy a surgical contra-indication for acetabular fractures?
no
Obtain a fetal U/S pre-op. Xrays are safe.
LMWH is the safest AC.
Name 5 criteria for Gustillo 3 open fracture:
Close range shotgun injuries
High energy GSW
Presentation >24 hours
Contaminated barnyard injuries
Significant comminution or segmentation of fracture
Due to poorer prognosis
Wound >10cm
Vascular injury requiring repair
Injuries requiring soft-tissue coverage
5 things to decrease intramedullary pressure during reaming:
Flexible reamers
Fluted reamers
Fast speed
Small increments
Venting
7 indications for surgery in acetabular fractures
Roof arc angle >45 degrees
Subchondral bone 10mm deep on axial CT not intact
Posterior wall >40%
Displacement of roof >2mm
Marginal impaction
intra-articular loose bodies
irreducible fracture-dislocation
Operative indications in lateral third clavicle fractures? (3 patterns)
- fracture is medial to ligaments (2a)
- fracture is through ruptured ligaments (2B)
- comminuted fracture (5)
Are the short and long term outcomes of displaced olecrenon fractures in elderly treated non-surgically good or bad?
Good - Duckworth et al. 2014
Predictors of poor outcome for acetabular fractures
Age greater than 55
Intraarticular comminution
Osteonecrosis
Delay of greater than 12 hours for reduction of an associated hip dislocation (<6 hours ideal)
Intraoperative complications
Femoral head injury
Non-anatomic reduction
What is the best view for ruling out acetabular perforation by screw?
Obturator oblique
Who benefits from operative intervention in intra-articular calc fracutres?
IN all comers, what is the outcomes of operative vs. nonop?
women
<29 years old
light workloads
Comminuted fracture
Bohler’s angle >0-14 degrees (Higher Bohler’s is better)
Anatomic reduction (i.e. if you can restore anatomy)
In all comers, no difference
What finding indicates an adequate outlet view?
Symphesis shoulder overly S2 body
X-ray beam angled ~45 degrees cephalad (may be as much as 60 degrees)
adequate image when pubic symphysis overlies S2 body
ideal for visualizing:
- vertical translation of the hemipelvis
- flexion/extension of the hemipelvis
- disruption of sacral foramina and location of sacral fractures
What is optimal tip-apex distance?
< 25 mm
Where does the deep deltoid insert of the MM?
Posterior colliculus
According to AAOS CPG, what shoud you use in an unstable IT hip fracture in elderly?
cephalomedullary nail
WHat three joints are most predisposed to post-traumatic arthritis?
- ANkle
- Hip
- Knee
Radial nerve injury with humeral shaft fracture, 4 months out an EMG is done. What do fasciculations mean vs. fibrillations?
Fasciculations = healing nerve
Fibrillations = damaged nerve, indication for surgical exploration
(On NCS low amplitude and delayed potentials are bad)
Indications for an arthrotomy in setting of GSW? (2)
- passage through gut
- retained bullet in joint (can lead to lead poisoning)
Injuries asociated with clavicle fracture
(6)
Head injury
Scapular injury/SSSC/scapulothoracic dissociation
Pneumothorax
Vessel injury
Rib fracture
Brachial plexus injury
What exam finding is consistent with peroneal neurapraxia post tibial nailing?
EHL weakness (dropped hallux syndrome)
B/c branch of deep peroneal nerve to EHL is usually the one affected by proximal interlocking
NOT superficial peroneal
(JBJS Br 1999)
Acetabular approach with highest risk of avn to femoral head?
Kocher-Langenbach
How long after a pilon fracture will post-traumatic arthritis typically set in?
1-2 years
What sort of knee dislocation shows a “dimple sign” and why is this significant?
- posterolateral dislocations
- medial femoral condyle buttonholed through the capsule. These are difficult to reduce closed so should be done open urgently.
Femoral Head Fracture Classification. Describe
Pipkin
I: infrafoveal, not involving weight bearing surface
II: suprafoveal, involving weight bearing surface
III: associated femoral neck fracture
IV: associated acetabular fracture
JAAOS CPG Distal radius
Should you use vitamin C?
Yes - moderate evidence FOR use to prevent disproportionate pain
Where is the most common Hoffa fragment located?
Coronal shear fracture of lateral femoral condyle
What are the 5 associated acetabular fracture types?
- T-Type
- Associated both columns (Spur sign)
- Anterior wall, posterior hemi-transverse
- Posterior column and wall
- Posterior wall and transverse
What substitute has the highest compressive strength for filling a bone void (i.e. in tibial plateau fractures)?
Calcium phosphate
Benefits of Hemiarthroplasty over THA in femoral neck fractures
Lower incidence of post-operative dislocation
lower blood loss
lower operative time
Benefits to TEA in intra articular, comminuted distal humerus fractures in the elderly?
McKee et al RCT:
Quicker procedure, improved DASH scores at 6 months, improved elbow ROM, and decreased revision rates.
Frankle et al reccomend TEA if over 65 and: Arthritis, osteoporosis, or other diagnoses requiring steroids
What did the COTs trial tell us about clavicle fractures (shaft)?
They found that Constant and DASH scores were improved in the operative fixation group at all points in time, with union time being 28 weeks in the nonoperative group and 16 weeks in the operative group. Malunion was higher in the nonoperative group as well. This is for 100% displaced fractures.
2 options for ORIF of coronoid (technique)?
- A suture passed through 2 drill holes
- Posterior to anterior lag screws
Grade 1 open tibia treated staged with definitive management 48hrs later with BMP
What are the effects?
Decreased non-union only
Decreased infection rates only for grade III open
In what order should things be fixed in a terrible triad injury?
(1) restore coronoid stability through fracture fixation or capsular repair
(2) restore radial head stability through fracture fixation or replacement with a metal prosthesis
(3) restore lateral elbow stability through repair of the lateral collateral ligament (LCL) complex
(4) repair the medial collateral ligament (MCL) in patients with residual posterior instability
(5) apply a hinged external fixator when conventional repair did not establish sufficient joint stability to allow early motion.
What is the biggest contraindication to using a piriformis start point?
Pediatric patients.
It can cause AVN of the head.
What is a risk for HO in BBFA fractures and when can you safely excise it post-op?
- use of a single incision
- 6 months post op
(don’t worry about bone scan)
4 types of proximal tib-fib instability
Anterolateral - most common
posteromedial
superior
Atraumatic subluxation
What is the 1 year mortality following hip fracture?
14-36%
Also 50% loss of independance
Highest for Intertrochs
What approach is used for thigh fasciotomy?
Anterolateral
A laterally displaced scapula is a radiologic clue to what serious injury?
Scapulothroacic dissociation
Describe the radiographic union score for tibial fractures (RUST)
Look at each cortex on AP and lateral x-ray (4 in total)
Each one given a score
1: fracture line with no callus
2: callus with fracture line
3: callus with no fracture line
Radiographic healing is when bony callus is evident on 3 cortices AND score >/= 7
What does serendipity view assess?
Sternoclavicular joint
What is the characteristic deformity with malunited proximal tibia fractures?
Valgus and procurvatum
What is the most stable type of sacral fixation?
Combined iliosacral and lumbopelvic fixation (triangular osteosynthesis)
What serious condition is often found in conjunction with a posterior hip dislocation?
(not orthopaedic)
Thoracic aortic rupture
Predictors of poor outcome of polytraumatized patient (5)
Base deficit: most important predictor of morbidity and mortality
Elevated IL-6
High ISS
Elevated serum lactate
Intra-operative hypotension In polytrauma patients with severe brain injury
How much humeral head depression is an indication for hemi-arthroplasty?
40%
Three main surgical steps when there is a vascular injury requiring repair following knee dislocation.
- reduce and stabilize e.g. Ex fix first
- vascular repair - remove damaged area and use reverse saphenous graft (or bypass, etc as per vascular sx)
- perform prophylactic fasciotomies
Most important fragment in calcaneus fractures?
Constant fragment - sustentaclum tali
Work off of this fragment
5 indications for acetabular fracture fixation?
displacement of roof (>2mm)
posterior wall fracture involving > 40-50%
marginal impaction
intra-articular loose bodies
irreducible fracture-dislocation
What are the surgical approaches for an a) axillary or b) subclavian artery injury in an unstable patient with a scapulothoracic dissociation?
a) high lateral throacotomy with vascular repair
b) median sternotomy with vascular repair
Describe dynamic vs. static tension band
Dynamic: produces more compression force with loading
ie: olecranon, patellar
Static: produces a relatively constant force
ie: medial malleolus
Hip fractures in the elderly should have OR within what time frame?
48 hours
JAAOS CPG
Treatment for transabdominal GSW with intra-articular contamination?
Urgent I and D
Wound Healing: ABI should be greater than … ?
0.45
Factors for poor outcome post ORIF calcanues
age > 50
obesity
manual labor
workers comp
smokers
bilateral calcaneal fractures
multiple trauma
vasculopathies
men do worse with surgery than women
Secondary stabilizers of elbow (3)
Radiocapitellar joint capsule
origins of flexors and extensors
How do you investigate for urologic injury in pelvic fractures and what are the indications (3)?
retrograde urethrocystogram
indications for retrograde urethrocystogram include:
- blood at meatus
- high riding or excessively mobile prostate
- hematuria
Outcomes of spinal vs. GA in elderly with hip fractures?
Similar outcomes
Strong evidence
AAOS CPG 2014
Now you can tell your patients it doesn’t matter
Femoral neck fractures treated under what time frame have better outcomes
NO association between time to treatment of femoral neck fractures and outcome
outcomes based on QUALITY of reduction
Nonanatomic reduction leads to higher rates of AVN
With DRUJ instability associated with distal radius fractures, what is a sign on xray, what is the intra-operative test and what structure is most likely damaged if testing is positive?
- ulnar styloid fracture
- shuck test
- Radioulnar ligaments of TFCC
What is the rate of posterior mal fractures with a) spiral distal third fracture and b) any tibial shaft fracture ?
a) 40%
b) 10%
How long after fracture fixation before CRP starts to decrease in cases of no infection?
48 hours
What part of the urethra is most commonly injured in pelvic trauma?
Bulbous (or bulbomembranous)
JAAOS CPG Distal radius
What is the role for PT and early wrist ROM?
PT: limited evidence for
Early ROM: moderate evidence against - NO early ROM
Cemented or uncemented stems in arthroplasty for hip fractures in the elderly?
Moderate evidence supports preferential use of cemented femoral stems in patients undergoing arthroplasty for femoral neck fractures
AAOS CPG Sept 2014
Indications for tibial plateau ORIF
Articular stepoff >3mm (controversial)
Condylar widening >5mm
Varus/valgus instability
All medial plateau fractures
(These are like knee dislocations)
All bicondylar fractures
What are the two advantages of IM nail of tibia over casting?
- shorter time to union
- shorter time to weight bearing
Where does the saggital Poller screw go with proximal tibia fractures?
In the lateral aspect of the proximal fragment - it directs the nail medially to prevent valgus
Where does the coronal Poller screw go with proximal tibia fractures?
In the posterior aspect of the proximal fragment - prevents procurvatum deformity by directing nail anteriorly
What is the cut off of over-stuffing RH replacement and how do you assess it (give 3 ways)
No more than 2.5 mm
- Best assessed under direct visual examination of lateral UHJ.
- take intra-op xrays. Asses by visualising the lateral aspect of the ulnohumeral joint when the radial head is resected and comparing this to when the trial radial head is reduced in place. The lateral UH joint shouldnt be divergent with the radial head.
- size radial head replacement with excised anatomic head (if possible)
One study shows it shouldn’t go more than 1 mm proximal that the lateral aspect of coronoid.
What are the symptoms of Fat Emboli Syndrome?
The major clinical features of FES include hypoxia, pulmonary edema, central nervous system depression, and axillary or subconjunctival petechiae.
What nerve at risk with AIIS screws?
LFCN
Outcomes of locking vs. nonlocking plates in tibial plateau fractures
equivalent complications and outcomes vs. non-locking plate
Three indications for plate fixation of olecrenon fracture?
- comminution
- extension past the coronoid
- in the setting of associated instability
Three risk factors for malunion after treatent of femur fracture with IM nail?
- night time surgery
- use of a fracture table
- fracture comminution
TEA vs. ORIF for comminuted distal humerus fractures in elderly.
Name important Outcomes
4 things
TEA has:
- Less OR time
- Better functional outcomes at 2 years
- No difference in reoperation rates
- No difference in ROM
Indications for Damage control orthopaedics (7):
ISS Score:
- ISS > 40 in a patient WITHOUT thoracic trauma
- ISS > 20 in patient WITH thoracic trauma
Blood loss:
- Multiple injuries with severe pelvic/abdominal trauma and hemorrhagic shock
Bilateral femoral fractures
Pulmonary contusion on CXR
Hypothermia
Head injury with AIS greater than or equal to 3
Any patient “in-extremis”Indications of patient in extremis: 3 out of 4 of:
- BP
- Platelets
- Temperature
- Major soft tissue injuries
Name 6 risks of radioulnar synostosis
(there are 13)
Trauma related
Monteggia fracture
both bone forearm fractures at the same level
open fracture,
significant soft-tissue lesion
comminuted fracture
high energy fracture
associated head trauma
bone fragments on the interosseous membrane
Treatment related
use of one incision for both radius and ulna
delayed surgery > 2 weeks
screws that penetrate interosseous membrane
bone grafting into interosseous membrane
prolonged immobilization
Where does the blood supply for patella come from chiefly?
Inferior
Distal radius fractures: Predictors of loss of reduction
Lafontaine’s Criteria
Dorsal angulation >20 degrees
Comminution:
- Dorsal comminution >50%
- Palmar comminution
- Intra-articular comminution
Initial displacement >1cm
Initial radial shortening >5mm
Associated ulnar fracture
Severe osteoporosis
Primary stabilizers of elbow? (3)
Anterior bundle of MCL
LCL
Ulnohumeral articulation
Braking time post lower extremity fractures are decreased until when? Base line at?
Significantly decreased for 6 weeks after initiation of weight bearing
Baseline at 8-9 weeks
What single patient factor nearly doubles the mortality of patients 2 years following hip surgery for fracture?
Chronic renal failure
Acceptable alignment parameters for humeral shaft fracture?
What does the Cierny calssification describe?
Osteomyelitis:
- medullary
- superficial
- local
- diffuse
** 3 and 4 are indications for I and D along with sinus tract and abscess and failure of conservative treatment
Also host type:
Host Type
Type A = Normal
Type B = Compromised
Type C = Treatment is worse to patient than infection
What is a Holstein-Lewis fracture?
A spiral fracture of the distal one-third of the humeral shaft commonly associated with neuropraxia of the radial nerve
Advantages of ORIF clavicle fracture
Midshaft displaced
Advantages:
Improved results with ORIF for clavicle fractures with >2cm shortening and 100% displacement
Improved DASH and Constant scores with operative management at all time points
Improved functional outcome/less pain with overhead activity
Faster time to union
Decreased symptomatic malunion rate
Improved cosmetic satisfaction
Improved overall shoulder satisfaction
Increased shoulder strength and endurance
Decreased overall complications (JBJS2012 - McKee)
Disadvantages
Increased risk of need for future procedures
Removal of hardware COMMON (30%)
Debridement for infection
4 xray findings of DRUJ injury?
- ulnar styloid fx
- widening of joint on AP view
- dorsal or volar displacement on lateral view
- radial shortening (≥5mm)
Indications for surgery for clavicle fractures
Absolute:
Unstable group II (IIA, IIB, V)
Displaced fracture with skin tenting
Subclavian artery or vein injury
Floating shoulder
Symptomatic nonunion
Posteriorly displaced group III fractures (posterior displaced medial fracture)
Displaced Group I (middle 1/3) (100% displaced) with >2cm shortening
Relative:
Brachial plexus injury
Questionable b/c 66% have spontaneous return
Closed head injury
Seizure disorder
Polytrauma patient
After you fix the radius in a Galeazzi fracture (radius), what do you do?
Assess DRUJ:
If reduced and stable: 6 weeks casting in supination
IF reduced but not stable: pin for 6 weeks
IF not reduced: Dorsal capsulotomy, remove interposed tissue, usually ECU, fix any large styloid boney fragments, pin for 6 weeks in supination
How much fluid do you bolus in a paediatric trauma patient?
20mL/kg
Which direction of subtalar dislocation is more common? More likely to be open?
Medial more common
Lateral more likely to be open
4 indications for fixation of sacral fractures
- displaced fractures >1 cm
- soft tissue compromise
- persistent pain after non-operative management
- displacement of fracture after non-operative management
How much do you want to preserve for great toe amps?
1 cm proximal phalanx. This preserves plantar fascia, sesamoids and FHB.
What combination of pressure and solution type should you use for open fracutre I&D?
Saline better than soap (soap had increased reoperation rates)
Pressure doesn’t matter - can be very low, low or high pressure
(FLOW study NEJM 2015)
What has to be elevated out of the way when using an anterolateral approach for talar neck orif?
EDB
Most important predictor of 1 year survival after femoral neck fracture in elderly
Preoperative mobility
Other risks for mortality include:
Male sex
preoperative cognitive impairment
CRF
Delay in surgery > 4 days
TIbial plateau fractures with highest rate of vascular injury?
What must you do?
Shatzker IV: represents medial fracture dislocation
Must do ABI
What are the three factors that influence development of post traumatic OA in the long term?
Congruity
Instability
Alignment
JAAOS 2014
What is the primary treatment for delayed EPL rupture following closed treatmnet of DR fracture?
EIP to EPL transfer.
Best order for insertion of cannulated screws?
1-inferior screw along calcar (posterior aspect)
2-posterior/superior screw
3-anterior/superior screw
Starting point at or above level of lesser troch
Where is characteristic location for a bipartite patella?
Superolateral
Risk factors for wound problems after operative management of calcaneus fracture? (3)
Open fractures
>
Diabetes
>
Smoking
2 absolute indications for amputation following trauma
crush injury with warm ischaemia time >6hrs
Non-repairable arterial injury