Trauma Flashcards
List risk factors for a clavicular shaft fracture non-union
Advanced age, female gender, smoking, extensive comminution, fracture displacement > 2cm (most likely predictor)
What is the age at which the medial clavicular epiphysis closes? Why is this an important piece of trivia?
20-25 yrs, last in the body. Important to distinguish SC dislocation from a physeal fracture.
Describe how to obtain a serendipity XR, and what it’s evaluating for.
Patient supine, beam at 40-45* cephalic. Looking for anterior-posterior displacement of the SC joints. Bilateral on one XR is most helpful.
Operative indications for SC dislocations?
Posterior dislocations: put mediastinal structures at risk
If taking an SC dislocation to the OR for reduction, what service should be immediately available?
Thoracic, if there is mediastinal involvement or complications
Describe the classification of distal clavicular fractures
Neer
Type 1: lateral to CC with intact ligaments, stable -> non-op
Type 2a: medial to CC, with intact ligaments, unstable -> op
Type 2b: lateral to CC with both torn, between CC with conoid torn, unstable -> op
Type 3: intra-articular, stable, non-op
Type 4: physeal, stable, non-op
Type 5: comminuted, unstable, op
What is the most important predictor of functional outcome after a scapulo-thoracic dissociation?
Neurovascular status at the time of injury
What are the predictors of humeral head ischemia after proximal humerus fracture?
<8mm calcar on articular segment, disrupted medial hinge. Head split doesn’t predict vascularity
What is the main blood supply to the greater tuberosity of the humerus?
Arcuate artery, branch of the anterior humeral circumflex
Describe the Neer classification of proximal humerus fractures
Based on position and number of fragments: anatomic neck, surgical neck, GT, LT. 1-4 ‘part’. Considered separate ‘part’ if displaced >1cm (5 if GT) or 45deg angulation.
What is the most common complication following ORIF of proximal humerus fracture?
Screw cutout from the head segment
When following a non-op’d humeral shaft fracture is a lack of callus concerning for nonunion?
Six weeks.
No callus at 6 weeks as a nearly 100% rate of nonunion
Where is the Volkmann fragment?
Posterior tibial plafond / posterior malelolar fragment
Where is the Chaput fragment?
Anterior lateral tibial plafond
What is a sequestrum?
What is an involucrum?
Sequestrum: is the nidus of a bone abscess; nidus of dead bone
Involucrum: new bone forming around an abscess
What is the rate of distraction for distraction osteogenesis?
1mm/day
What is the most predictive factor for AVN of the humeral head in a proximal humerus fracture?
Calcar length <8mm attached to head segment
