Trauma Questions Flashcards
A 45-year-old patient sustains the injury shown in figure A. What radiographic finding most highly suggests a lateral meniscal injury?
This is a Shatzker II tibial plateau fracture.
Gardner (2005) showed that:
- Joint depression of > 6 mm
- Joint widening of > 5 mm
was associated with lateral meniscus injury 80% of the time
A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. What is the most appropriate treatment for this type of injury?
This is a reverse obliquity intertrochanteric femur fracture.
Don’t use a DHS because shear force will result in medial displacement of the femoral shaft
Haidukewych showed a 56% failure rate when these are treated with DHS, compared to 13% with blade plate
*Best treatment is cephmedullary nailing (as per Sadowski)
A 48-year-old female sustains the injury seen in Figure A. Which of the following preoperative variables has been shown to be associated with improved outcomes following surgical treatment of this injury pattern?
Buckley (2002) showed improved outcomes after surgery if:
- women
- non-worker’s comp
- men < 30
- Bohler > 15°
- lighter workload
- single, simple displaced intra-articular fracture
A 24-year-old male sustains the injury seen in Figure A after being thrown from a motorcycle at a high speed. Which of the following fixation methods has been shown to be the most stable fixation construct for this injury?
This is an APC III injury, which is rotationally and vertically unstable with damage to the anterior ring, pelvic floor and posterior ligamentous complex
Sagi showed that optimal treatment is percutaneous iliosacral screw and anterior ring ORIF
Antegrade femoral nailing has an increased rate of which of the following when compared to retrograde femoral nailing?
Ricci showed that essentially there is no difference in outcome between antegrade or retrograde nailing except one gets hip pain and the other gets knee pain.
A 36-year-old woman presents with a grade 2 open midshaft femoral shaft fracture as the result of a high-speed motor vehicle collision. Concomitant injuries include a high-grade splenic laceration requiring splenectomy as well as a subdural hematoma that requires monitoring and maintenance of cerebral perfusion pressure. After irrigation and debridement of the open fracture, which of the following is the most appropriate management of the femoral shaft fracture at this time?
This patient has an unstable neurosurgical problem, so definitve orthopaedic care should be deferred. Flierl et al.
What has been shown to have similar biochemical and clinical characteristics as iliac crest autograft?
femoral intramedullary reaming contents
When comparing the posterior (antiglide) and lateral (neutralization) fibular plating techniques what are the benefits of each?
lateral:
- less peroneal tendonitis
posterior:
- increased strength/stiffness
- decreased prominence
- decreased joint penetration
- improved biomechanics
A 24-year-old male sustains the isolated, closed injury seen in Figure A as the result of a fall. What surgical treatment is recommended for this fracture?
The radiograph shows a comminuted olecranon fracture with extension distally past the coronoid. Plate fixation is recommended for olecranon fractures with significant comminution and those that extend distal to the midpoint of the trochlear notch, which is present in this instance. Hak et al.
A 70-year-old woman with known osteoporosis sustains a distal radius fracture of her dominant arm with some metaphyseal comminution. Adequate maintenance of reduction by non-operative treatment is unsuccesful. Which plating option provides the most appropriate treatment of this fracture?
Egol et. al. studied locked and conventional plates. They concluded that locked plates may be increasingly indicated for indirect fracture reduction, diaphyseal/metaphyseal fractures in osteoporotic bone, bridging severely comminuted fractures, and the plating of fractures where anatomical constraints prevent plating on the tension side of the bone. Conventional plates remain the fixation method of choice for periarticular fractures that demand perfect anatomical reduction, and certain types of non-unions that require increased stability for union.
A 33-year-old male is involved in a motor vehicle accident and suffers a right pilon fracture. Which of the bone fragments labeled on the distal tibia in the axial CT scan shown in Figure A is attached to the posterior tibiofibular ligament?
Figure A is an axial CT scan slice of an intra-articular distal tibia fracture. The bands of the posterior tibiofibular ligament pass obliquely from the fibula to the posterolateral aspect of the distal tibia. The ligaments of the ankle often remain intact after a pilon fracture producing the major fracture segments consisting of posterolateral or Volkmann’s fragment (labeled D), the anterolateral or Chaput fragment (labeled B), and the medial fragment (labeled C).
A 52-year-old carpenter falls off of a balcony while at work and sustains the injury shown in Figure A. The patient’s BMI is 52 and he smokes 2 packs of cigarettes per day; a clinical photograph of the limb is shown in Figure B. What is the most appropriate next step in management?
closed reduction
Ex Fix
ORIF later on when swelling settles
All of the following techniques can help to prevent apex-anterior angulation during intramedullary nailing of proximal one-third tibia fracture
- posterior blocking screw
- posterior starting hole
- interlocking the nail in a semi-extended knee position
- anteriorly directed nail
A 34-year-old female presents to the trauma bay with hemodynamic instability following a motor vehicle collision. A chest radiograph shows a left-sided hemothorax and her pelvis radiograph is shown in Figure A. Which of the following is the next most appropriate step in managment?
This is an APC III and requires pelvic binder in resuscitation bay
A 29-year-old male sustains the isolated lower extremity injury shown in Figure A. During open reduction, what structure must be kept intact in order to protect the remaining blood supply to the talar body?
This is a Hawkins 3 talar neck #
critical to preserve the deltoid ligament because the deltoid branch of the PT, which supplies the medial half of the talar body, is the only remaining blood supply.
A 40-year-old female sustains the injury seen in Figure A. What other associated soft-tissue knee injury is most commonly associated with this fracture?
peripheral lateral meniscus tear
double arc sign
A 33-year-old male sustains the injury shown in Figure A. He is initially treated with a spanning external fixator followed by definitive open reduction internal fixation of the tibia and fibula. His wounds healed without infection or other complications. Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work?
This is a tibial plafond #
lower level of education predicted inability to return to work
What is the most common complication of the fracture seen in figure A, if operatively treated as seen in figure B?
decreased elbow range of motion
A 25-year-old man is struck by car while crossing the street. His injuries include the closed left tibial shaft fracture shown in Figure A. He is a smoker, but is otherwise healthy. Intramedullary nailing is performed without initial complications. Which of the following puts this patient at greatest risk for tibial nonunion?
Post-operative gapping at the fracture site significantly increased the risk of reoperation due to nonunion or malunion.
A 33-year-old secretary presents three months after a motor vehicle collision with a mild asymmetry to her sternal area and difficulty swallowing. She denies any complaints of respiratory distress or upper extremity paresthesias. Her upper extremity neurovascular exam shows no deficits. A 3-D computed tomography image is shown in Figure A. What is the most appropriate treatment for this patient?
The clinical presentation is consistent with a chronic sternoclavicular dislocation, which is defined as being greater than 3 weeks old. The 3D CT image shows posterior displacement of the medial clavicle relative to the sternum. Chronic anterior dislocations are recommended to be treated conservatively, especially if not symptomatic, but as this is a posterior dislocations, current recommendations are to treat them with reduction in order to avoid delayed issues with the medial clavicle interacting with the mediastinal structures.
