Trauma

Question 1

Classic deformity in Proximal third tibia fractures and name options to control with IMN

Answer 1

Apex anterior (Procurvatum) and Valgus (due to patellar tendon, gastroc and pes anserene)

Lateral parapatellar entrypoint
Extended medial parapatellar approach
Suprapatellar approach
Poller blocking screws
Unicortical plating (anteromedial)
More lateral entry point
Universal distractor

Question 2

LaFontane predictors of Distal Radius fracture instability

Answer 2

Dorsal angulation > 20 deg
Dorsal comminution > 50%
Palmar comminution
Articular comminution
Initial displacement > 1 cm
Initial shortening > 5 mm
Ulna fracture
Severe osteoporosis

Question 3

Indications for Tibial Plateau ORIF

Answer 3

Articular step-off of >3mm
Condylar widening >5mm
Varus / Valgus instability
Medial Fractures
Bicondylar Fractures

Best outcomes with:
Restoration of joint stability

Bad outcomes with:
Ligamentous instability
Meniscectomy
Alteration of the mechanical axis >5 degrees

Question 4

Medical workup in NOFs

Answer 4

Cause of fall (TIA / MI / UTI / Arrhythmia)
Hb
Electrolytes
Anticoagulants
Albumin (70% morbidity if <3, 17% morbidity if >3)

Question 5

MESS Score and what it means

Answer 5

Mangled Extremity Severity Score
Score >7 = 100% chance of amputation.

“VISA gives you double points after 6 hours”

Velocity
Ischamia
Shock
Age

Velocity:
Low = 1, Medium = 2, High = 3, Extreme = 4

Ischamia:
Poor pulse = 1, Poor perfusion = 2, Avascular = 3

Shock (SBP < 90):
Transient = 1, Persistend = 2

Age:
< 30 = 0, < 50 = 1, > 50 = 2