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Podiatry Handbook notes > Trauma chapter > Flashcards

Trauma chapter Flashcards

1
Q

How to treat metatarsal fractures

A
  • close reduce to correct sagittal and transverse displacement
  • if unable to reduce ORIF with pinning
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2
Q

Etiology of 5th met fractures

A
  • Large ground reactive with failure of stationary foot to evert
  • Torsion at the 5th met as a stabilizer to the foot
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3
Q

Why are 5th met fractures hard to heal

A
  • Watershed area of inraosseous blood supply to the metaphyseal region
  • Mechanical pull of PB
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4
Q

What are the arteries that provide intraosseous circulation (3)

A

1) periosteal plexus
2) nutrient artery
3) metaphyseal/epiphyseal arteries

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5
Q

Conservative treatment options for 5th met fracture

A

-6-8weeks NWB casting

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6
Q

Surgical treatment options for 5th met fracture

A

-IM screw 4.5 cancellous is narrowiest that should be selected

  • Ex-fix
  • Trephine arthrodesis with graft from calcaneus
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7
Q

What are the classification systems to describe 5th metatarsal fractures

A
  • Stewart classification
  • Torg classification
  • Lawrence and Bott classification
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8
Q

Describe the Stewart classification

A

1) Extra-articular Jones fracture
2) Intra-articular non comminuted fracture
3) Extra-articular avulsion fracture (PB)
4) Intra-articular comminuted fracture
5) Apophysis fracture

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9
Q

Describe Torg Classification

A

Type I: acute injury

Type 2: delayed union

Type 3: Nonunion

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10
Q

Describe Lawrence and Bott classification

A

1) Avulsion fracture due to lateral band of plantar fascia or PB contractures
2) Jones fracture due to ground reactive force with failure of the foot to evert
3) Diaphyseal fracture due to chronic stress, and repetitive distractive forces

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11
Q

Surgical treatment of 5th metatarsal fractures

A

-Tension band… Locking compression with distal ulnar hook plate

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12
Q

What is the etiology of Tailor’s bunion

A
  • structural

- biomechanical: varus 5th toe, flatfoot,

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13
Q

Classification system for Tailor’s bunion

A

Fallat classification

1) Enlarged 5th met head
2) Lateral bowing
3) Increased IM angle
4) Combination of all 3

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14
Q

Angles to consider with Tailor’s bunion

A
  • Lateral deviation angle: abnormal 8

- 5th MT IMA angle: 8 is abnormal

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15
Q

Surgical procedures used to correct Tailor’s bunions (11)

A
  • Exostectomy
  • Arthroplasty
  • Davis
  • Dickson and Dively
  • Devries
  • Amberry
  • McKeever
  • Reverse Hohmann
  • Long oblique distal osteotomy
  • Reverse wilson
  • Reverse Austin
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16
Q

Describe exostectomy

A

removal of lateral eminence

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17
Q

Describe arthoplasty

A

removal of part/whole 5th mt head

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18
Q

Describe Davis

A

reverse Silver

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19
Q

Describe Dickson and Dively

A

Davis+removal of bursa

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20
Q

Describe DeVries

A

removal of lateral plantar condyle

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21
Q

Describe Amberry

A

Davis+removal of base of proximal phalanx

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22
Q

Describe McKeever

A

resection of 1/2-2/3 of 5th met

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23
Q

Describe reverse Hohmann

A

transverse osteotomy in neck

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24
Q

Describe long oblique distal osteotomy

A

Weil osteotomy like cut at the MT neck

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25
Q

Anatomy associated with Lisfranc complex

A
  • Complex composed of dorsal (weakest) Plantar (strongest) and interosseus ligaments
  • 2nd TMT joint is the keystone of the arch
  • No interosseus ligament between 1st and 2nd MT
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26
Q

Etiology of Lisfranc fracture

A
  • most injuries in Dorsal direction
  • Forced abduction
  • Twisting with an axial loading of a PF foot
  • Motor vehicle accident
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27
Q

Clinical signs present with Lisfranc injury

A

Plantar ecchymosis sign

Apprehension sign: with FF DF and abduction

Stress exam of midfoot: unstable TMTJ with pronation and eversion

RULE OUT COMPARTMENT SYNDROME

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28
Q

X-ray findings associated with Lisfranc injury

A

Space between 1st and 2nd MT should be equal inspace with medial and intermediate cuneiform

  • Drop in arch
  • Fleck sign
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29
Q

What are the classification systems used to describe Lisfranc injuries

A
  • Harcastle
  • Quenu and Kuss
  • Nunley
30
Q

When is surgery needed with Lisfranc injuries:

A

When there is plantar instability and when there is >2mm displacement

31
Q

How many incisions are used with Lisfranc surgery and what structures are fixated

A

3 incisions are used.

  • medial to 1st met
  • in 2nd interspace
  • in 4th interspace

ORIF used to achieve arthrodesis of 1st-3rd TMTJ

Do not fuse 4 and 5 because they are essential joints.

32
Q

What is the etiology of talar neck fracture and what xray view is used

A

Etiology: axial load+ hyper dorsiflexion. Aviators Astralagus

-Canale X-ray view

33
Q

What is the etiology of talar head fractures

A

1) Crush/compression

2) Axial load on navicular

34
Q

Etiology of talar body fractures

A

1) osteochondral
2) Comminuted

These have similar rates of AVN as neck fractures

35
Q

Etiology of posterior process fractures

A

-Shepard’s or cedell fractures occur with forced PF of the foot.

Steida process: intact medial tubercle

36
Q

Blood supply to the head/neck of talus, body of the talus and posterior portion of the talus

A
  • Head/Neck: DP and ATA
  • Body: Artery to tarsal canal (PTA), artery to tarsal sinus(peroneal)
  • Posterior: peroneal artery and calcaneal branches
37
Q

Describe Canale view:

A

AP view with foot PF, pronated 15 degrees to view angular deformity of talar neck

38
Q

Describe Hawkins sign

A

subchondral sclerosis on AP view at 6-8 weeks and indicates healing

39
Q

Treatment of talar fractures

A

surgical emergency if protrusion of bone against skin causing skin necrosis, prompt reduction of fracture needed.

40
Q

What classification system used for talar neck fractures and what does it say about blood vessels damaged and risk for AVN

A

Hawkins classification

1: 1 vessel disrupted. 12% risk for AVN
2: 2 vessels disrupted. risk of AVN 20-50%
3: 3 vessels disrupted. Risk of AVN 50-90%
4: all vessels disrupted. Risk of AVN 90-100%

41
Q

What classification system used for talar body fractures

A

Sneppen classification

42
Q

describe sneppen

A

1: OCD Talar dome- compressive injury
2: Body (coronal/sagittal)- shear, sever DF
3: Posterior tubercle (shepard or cedell)
4: Lateral process- Snowboarder fracture with DF eversion
5: Crush injury

43
Q

What is the MOI for posterior process fracture

A

Forced plantarflexion with compression of talar posterior process between the posterior malleoli and calcaneal tubercle

44
Q

Clinical presentation sign seen with posterior process fractures

A

Nutcracker sign: pain with forced ankle PF

45
Q

Which part of the Navicular is considered to be avascular

A

Plantar central 1/3

46
Q

What classification system is used to describe navicular fractures

A

Watson and Jones classification

47
Q

Describe Watson and Jones classification

A 
I: Fracture of Navicular tuberosity
II: Dorsal lip avulsion fracture
III: Fracture of the navicualr body. (Sangeorzan)
3A: Coronal
3B: Dorsolateral to plantarmedial
3C: comminution 
IV: stress fracture
48
Q

Clinical presentation of Calcaneal fracture

A

Mondors sign

back pain between T12 and L2

Compartment syndrome

Hoffa’s sign- less taut Achilles tendon

Lateral wall blowout

49
Q

X-ray views to get when suspecting calcaneal fracure

A

Brodens view: to view posterior facet

Isherwood view: 3 oblique views to view all facets

Calcaneal axial view: lateral widening and varus orientation

50
Q

Radiographic angles to keep in mind when dealing with calcaneal fractures

A

Bohler;s angle: normal 20-40 decrease with fracture

Gissane’s angle:normal 120-145. Increase with fracture

51
Q

What classification systems are used with calc fractures

A

-Extraarticular, X-ray: Rowe

Intraarticular, CT: Sanders

Essex-Lopresti

52
Q

Describe Rowe’s classification

A

IA: fracture through calcaneal tuberosity
IB: Fracture through sustentaculum tali
IC: fracture through anterior process

2A: Posterior process
2B: Avulsion fracture of Achilles tendon

3: oblique fracture through body but extraarticular
4: oblique fracture through body intraarticular
5: comminuted/joint depression

53
Q

Describe Sander’s classification

A

1: any fracture that is non displaced
2A:Displaced lateral
2B: Displaced middle
2C: Displaced medial

3AB, 3AB, 3BC: 3 fragments

4: four comminuted fragments

54
Q

Describe Essex and Lopresti

A

A: tongue type

B: Joint depression

55
Q

What are the goals of surgical treatment of calcaneal fractures (3)

A
  • Restore the height/length
  • Prevent varus/valgus
  • Prevent posterior facet step off
56
Q

What are the poiatric surgical emergencies(4)

A

Gas gangrene

Compartment syndrome

Necrotizing fasciitis

  • open fractures
  • anything that causes N/V compromise
57
Q

What classification system is used for open fractures

A

Gustilo and Anderson

58
Q

Describe Fustilo and anderson

A

1- Opening in the skin <1cm
2- Opening in the skin between1-5cm

3A: Greater than 5 cm with great soft tissue coverage
3B: Greater than 5cm with periosteal stripping
3C: Greater than 5 cm with arterial damage3

59
Q

Fracture blisters, etiology , how to prevent, how to resolve

A

etiology: due to high energy trauma from mechanical shear force

Early operation prevents formation of blisters

Treatment: best to wait for blister to resolve than cutting through it

60
Q

How to diagnose compartment syndrome:

A

Stryker (Wick’s), slit catheter

61
Q

What are the compartment pressures during a compartment syndrome

A

Intra-compartmental : >30mmhg

Extra-compartmental: within 10-30mmHg of diastolic BP

62
Q

Clinical presentation of compartment syndrome

A

6p’s

Pain out of proportion
Paresthesia
Pallor
Pulselessness
Paresis
Paralysis
Pressure
63
Q

What is Volkman’s contracture

A

ischemic necrosis causes muscular contracture

64
Q

What organism to think of if puncture wound through shoe

A

pseudomonas

65
Q

What organism to think of if puncture wound through soil

A

clostridia

66
Q

What organism to think of if puncture wound from dog bite

A

pasteurella multocida

67
Q

What organism to think of if puncture wound from cat bite

A

pasteurella multocida

68
Q

What organism to think of if puncture wound from cat scratch

A

bartonella henslae

69
Q

What organism to think of with human bite

A

eikenella

70
Q

What classification system for nail injury

A

Rosenthal

71
Q

Describe rosenthal classification

A

Zone 1: distal to distal aspect of distal phalanx

Zone 2: Distal to lunula

Zone3: Distal to most distal joint.

72
Q

What are the compartments of the foot

A

9 of them

Superficial and deep centrall

medial

4 interosseus

Lateral plantar

deep interosseus

Podiatry Handbook notes (10 decks)

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