Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Huang's Orthopaedic Surgery > Trauma - Lower Extremity > Flashcards

Trauma - Lower Extremity Flashcards

1
Q

What is a Canale view?

A 
X-ray view for the talar neck.
Taken with:
- Ankle in maximum equinus
- Foot placed on cassette
- Pronated 15 degrees from vertival
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name and describe the classification for talar neck fractures:

A

Hawking classification: Based on the number of talar articulations dislocated

  • Type 1: nondisplaced
  • Type 2: Associated subtalar subluxation or dislocation
  • Type 3: Associated subtalar AND ankle dislocation
  • Type 4: Associated subtalar AND ankle AND talonavicular dislocation (in essence a Type 3 with talonavicular dislocation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the anatomical classification of talus fractures?

A 
Lateral process fractures
Posterior process fractures
Talar head fractures
Talar body fractures
Talar neck fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the classification for Talar body fractures?

A
  • Shear type 1 (A & B) - vertical shear of the talar body
    Type 1A: Coronal plane
    Type 1B: Saggital plane
  • Shear type 2 - horizontal shear of the talar body
  • Crush
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Hawkin’s sign of the talus? What does it suggest?

A 
Radiographic sign of subchondral osteopenia seen on AP/mortise view of ankle seen at 6-8 weeks & lateral at 10-12 weeks (more difficult to see on lateral bc of overlapping structures)
Suggests a viable talus, however:
- It does not rule out AVN
- Its absence does not rule in AVN
- But its a good suggestor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name 2 radiographic signs suggesting Talar AVN:

A
  • ABSENCE of Hawkins sign (remember Hawkins sign is a good thing - it suggests a viable talus with good blood flow)
  • Relative sclerosis of the talus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the physiology behind relative sclerosis of talar AVN?

A
  • The remaining bones get reabsorbed and osteopenic (as part of normal healing and bc of the non-weight bearing status).
  • Necrosed talus has no blood supply to reabsorb it so it becomes sclerotic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do you do with a patient who you are worried about talar AVN?

A

Make them non weight bearing and follow often. Cannot see AVN until about 6-8 weeks and they may not present for years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is it OK for a patient to fully weight bear on a necrosed but sclerosed talus? What are the risks?

A

Yes, but they risk collapse once the blood flow comes back and the bone gets reabsorbed. In that case they will get arthritis and risk needing a fusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the natural history of talar AVN?

A

The blood supply will come back and the talus will be viable. May take YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the management of talar neck fractures?

A

Undisplaced (Hawkins 1): non-op. SLC x 12 weeks. NWB x 6-8 weeks to ensure no AVN
Displaced (Hawkins 2-4): ORIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the physiology behind Hawkins sign of the talus?

A

Suggests PRESENCE OF BLOOD FLOW & VIABILITY of the talus (Hawkins sign is a good thing)
Because it suggests that blood is available to resorb bone (aka part of the healing process)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the surgical approaches to the talus?

A

Anteromedial
Anterolateral
Posterolateral
Combined anteromedial & anterolateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What percentage of femur fractures will have an ipsilateral femoral neck fracture?

A

5-10% - so check for them - especially in the young as it’s a surgical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Percutaneous placement of a lateral proximal tibial locking plate that extends down to the distal third of the leg is associated with postoperative decreased sensation of which of the following distributions?

A

Dorsal midfoot

- Affects superficial peroneal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the greatest risk of a varus malunion of the distal tibia?

A

Ipsilateral ankle stiffness and arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In the trauma literature, what is the most common reason for anterior cortical perforation of the distal femur with femoral nailing?

A

Mismatch between radius of curvature of the implant and the femur
Other factors:
- Too posterior a start point
- Eccentric reaming

18
Q

What is the benefit of reamed versus unreamed nailing of tibia fractures?

A

Faster time to healing and +/- lower re-intervention rate (some studies) in CLOSED injuries only
No differences in complications (infection, compartment syndrome)

19
Q

What type tibial plateau injury has the highest rate of associated vascular injury?

A

Schatzker IV

  • Because high energy and the femur often follows the tibia
  • MUST suspect knee dislocation and do proper workup (ABI)
20
Q

What is the most common associated injury with Schatzker 2 injuries?

A

Meniscal tears (57% - usually peripheral tears)
ACL (25% - more common in severe fractures)
PCL (5%)
LCL (3%)
MCL (3%)
Peroneal nerve (1%)

21
Q

In IM Nail of proximal tibia fractures, where do you put your blocking screws to prevent valgus & apex anterior deformity?

A

Lateral & Posterior
Lateral prevents the valgus deformity
Posterior prevents the apex anterior deformity

22
Q

What is the Insall-Salvati ratio?

A

Ratio that measures for positioning of the patella.

On lateral radiograph with the knee flexed 30deg, it’s the ratio between the patellar tendon length distal to the patella to the size of the patella itself.
- Normal is 0.8-1.2. >1.2 indicates patella alta, <0.8 indicates patella baha

23
Q

What images are necessary for distal femur fractures to make sure there is no intercondylar screw penetration following fixation? Why?

A

AP with the leg in 30deg IR.
B/c the lateral metaphysis is angulated 10deg from the sagittal and the medial is 25deg from the sagittal, so must IR to get true AP

24
Q

Where is the most common location for a bipartite patella?

A

Superolateral

25
Q

In a young patient with a femur fracture and ipsilateral femoral neck fracture, which should be addressed first?

A

Femoral neck fracture

26
Q

In a young patient with a femoral neck fracture, what is the advantage of fixing it open?

A

Anatomical fixation

27
Q

In biomechanical studies, what was the strongest fixation for high Pauwel’s angle femoral neck fractures in the young population?

A

Proximal femoral locking plates

- 5 of 8 failed in incremental loading and 3/8 failed with cyclical loading (Aminian 2007)

28
Q

In high Pauwel’s type femoral neck fractures in the young population, what type of implant showed the best outcomes?

A

Fixed-angle devices > cannulated screws

- Fixed-angle devices included DHS, DCS, Gamma nail

29
Q

When are syndesmotic screws taken out (at the earliest)?

A

3 months

30
Q

What is a hoffa fracture of the distal femur?

A

Coronal fracture of the distal femoral condyle

- Most commonly the lateral femoral condyle

31
Q

How do you treat a hoffa fracture of the distal femur?

A

AP screws across the affected condyle

- Lateral more common than medial

32
Q

Describe the stages of a supination/adduction ankle injury:

A 
Fixed supination
Adductory force
1. Either:
- LCL tear
- Distal fibula avulsion fracture
- Transverse fracture of fibular at or below syndesmosis (Weber A/B)
2. Vertical fracture of medial malleolus
33
Q

Describe the stages of a supination, ER ankle injury:

A

Fixed supination, ER force

  1. AITFL injury/Tillaux fracture (anterior tibia)
  2. Spiral fibular fracture/Wagstaff fracture (Fibula)
  3. Posterior mall or PITFL
  4. Medial malleolus fracture or deltoid injury
34
Q

Describe the stages of a pronation, Abduction

A
  1. Deltoid ligament or transverse medial mall fracture
  2. AITFL/PITFL ligament injury
  3. Short oblique fracture of fibula. IoM intact
35
Q

Describe the stages of a pronation, ER injury

A
  1. Deltoid ligament rupture or transverse fracture of medial malleolus
  2. AITFL injury/Tillaux/Wagstaff fracture
  3. IoM injury with high fibula fracture
  4. PITFL or posterior mall/Volkman’s fracture
36
Q

What is the acceptable alignment of tibial shaft fractures?

A 
< 5 deg varus/valgus
< 10 deg AP
< 10 deg Rotation
< 1cm short
> 50% cortical apposition
37
Q

What is the risk of non-operative management of oblique & spiral tibial fractures?

A

Shortening

38
Q

What is the risk of nonoperative management of midshaft tibial fractures with an intact fibula?

A

Varus malunion

- Fibula acts as a strut to push fracture into varus

39
Q

What vascular structure is at risk if you go too medially in the proximal thigh (aka plunge with your drill or with the depth gauge)?

A

Profunda femoris

- Aneurysm

40
Q

What percent of intraarticular distal femur fractures has an associated Hoffa fracture?

A

30-40% - so get a CT scan if it’s an intraarticular distal femur fracture to look for this!

41
Q

What is a Hoffa fracture of the distal femur

A

Coronal shear fragment of the distal femoral condyle

42
Q

What side of Hoffa fracture is more common?

A

Lateral

Huang's Orthopaedic Surgery (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions