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Trauma Flashcards

1
Q
A
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2
Q

in field triage transport first or fluids first?

A

always transport first, fluids after

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3
Q

pre-hospital blood products - do they help?

A

no more than non-blood products in reducing mortality

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4
Q

when is femoral traction for femur fracture CONTRA indiciated

A

if obvious knee injury

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5
Q

ISS score method

A

take the three highes AIS scores (1-6); any score of 6 automatically makes ISS 75 - ie nonsurvivable

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6
Q

SBP cuttoff as risk factor for mortality

A

90mmHg

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7
Q

key value that indicate shock

A

sbp < 90; lactate > 2; base deficit > 4; TEG values that indicate HYPO coag; hypothermia< 35degC

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8
Q

when to fix pelvic ring, spine, femur or acetab frx

A

WITHIN 36 hrs IF lactate < 4; base def < 5.5; or pH > 7.25

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9
Q

leading cause of death in americans < 45 years

A

injury

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10
Q

ISS cut off for poly trauma

A

16 on ISS

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11
Q

m/c location for nonfatal GSW

A

extremities

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12
Q

damage by shotgun - which factors

A

distance, mass of pellet and shoot pattern

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13
Q

are bullets sterile

A

NO, need to give tetanus

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14
Q

transabdominal GSW causing a EXTRA-articular STABLE fracture

A

non op is ok with 24 hrs broad spec abx

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15
Q

percentage of pts with associated injuries with OPEN fractures

A

typically one third

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16
Q

when to give tetanus toxin

A

if clean or dirty would and > 10 years since last dose, if clean and < 3 doses or unknown, if DIRTY then give both toxoid and TIG

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17
Q

if ABI < 0.9 get which study

A

angio

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18
Q

which abx to add for fresh water injury

A

fluoroquinolone

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19
Q

irrigation guidelines

A

no diff in revision surgery for high vs low vs super low pressure; more revision when using soap vs nl saline solution; no diff when compared to bacitracin; more wound complication with baci

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20
Q

when to provide flap coverage for open frx

A

within 5-7 days; infection rate is 5 vs 31%

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21
Q

comorbids effect on open long bone frx infection

A

ASA A -5%; then 15% then 31%

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22
Q

retoversion during femur IMN leads to

A

externally rotated gait

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23
Q

advntage of NPWT in open wounds and incisions

A

helps reduce infection, improve grannulation bed, reduce drainage and and accelerate primary closure, improve tissue edema

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24
Q

fixation of ankle fractures in diabetics

A

add syndesmotic screws and prolonged immobilization

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25
Q

most cost effective option for mid shaft clavicle fracture

A

sling and delayed surgery if needed

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26
Q

calcium sulfate vs phosphate

A

phosphate is stronger and takes longer to resorb

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27
Q

where to apply clamp for syndesmosis

A

at level of syndesmos and mid tibia

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28
Q

posterior mal with syndemosis injury

A

FIX the posterior mal - even if small size

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29
Q

distal third tibia frx - IMN vs plate

A

better alignment with plate and NO difference in union, infection, or wound issues

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30
Q

most common associated injuries with plateau

A

lat meniscus, then ACL and then collaterals; up to 50% have meniscus injury; highest in schatazker 2 and 4

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31
Q

allograft is osteoinductive or conductive

A

osteoconductive

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32
Q

if lisfranc is suspected but xrays are negative what next

A

WB xrays of foot. Ligamentous injuries don_t need a CT

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33
Q

early fixation of hip fracture reduces

A

pna rate, DVT rate, complication rate, and mortality iat 30 days if done within 48 hrs

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34
Q

mortality in trauma with TXA

A

early TXA administration within 3 hours can reduce mortality

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35
Q

main benefit of ex-fix to pelvis

A

allows for stable clot - does NOT offer “rigid” fixation

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36
Q

plate fixation for which olecranon fractures

A

comminuted, poor bone quality, fracture lines distal to the trochlear midpoint, those invovling cornoid process and monteggia frx dislocation

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37
Q

comanagement of geriatric hip fractures leads to

A

decreased overall mortality (not inpatient); improved ambulation at discharge, lower costs per patient, lower LoS, lower complication and readmission rates

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38
Q

benefits of THA in active hip frx

A

better outcomes, lower overall long term costs, lower revision rates

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39
Q

subtle lisfranc widening parameters

A

interMT space > 2.7mm or space between medial cuneiform and 2nd MT > 2mm

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40
Q

tx of poterior Sternoclavicular dislocations

A

first try closed reduction in OR

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41
Q

higher risk of infection with which plateaus

A

bicondylar, male, smoker, higher ASA, or pulm disease

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42
Q

ASIA A vs B

A

B would have some sensory remaining - even if its just perianal sensation

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43
Q

whats more common in displaced fem neck frx non union or malunion

A

NON-union

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44
Q

recommended ex fix pin care guidelines

A

shower and dry dressing - no data on peroxide vs CHX

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45
Q

how to approach coronoid fractures

A

medially based FCU split - needs a buttress plate; or can use medial hotchkiss approach

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46
Q

hotchkiss approach to elbow

A

most anterior of the medial approaches

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47
Q

non union with bulbous appearing cortex is a

A

HYPERtrophic non-union

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48
Q

patient RF for non-union

A

DM, obesity, nicotine, (Meds - nsaids, steroid, antiepileptics and anticoag), endocrine abnormalities

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49
Q

contraindication to electrical stim device for nonunion

A

synovial pseudoarthrosis; mobile non-union; fracture gap > 1cm

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50
Q

oligotrophic non union can look like

A

atrophic non-union as in they have no callus but have viable bone ends

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51
Q

definition of atrophic non-union

A

have avascular or hypovascular bone ends - may require a osteogenic and osteoinductive bone graft to address

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52
Q

pseudoarthrosis has joint fluid T/F

A

T - has synovial fluid

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53
Q

RIA advantage and disadvantage

A

large volume of graft but lots of EBL

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54
Q

where is fracture shortening better tolerated

A

UE is tolerated better than LE

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55
Q

limit of angular deformity at distal humerus

A

10 valgus; 15 varus;

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56
Q

tolerance of angular deformity at knee or ankle

A

10deg max; even as little as 5 deg can lead to hip or knee OA

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57
Q

Ciery-Mader Stage of osteo

A

Stage 1-4; 1 is IM; 2 is superifical bone only; 3 is whole cortex with invovled endosteum - but not circumferential at the axial level; 4 is entire segment.

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58
Q

rate of RoH in clavicle frx in various plating styles

A

no diff in RoH or union b/w Ant or sup plating

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59
Q

rate of non union with DISPLCED midshaft clavicle

A

15-20%

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60
Q

acromium development

A

pre (tip), meta (base) and meso (middle)

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61
Q

spur sign in acetab frx

A

part of hemipelvis still attached to the pelvis - seen on obturator oblique view

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62
Q

worst solvent to be injected at high pressure

A

oil-based; greeese and CFC based need aggressive debridement, water and latex are least destructive

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63
Q

factors that impact outcomes after solvent injection trauma

A

involvement of tendon sheath, extent of proximal spread; pressure, delay in surgery

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64
Q

capitellar fracture sign

A

double arc sign - internal rotation of the fragment or a poor lateral view can mask this

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65
Q

distal femur periprosthetic frx - lock plate vs IMN

A

lock plate has more NON_union; IMN has more MAL-union

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66
Q

optimal fixation for quad tendon

A

use knotless SUTURE anchors - least amount of gapping with cycling loading and highest load to failure ; better than transosseous or threaded suture anchor

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67
Q

optimal plate length for distal femur frx

A

at least 9 holes in shaft allowing for at least 8 holes proximal to fracture

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68
Q

factors that lead to implant failure in distal femur ORIF

A

obesity, open frx, smoking and YOUNGER age.

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69
Q

factors outcomes in acetab ORIF with posterior wall

A

lots of comminution, greater than 3 fragments suggests decreased success ;

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70
Q

lateral plateau with 10mm joint depression - look for

A

lateral meniscus tears , 8x higher chance

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71
Q

open contaminated distal femur fracture tx

A

ex -fix with I&D and then staged ORIF

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72
Q

tx of open frx in BRAKISH water

A

doxy and 3rd gen cefalosporin

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73
Q

lock plate vs 95 blade plate with distal femur frx

A

no difference in hardware removal; but better able to lock plate with associated coronal fragments

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74
Q

tx of vertical sheer hemi pelvis initially

A

binder and distal femur skeletal traction to reduce the vertically displaced fragment

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75
Q

rate of hardware removal clavicle ORIF

A

25-30 %

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76
Q

immediate mortality rate after hip fracture in hospital

A

6%, 30% at 1 year

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77
Q

LEAP study outcomes

A

amputation and limb salvage had same outcome at 2 years but limb salvage has more re-operation, hospitalization and complication

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78
Q

shortening malunion is better tolerated WHER

A

Upper extremity

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79
Q

angular deformity allowed at distal humerus

A

10 deg of valgus and 15 of varus

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80
Q

clavicle blood supply

A

has no nutrient vessel supply -only periosteeal

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81
Q

what percent of clavicle frx are middle and lateral

A

80% middle; 15% lateral

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82
Q

clavicle classificaiton systems

A

overall it_s the ALLman classificaiton; medial is described by dislocation of SC; middle is middle; lateral is NEER classification

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83
Q

clavicle plating

A

superior is for AXIAL; ant-inferior plating is for bending

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84
Q

non op vs operative clavicle ORIF strengthening

A

4-6 weeks for ORIF; 6-10 for non-op

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85
Q

ogawa classification of coronoid fracture

A

1 is nea the base - more unstable; 2 is at the tip

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86
Q

kuhn classificaiton of acromial fracture

A

1 -non displaced; 2 - displaced but SubAc space preserved; 3 -impingment

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87
Q

scapular frx follow up

A

xray every 2-3 week if non-op

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88
Q

typical deformity in non op prox humerus

A

varus and apex anterior

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89
Q

most common complication of prox hum ORIF

A

screw penetration; not cut out

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90
Q

what inserts on Greater tuberosity of shoulder

A

SSp, ISP AND terres minor

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91
Q

what supplies GT of prox hum

A

arcuat artery of Liang - crosses biceps groove via the ANTERIOR circumflex

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92
Q

highest risk of axillary nerve injury seen with what

A

frx dislocation of prox hum

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93
Q

axilary radiograph uses

A

to ensure GH reduction but may exaggerate the angular deformities

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94
Q

down side to Neer classification for prox hum frx

A

POOR interobserver reliability

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95
Q

plate application in prox hum frx

A

LATERAL to biceps groove; may need to take down anterior third of deltoid insertion

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96
Q

when is IMN contraindicated for prox humerus frx

A

HEAD splitting and osteoporosis

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97
Q

risk of post-traumatic OA in prox hum frx

A

four part; < 8mm calcar, dislocations

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98
Q

common complication of locked screws in prox hum frx

A

head penetration

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99
Q

outcomes of prox hum frx

A

expect improvement up to 1 year; variable outcome based on pre-existing fxn, tuberosity and cuff status

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100
Q

where does IMN canal terminate in humerus

A

3cm prox to olecranon fossa

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101
Q

dual innervation of brachialis

A

radial nerve and MSC

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102
Q

interval in posterior approach to humerus

A

between LATERAL and LONG head of triceps

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103
Q

what exercises are allowed immediately after application of sarmiento

A

applied 7-10 days after splint - ok to begin isometric biceps, triceps, deltoid . Active wrist and hand exercises too

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104
Q

tolerances for humeral shaft frx

A

20 apex ant/post; 30 varus valgus; or 15 rotation, 3cm shortening allowed

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105
Q

infection rate of open fractures of humeral shaft

A

12% withOUT fixation; 10.8% WITH fixation

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106
Q

union rate plate vs IMN for humerus

A

lower with plates

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107
Q

ex fix of humerus

A

SPAN the elbow - 2 pins proximal to humeral shaft fracture and in 2 iin Ulna (preferred) - ulna allows for less NV injury and maintained pronation supination

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108
Q

retrograde humeral nails main downside

A

greater mismatch in size and shape - leads to over reaming

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109
Q

risk of humeral nail interlocks

A

proximally - axillary artery; lateral antebrachial nn, brachial aa, and median nn - distally

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110
Q

when to consider NCV for rad nn palsy for BASELINE

A

at 6 weeks for BASELINE testing

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111
Q

triceps sparing approach

A

involves mobilization of the ulnar nerve with release of extensor mechanism

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112
Q

distal humerus fracture patterns and elbow position

A

when elbow is flexed past 90 - then you get INTERcoloumn frx; when at 90 - you get transcondylar

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113
Q

posadas frx

A

distal humerus transcondylar with distal fragment anteriorly displaced - causes concomittant dislocation of radial head and ulna

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114
Q

Milch classification

A

1 - does not violate lateral trochlear ridge; 2 DOES include Lateral trochlear ridge - hence more unstable as ulna can dislocate

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115
Q

H type pattern of distal humerus is at risk for

A

trochlear osteonecrosis - free fragment

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116
Q

bryan and morrey classification of Lat Condyle frx

A

1 - coronal shear (fix); 2 - cartilage sheer, 3 - comminuted compression (generally excise 2-3); 4 - involves MOST of trochlea

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117
Q

how to find radial nerve posteriorly

A

use later BRACHIAL cutaneous off the post aspect of lateral IM septum - follow proximally to level of deltoid tuberosity on the posterior aspect

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118
Q

when to begin active ROM of elbow after ORIF

A

7-10 days - goal is early ROM

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119
Q

post op ROM after distal humerus ORIF

A

usually 105 arc of motion; with loss of extension more common then flexion

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120
Q

position of arm in radial head frx

A

typically PRONATION -with axial load

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121
Q

tension band for olecranon does NOT resist what forces

A

angular forces

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122
Q

most common monteggia

A

Bado 2 - posterior dislocation of Radial head

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123
Q

shape of proximal ulna

A

has on avg a 6 deg dorsal bend that must be taken into account when placing a plate

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124
Q

coronoid frx implies

A

elbow instablity event occurred

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125
Q

what part of coronoid is most important for VARUS stability

A

medial facet and sublime tubercle - key for VARUS stability as MCL inserts there

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126
Q

posterolateral elbow instablity due to which ligament disruption

A

LCL and coronoid tip frx with possible radial head frx

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127
Q

posteromedial elbow instability due to

A

also due to LCL disruption but anteromedial coronoid fracture is present

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128
Q

approach for medial coronoid frx

A

medial approach by splitting FCU heads or more anterior when you need access to anteromedial facet

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129
Q

best fixation for anteromedial coronoid frx

A

buttress plate via medial approach

130
Q

main stability offered by coronoid process

A

anterior and VARUS

131
Q

MCL status in terrible triad, elbow injury

A

do NOT need to repair MCL if you address LCL and bony injuries in terrible triad.

132
Q

down side of Kocher approaches

A

Kocher (ECU/Anconeus) can lead to injury of LCL; (ECU Split) can lead to injury of PIN; Kaplan (ECRL/Common Extensior) is more anterior

133
Q

downside of overstuffing with radial head replacement

A

limited flexion and erosion of capitellum

134
Q

ismetric point of LUCL in elbow

A

center of capitellum and 2mm anterior to Lat epicondyle

135
Q

common cause of revision surgery after terrible triad

A

for stiffness - 25% need surgery for this and usually get about 30-40 degrees

136
Q

rate of post truamatic OA in terrible triad

A

60-70% on XR but not often symptomatic

137
Q

when are central fibers of interosseous membrane of forearm MOST tight

A

neutral rotation

138
Q

most common complication after sub Q ex-fix for pelvis

A

asymptomatic Heterotopic ossification

139
Q

midhsaft femur fracture with IMN - interlock technique

A

static on proximal and distal fragments

140
Q

platuea with low suspicion for vascular injury - do you need ABI

A

NO - go to ex-fix first

141
Q

fixation of posterior mal accomplishes the following

A

resotres incisura competence and therefore reduces syndesmosis malreduction; stabilizes via PTFL, improves ankle surface area, and posterior stabiliy of talus

142
Q

how does ca-phos dissolve

A

osteoclast mediated degradation

143
Q

what factor is associated with non-union, revision and hardware failure of tibia nails

A

STAINLESS STEEL nails

144
Q

most common cause of nec-fascitis

A

POLY microbial; usually includes streptococci A and enterobacter - most common MONO microbial cause is Group A strep

145
Q

most common assoc diagnosis with nec -fasc

A

diabetes

146
Q

rash from wound vac resolves in

A

48 hours

147
Q

WHY is wound vac contraindicated in tumor bed

A

increased angiogenesis and unclear effect on tumor cells

148
Q

rate of symptomatic malunion in clavicle

A

about 9%

149
Q

pilon or distal tibia ORIF with or without fibula fixation

A

fibula fixation had no effect on alignment, outcomes, or reduction but DID have higher rate of complications related to fibular fixation - hardware removal

150
Q

RIA vis iiac crest graft

A

more quantity than anteior iliac crest harvest and less pain; similar effect on union

151
Q

location of comminution in YOUNG femoral neck frx

A

inferior and posterior

152
Q

NPWT on split thickness skin graft

A

helps incorporate the graft

153
Q

varus posteromedial vs valus posterolateral

A

valgus posterolateral is the terrible triad and has a coronoid fracture with radial head fracture; varus posteromedial has the anteromedial coronoid facet fracture

154
Q

hemorrhag class 1 and 2

A

1 and 2 are BOTH normotensive, 2 has tachycardia and lower UoP

155
Q

hemorrhagic class 3 v 4

A

3 has HR > 120 and confused with UoP 5-15cc/hour’ 4 has NO UoP, lethargic and HR > 140

156
Q

effect of comanagement protcols for hip frx after 60

A

improved Mortality, LoS, complication, readmission rates and ambulatory status at discharge - NO effect on surgical time or time to Surgery, blood loss, or INPATIENT mortality

157
Q

screws vs DHS for hip fracture

A

DHS better for HIGH pauwels angle

158
Q

Demineralized bone matrix is osteo-what

A

osteoinductive (has small amounts of BMP) and osteoconductive

159
Q

allograft is osteo

A

osteoconductive only

160
Q

dropped hallux after tibia IMN

A

due to transient neuropraxia and NOT due to AP screw - most resolve by 4 months

161
Q

benefits of ORIF on distal radius in elderly

A

better motion earlier on, GRIP strength better at 1 year

162
Q

elderly with posterior wall frx have associated

A

knee injuries fractures > ligamentous

163
Q

acceptable malrotation in femur fractures

A

15 deg

164
Q

eldery distal radius frx with positive ulnar variance - tx?

A

NON-op

165
Q

comminution and strain

A

motion is distributed over tiny fragments so overall less strain

166
Q

risk factors for distal femur non-union

A

short plate length (< 9holes); obesity, smoking, YOUNGER age, and OPEN frx - non-locking screws is NOT a risk factor for early failure

167
Q

best tx for Lisfranc

A

FUSION

168
Q

what is the effect of multidiscplinary team for hip frx

A

lower overall cost per patient - no difference in inpatient mortality but there is a diff in OVERALL mortality

169
Q

distal radius ORIF in elderly leads to

A

better GRIP at 1 year; better xrays

170
Q

main ligaments of Lis franc

A

dorsal (weakest) plantar; and oblique interosseous (Strongest)

171
Q

pelvic bleeding from ring fracture is usually caused by

A

sup gluteal; but can also be caused by pudendal if near pubic symphisis

172
Q

tx of morelle lavalle with fracture

A

perc debridement with delayed ORIF OR open debridement with closure of ONLY fascia

173
Q

what instability does terrible triad lead to

A

valgus posterolateral - radial head; coronoid and dislocation

174
Q

varus posteromedial elbow injuries show what structural dmage

A

LARGE anteromedial coronoid fragment - INTACT radial head

175
Q

kocher vs kaplan approaches

A

Kocher (ECU/Anconeus) can lead to injury of LCL; (ECU Split) can lead to injury of PIN; Kaplan (ECRL/EDC split) is more anterior

176
Q

what must be added to atrophic nonunion fixation

A

bone graft

177
Q

amputaiton vs limb salavage

A

better outcomes at 2 years (statistical and clinically) if compared with patients would need flaps or fusions - once these were controlled- then salvage was clinically but not statistically better

178
Q

ptsd in trauma

A

females are 4x higher risk and LE or pelvic injury has 2x higher risk

179
Q

orif vs IMN for humeral shaft - diff in Rad n injury

A

NO difference in iatrogenic injury -only proven diff is shoulder complication

180
Q

pilon outcomes factors

A

no highschool grad is worse outcome; no diff in outcomes for complextiyof fracture at LONG term

181
Q

llong bone septic non-union tx

A

must use spacer - NOT abx nail alone.need to create masquelet for defect as well

182
Q

how does ca phos get absorbed

A

via osteoclast

183
Q

how is hydroxyapatite degraded

A

macrophage and giant cells

184
Q

LEAP results at LONG term

A

equivalent outcomes - return to work is same at 2 years; lifetime cost is 3x HIGHER in amputation group

185
Q

which traits are seen in sacral dysmorphism

A

large S1 foramina; residual S1 disk; mamillary bodies; and steep alar slope

186
Q

dvt ppx reccs for hip frax

A

ACChest Phys recommends 35 days; but at least 10-14 days; PENTHIFRA study shows fondaparinaux better in DVT rates vs lovenox

187
Q

how to cover for brackish water

A

doxy and 3rd gen cefalosporin

188
Q

should you delay surgery for hip frx on plavix

A

NOPE

189
Q

Nsaids vs xrt for HO ppx - whats main conclusion

A

same equialent efficacy or inefficacy, both a/w non-union

190
Q

how accurate are pre and post debridement cultures

A

most open wounds are NEITHER; but generally of cases that become infected, post-debridement is usually 42% - not routinely recommended to get cultures

191
Q

non union of fem neck frx - tx

A

valgus ostetomy

192
Q

risk factors for repeat pelvic angio

A

continued hypotension; PRE angio transfusion > 2 units; or multiple vessels requiring angio

193
Q

bisphos on fracture surgery timing

A

can start within 1 week post-op

194
Q

knee injury incidene with acetab frx

A

15% have associated knee injury; upto 30% are fractures

195
Q

mc complication of IN-FIX for pelvis

A

asymptomatic Heterotopic ossification

196
Q

DBX vs Allograft

A

DBX has BMP so It IS osteoINDUCTIVE; allograft cancellous is DEAD - so only conductive

197
Q

board answer for valgus impacted

A

CRPP

198
Q

femu fracture risk factors for malrotation

A

diaphyseal comminution

199
Q

RIA is what type of graft

A

osteo inductive, conductive and genic

200
Q

what does triplane look lke on AP and lateral

A

on AP - SH 3; on lateral SH 2 with post metaphyseal component

201
Q

tibia flexible IMN post-op tx

A

still requires splint or cast for a short period of time; non-op needs longer immobilization - no difference in malunion

202
Q

where do fractures during THA occur

A

most often at calcar; worst in lateral approach

203
Q

risk factors for intra-op femur fracture during THA

A

lateral approaach, UNCEMENTED, full coat during revision; female gender, and age.

204
Q

r/f for infection after plateau orif

A

male; pulm disease; high ASA, bicondylar, smoking - NOT renal disease

205
Q

fibular fixation during pilon leads to

A

increased complication (mostly due to implant removal) -

206
Q

bone marrow aspirate Is osteo_.

A

inductive AND genic

207
Q

distal femur periprosthetic frx - lock plate vs IMN

A

plate has more NON union vis retro IMN; retro IMN has more malunion

208
Q

fators a/w need for hip replacement in acetab frx

A

older >40; post wall involvement, fem head lesion; impaction; poor post-reduction congruity; intial displacement > 20mm; use of extendediliofem approach

209
Q

strongest fixation for medial mal lag vs antiglide

A

antiglide is more biomex stronger for vertical shear mal; transverse frx use the bicortical screw

210
Q

timing of compartmetn closure and orif for plateau

A

no diff in infection rate; in terms of when to orif vs when to close fascia

211
Q

RoH of tibia flexi nails

A

not needed!

212
Q

predictor of failed fixation for patella

A

increasing age and fixation with wires; OPEN is not a risk factro

213
Q

smashed humeral shaft frx what is tx

A

non-op

214
Q

distal third tibia frx - IMN vs plate

A

no diff in union; wound issues or superfiical or deep infection - less malalignment with plate

215
Q

after reduction of knee dislocation there is no pulse what next

A

vascular consult and explore popliteal fossa

216
Q

risk of life threatening injuries with multilig

A

27%; TBI is 10%; pneumothrax is about 14%; m/c is ipsilatera fracture - 58%

217
Q

what is best use of extended iliofemoral approach to tab frx

A

if BOTH columns are involved or malunions or nonunions

218
Q

adv to tibia IMN vs plate

A

imn has lower radiation; surgery time and less difficult hardware removal

219
Q

posterolateral approach to ankle

A

between FHL and peroneus longus

220
Q

multiple attempts of closed reduction of fem head is associated with

A

osteonecrosis

221
Q

SCH frx with lost perfusion after fixation and no pulse

A

remove pin and unreduce - artery may be trapped in fracture

222
Q

what are risk factors for infection after pevlic and acetab frx

A

obesity with leukocytosis or pre-op angio embolizaion

223
Q

downside of kocher approach

A

cannot extend the approach proximally - unlike a more anterior kaplan

224
Q

main deformity with prox tibia frx IMN

A

PROcurvatum and valgus

225
Q

upper limit for rotational difference in femur fractures

A

15deg

226
Q

modulus of elasticity of titanium

A

100MPa

227
Q

worst WB for acetab frx

A

standing from seated position

228
Q

time up and go vs single leg stance

A

TUG is more for predicting need for walking aid at 2 yeasr; the Leg stance is more for ambulation at 2 y

229
Q

what is most a/w GSW to hip

A

bowel perf; visceral injury

230
Q

what is vitamin C dosing fo CRPS

A

50days of 500mg

231
Q

what is mortality of hip fracture IN HOUSE

A

6% - 30% at 1 year

232
Q

how does electrostim of bone work for healing

A

upregulates growth factors aand BMP, TGF B

233
Q

highest risk of what after patella ORIF

A

ant knee pain

234
Q

tibial amutation bridging vs non-bridge

A

same outcoms but bridging (ERTL) has more complications

235
Q

actual vs perceived intimate partner violence rates

A

40% actual; 10% perceived

236
Q

SPRINT Trial results on risk for adverse events (non union; malunion; hardware failure)

A

stainless steel nail

237
Q

best view for medial epicondyle frx dispacement

A

humeral axial view

238
Q

tx of distal third tibia frx

A

plate BOTH tibia and fibula

239
Q

optimal pin site care

A

shower and dry dressing - no data on peroxide vs CHX

240
Q

shortening of the femur does what to mechanical axis

A

medializes it

241
Q

pilon fracture plate options

A

look for ANTERO lateral plate; -not same as lateral; also - nonlocked over locked

242
Q

most common reason for malreduced mortise

A

malreduced fibula or lateral malleolus

243
Q

what to do with partial union of tibia with mild symptoms after IMN

A

nothing -observ

244
Q

competitive inhibition of plasminogen activation - what drug

A

TXA

245
Q

midline distal third tibia superficial nerve is usually

A

SUP peroneal - not deep

246
Q

gull sign is seen when and means what

A

best on obt oblique - post wall fragment

247
Q

debridement of open tibia and infection risk

A

no correlation on TIMING vs infection; BUT there is reduced infection on debridement vs NON-OP

248
Q

LC fractures and mortality

A

increases with LC grade due to HEAD injury; only modest climbs due to sepsis, ARDS, shock

249
Q

APC and mortality

A

highest rate of fluids, hemorrhage, increasing death rates are due to shock, sepsis, and ARDS - overall highest mortality

250
Q

distal tibia blocking screws

A

place it medial to avoid varus - opposite of proximal tibia

251
Q

open fracture and co-morbidity

A

greater than 3 is higher risk of infection

252
Q

mortality of elderly distal femur fractures

A

typically 25-38% at 1 Year; the same as geriatric hip fractures

253
Q

risk factors for mortality in elderly distal femur

A

advanced renal disease; periprosthetic, dementia, CHF, metastases; non-op has higher mortality. Surgery within 4 days REDUCES 1 year mortality

254
Q

tx of interprosthetic femur fractures with previous distal femur plate

A

revise the distal femur plate to long one - do not use anterior locking plate

255
Q

m/c complication of triangular osteosynthesisi

A

hardware prominence and pain

256
Q

NON displaced transverse patella frx tx

A

if intact extensor mechanism - non-op aand immobilize for short time before isometric quad

257
Q

TXA and adult trauma mortality

A

TXA can improve mortality rates if given within 3 hours

258
Q

best imaging for occulat periprosthetic frx

A

if after negative xray and some time - can get delayed bone scan

259
Q

if continued elbow instability after terrible triad ORIF then

A

check LUCL - and fix

260
Q

best tx for vertical fem neck

A

SHS and side plate

261
Q

supra vs infrapatellar IMN for tibia and knee pain1

A

same incidence

262
Q

ASIA A vs incomplete

A

A is complete; if sacral sparing or peri-anal sensation is intact then it CANNOT be A

263
Q

GSW with transected nerve - when to repair

A

1-3 weeks later to allow soft tissue declaration

264
Q

osteomyoplasty transtibial amputation has what restriction

A

no early fitting or WB due to need for bony union

265
Q

best way to tension EIP to EPL transfer

A

awake with local anesthetic

266
Q

which monteggia has worst prognosis

A

Bado 2 - posterior dislocation of Radial head; main complications are non-union and plate failure

267
Q

peroneal instability after ankle fracture - what is a radiographic clue

A

on lateral view look for fleck sign off fibula -needs repair after trial of bracing

268
Q

what to do if ipsilateral fem neck frx with shaft if CT is negative

A

STILL needs intra-op fluoro

269
Q

risks for distal forearm fracture redisplacement after closed reduction in kids

A

higher risk if worse initial translation (NOT angulation)

270
Q

order of destructiveness in high pressure solvents

A

water and latex are least; grease and CFC refrigerant are intermediate; oil -based is worst and can require amputation due to chronic inflammation

271
Q

tx of perilunate dislocation

A

if < 8 weeks surgery, lig repair; If > 8 weeks - PRC

272
Q

Faith trial on SHS vs CRPP

A

similar rates of union, shortening, or re-operation at 2 years; SHS had more AVN, increase LOS

273
Q

risk factor for shortening with fem neck frx

A

male, higher weight; older age; and pauwels 3

274
Q

CTA vs ABI

A

if post-treatment exam is still asymmetric or concerning, do not need ABI - go straight to angio

275
Q

best view for retrograde ant column screw

A

iliact inlet view - allows to see AP position of screw in rami when placing ant column screw

276
Q

what is associated with mortality in 90 y old after trauma

A

need for ventilation

277
Q

tx of periprosthetic humerus frx

A

ORIF - do not revise arthroplasty unless loose stem - even if cement

278
Q

if pt is long term bisphos with femur pain and neg xray what next

A

prophylactic nail - no advanced imaging

279
Q

traumatic amputation of proximal phalanx should be treated with

A

removal of ray. The stump weakens grip and gets in the way

280
Q

short head of biceps innervation in FEMUR

A

before nerve splits into peroneal and tibial

281
Q

most common complication of distal radius frx

A

median nerve dysfunction up to 30% in some high E cases

282
Q

hybride ex fix vs dual plate for schatzker 5

A

dual plate has higher deep infection rate; ex fix has more pin site superficial infection and more malunion

283
Q

what patient factor can cause anterior cortex perforation of IMN in femur

A

short stature

284
Q

when to fix vancouver AG

A

Greater troch frx needs ORIF cables and troch plate

285
Q

when fixing unstable pelvic ring posteriorly look for_

A

sacrl dysmorphism - may need SI screw at S1 and Trasnsiliac Transacral at S2

286
Q

what is risk factor for TKA after cruciate injury

A

age > 50 – male gender and age <20 are PROTECTIVE

287
Q

tibia fracure compartment syndrome is a/w with

A

younger age; open fracture does NOT increase chance of compartment syndrome

288
Q

debridement of which muscle can prevent HO in acetab frx

A

glut minimus

289
Q

does pin care affect infection rate after SCH frx

A

no difference; only younger age increases risk of infection

290
Q

downside of kocher langenbach approach

A

cannot access SI , comminution going into sciatic notch or fractures extending into the wing

291
Q

downside of helical blade fixation for CMN

A

higher migration and atypical cut out (superolateral)

292
Q

what factor is most related to IATROgenic radial nn palsy during humerus ORIF

A

APPROACH - highest with lateral then with posterior

293
Q

how long to continue abx after open frx debridement

A

24-72 hrs

294
Q

modulus of elasticity equation

A

stress over strain

295
Q

toughness is the

A

area under stress/strain curve

296
Q

brittle definition

A

NO plastic deformation before failure

297
Q

anisotropic vs viscoelastic

A

aniso is based on direction; visco is based on RATE

298
Q

adv of locking screw diameter

A

stronger to shear and bending

299
Q

rate of fragility fracture

A

is falling but overall numbers are increasing due to population demographics

300
Q

what is prolia

A

denosumab - blocks RANKL - need to supplment with vit D and Ca

301
Q

vit d def cutt off

A

< 25

302
Q

most common sciatic variant

A

11% split sciatic nerve and spit pirfiromis

303
Q

vessel damage APC vs LC

A

apc has Sup glut; LC generally has obturator and pudendal or ext iliac

304
Q

APC 1 vs 2

A

in BOTH you have symphsis widening and sacrospinous/tuberous lig tearing; but in APC 2, widening is > 2.5cm and Ant SI is torn too

305
Q

what is a complication of binder application

A

pressure sores to soft tissue at 24 hours

306
Q

which patients get pelvic angio

A

if refractory to 4 L of transfusion

307
Q

before inserting foley in pelvic frx

A

need retro Urethrogram

308
Q

LC 2 vs tx

A

post ORIF and LC 3 is ant and bilat post ORIF

309
Q

common theme b/w APC 3 LC 3 and VS

A

both vertically and rotationally unstable - anterior ex-fix ALONE is NOT suffiicient

310
Q

APC 3 a/w

A

abdominal trauma; high blood loss; shock; and mortality in poy trauma

311
Q

what are late uro complications in men from pelvic frx

A

stricture is m/c (up to 30-40%)

312
Q

poor outcomes a/w with what in pelvic ring fr

A

poor reduction on posterior ring

313
Q

femur frx with chest injury what is tx?

A

consider Ex-fix even if hemodynamically stable if serious lung compromise - reaming can lead to ARDS

314
Q

osteo tx with bone loss

A

if < 2cm then acute shortening is ok in UE; but LE typically use distraction osteogeneis for any significant bone defect

315
Q

typical rate of distraction osteogeneis

A

1mm/day in .25mm increments (4 times per day)

316
Q

surgery cut offs for scapular frx

A

GPA < 22 (normal is 35-40); lateral border offset of 20mm; or angulation of 45 def in scapular Y;

317
Q

when to get pre-op EMG for glenoid frx

A

if > 2 weeks since injury and fracture line includes spinoglenoid nothc

318
Q

what two factors increase risk of prox hum frx osteoNecrosis

A

<8mm calcar and four part; also head split fracture

319
Q

after application of sarmiento when to move arm

A

pendulums right away; can begin isometric biceps, triceps

320
Q

most common distal hum frx pattern

A

intercondylar

321
Q

high E femoral shaft fractures are a/w

A

chest, pevlic and UE injures

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