1
Q
Mayfield classification of progressive perilunate dislocation
A
- Stage I represents scapholunate failure
- stage II, capitolunate failure
- stage III, triquetrolunate failure
- stage IV, dorsal radiocarpal ligament failure, allowing lunate dislocation.
2
Q
Johnson and Strom in 1989 PTT insufficiency
A
- Stage I disease is characterized by swelling, pain, inflammation, and often effusion within the posterior tibial tendon sheath.
- Stage II disease is characterized by the loss of function of the posterior tibial tendon and inability to perform a single-leg toe raise. There is attempted compensation by use of the anterior tibial muscle and tendon unit as an accessory inverter of the hindfoot.
- stage IIA, less than 30% of the talar head is uncovered on standing anteroposterior radiographs and abduction deformity is minimal
- stage IIB, more than 30% of the talar head is uncovered and the abduction deformity is severe.
- stage III disease, the function of the posterior tibial tendon is lost, and a semirigid or rigid hindfoot deformity with valgus abduction occurs and degenerative changes may be apparent on radiographs
- Stage IV disease was described by Myerson et al. and involves valgus positioning and incongruence of the ankle joint in addition to stage III findings.
3
Q
Wagner Classification for Foot Ulcers
A
- 0 Skin at risk
- I Superficial ulcer
- II Exposed tendon and deep structures
- III Deep ulcers with abscess or osteomyelitis
- IV Partial gangrene
- V More extensive gangrene
4
Q
- Brodsky Depth-Ischemia Classification for Foot Ulcers
- Proprioceptive dysfunction
- Neurotraumatic theory
- Neurovascular theory inflammatory theory
A
DEPTH Classification Description
- 0 At risk foot, no ulceration
- 1 Superficial ulceration, no infection
- 2 Deep ulceration, tendons or joint exposed
- 3 Extensive ulceration or abscess
- ISCHEMIA
- A Not ischemic
- B Ischemia without gangrene
- C Partial forefoot gangrene
- D Complete gangrene
- ISCHEMIA
5
Q
Eichenholtz Classification of Charcot Arthropathy in the Diabetic Foot
A
STAGE RADIOGRAPHIC SIGNS CLINICAL SIGNS
- 0 No osteoporosis noted Unilateral oedema, erythema; warm, intact skin
- 1 Fragmentation Osseous destruction, joint subluxation/dislocation Similar to stage 0
- 2 Coalescence Absorption of bone debris with the coalescence of small fracture fragments Decreased erythema, warmth, oedema
- 3 Consolidation and remodelling fracture fragments No oedema, warmth, or erythema
6
Q
Jersey Finger Refers to an avulsion injury of FDP from insertion at base of distal phalanx
A
Leddy and Packer classification
- Type I FDP tendon retracted to palm. Leads to disruption of the vascular supply Prompt surgical treatment within 7 to 10 days
- Type II FDP retracts to level of PIP joint Attempt to repair within several weeks for opitmal outcome
- Type III Large avulsion fracture limits retraction to the level of the DIP joint Attempt to repair within several weeks for opitmal outcome
- Type IV Osseous fragment and simultaneous avulsion of the tendon from the fracture fragment (“Double avulsion” with subsequent retraction of the tendon usually into palm) If tendon separated from fracture fragment, first fix fracture via ORIF then reattach tendon as for Type I/II injuries
- Type V Ruptured tendon with bone avulsion with bony comminution of the remaining distal phalanx (Va, extraarticular; Vb, intra-articular)
7
Q
Kienbock’s Disease Avascular necrosis of the lunate leading to abnormal carpal motion
A
- Stage I No visible changes on xray, changes seen on MRI Immobilization and NSAIDS
- Stage II Sclerosis of lunate Joint
- leveling procedure (ulnar negative patients)
- Radial wedge osteotomy or STT fusion (ulnar neutral patients)
- Distal radius core decompression Revascularization procedures
- Stage IIIA Lunate collapse,
- no scaphoid rotation Same as Stage II above
- Stage IIIB Lunate collapse, fixed scaphoid rotation
- Proximal row carpectomy, STT fusion, or SC fusion
- Stage IV Degenerated adjacent intercarpal joints Wrist fusion, proximal row carpectomy, or limited intercarpal fusion
8
Q
Rheumatoid thumb deformities
A
- Type I, the most common, is a boutonniere deformity
- Type II, which is rare, includes metacarpophalangeal joint flexion, interphalangeal joint hyperextension, and trapeziometacarpal joint subluxation or dislocation
- type III, the second most common, is a swan-neck deformity
- type IV, which is unusual, results from ulnar collateral ligament laxity and includes the abduction of the proximal phalanx with metacarpal adduction
9
Q
Eaton and Littler Classification of Basilar Thumb Arthritis
A
- Stage I slight joint space widening (pre-arthritis)
- Stage II slight narrowing of CMC joint with sclerosis, osteophytes <2mm
- Stage III marked narrowing of CMC joint with osteophytes, osteophytes >2mm
- Stage IV pantrapezial arthritis (STT involved)
10
Q
Mallet Finger - A finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint - the disruption may be bony or tendinous
A
Doyle’s Classification
- Type I Closed injury with or without small dorsal avulusion fracture
- Type II Open injury (laceration)
- Type III Open injury (deep soft tissue abrasion involving loss skin and tendon substance)
- Type IV Mallet fracture
- A = distal phalanx physeal injury (pediatrics)
- B = fracture fragment involving 20% to 50% of articular surface (adult)
- C = fracture fragment >50% of articular surface (adult)
11
Q
Wassel Classification of Preaxial Polydactyly
A
- Type I Bifid distal phalanx
- Type II Duplicated distal phalanx
- Type III Bifid proximal phalanx
- Type IV Duplicated proximal phalanx (most common)
- Type V Bifid metacarpal
- Type VI Duplicated metacarpal
- Type VII Triphalangia
12
Q
SNAC A condition characterized by advanced collapse and progressive arthritis of the wrist that results from a chronic scaphoid nonunion
A
- Stage I • Arthrosis localized to the radial side of the scaphoid and radial styloid
- Stage II •Scaphocapitate arthrosis in addition to Stage 1
- Stage III • Periscaphoid arthrosis (proximal lunate and capitate may be maintained)
13
Q
Cervical Myelopathy is a common degenerative condition caused by compression on the spinal cord that is characterized by clumsiness in hands and gait imbalance.
A
Nurick Classification Based on gait and ambulatory function
- Grade 0 Root symptoms only or normal
- Grade 1 Signs of cord compression; normal gait
- Grade 2 Gait difficulties but fully employed
- Grade 3 Gait difficulties prevent employment, walks unassisted
- Grade 4 Unable to walk without assistance
- Grade 5 Wheelchair or bedbound
14
Q
Cervical Myelopathy is a common degenerative condition caused by compression on the spinal cord that is characterized by clumsiness in hands and gait imbalance.
A
Ranawat Classification
- Class I Pain, no neurologic deficit
- Class II Subjective weakness, hyperreflexia, dyssthesias
- Class IIIA Objective weakness, long tract signs, ambulatory
- Class IIIB Objective weakness, long tract signs, non-ambulatory
15
Q
Spinal cord injury ASIA
A
ASIA Classification
- Step 1 Determine if patient is in spinal shock check bulbocavernosus reflex
- Step 2 Determine neurologic level of injury
- lowest segment with intact sensation and antigravity (3 or more) muscle function
- strength in regions where there is no myotome to test, the motor level is presumed to be the same as the sensory level.
- Step 3 Determine whether the injury is COMPLETE or INCOMPLETE
- COMPLETE defined as
- (ASIA A) no voluntary anal contraction (sacral sparing) AND 0/5 distal motor AND 0/2 distal sensory scores (no perianal sensation) AND bulbocavernosus reflex present (patient not in spinal shock)
- INCOMPLETE defined as voluntary anal contraction (sacral sparing) sacral sparing critical to determine complete vs. incomplete OR palpable or visible muscle contraction below injury level OR perianal sensation present
- COMPLETE defined as
16
Q
lumbar spinal stenosis is a degenerative condition characterized by narrowing of the lumbar spinal canal due to bony structures soft tissue structures
A
Anatomic classification
- central stenosis - caused by ligamentum hypertrophy directly under the lamina
- lateral recess stenosis (subarticular recess - caused by facet joint arthropathy and osteophyte formation
- foraminal stenosis - occurs between the medial and lateral border of the pedicle caused by a substantial loss of disk height, foraminal disk protrusions or osteophytes, or angulation in the setting of degenerative scoliosis
- extraforaminal stenosis - located lateral to the lateral edge of the pedicle
17
Q
Degenerative Spondylolisthesis
- A condition characterized by lumbar spondylolisthesis without a defect in the pars
A
Myerding Classification
- Grade I < 25%
- Grade II 25 to 50%
- Grade III 50 to 75% (Grade III and greater are rare in degenerative spondylolithesis)
- Grade IV 75 to 100%
- Grade V Spondyloptosis (all the way off)
18
Q
thoracolumbar burst fractures are a common traumatic vertebral fracture that primarily involves a compression force through the anterior and middle column of the vertebrae leading to retropulsion of bone into the spinal canal
A
Thoracolumbar Injury Classification and Severity Score
- injury morphology
- neurologic status
- posterior ligamentous complex integrity
19
Q
odontoid fractures
A
Anderson and D’Alonzo Classification
- Type I Oblique avulsion fx of tip of odontoid. Due to avulsion of alar ligament. Although rare, atlantooccipital instability should be ruled out with flexion and extension films.
- Type II Fx through waist (high nonunion rate due to interruption of blood supply).
- Type III Fx extends into cancellous body of C2 and involves a variable portion of the C1-C2 joint.
20
Q
odontoid fractures
A
Grauer Classification of Type II Odontoid fractures
- Type IIA Nondisplaced/minimally displaced with no comminution. Treatment is external immobilization
- Type IIB Displaced fracture with fracture line from anterosuperior to posteroinferior. Treatment is with anterior odontoid screw (if adequate bone density).
- Type IIC Fracture from anteroinferior to posterosuperior, or with significant comminution. Treatment is with posterior stabilization.
21
Q
Incomplete Spinal Cord Injuries
- Defined as spinal cord injury with some preserved motor or sensory function below the injury level including
A
Clinical classification
- anterior cord syndrome
- Brown-Sequard syndrome
- central cord syndrome
- posterior cord syndrome
22
Q
Scheuermann’s Kyphosis
- A rigid thoracic hyperkyphosis defined by > 45 degrees
- > 45 degrees caused by anterior wedging of >5 degrees
- across three consecutive vertebrae,
- narrowed disc spaces
A
- Thoracic Scheuermann’s Kyphosis curve from T1/2 to T12/L1 with apex between T6-T8 better prognosis
- Thoracolumbar/lumbar Scheuermann’s Kyphosis curve from T4/5 to L2/3 with apex near the thoracolumbar junction associated with increased back pain more likely to be progressive and symptomatic more irregular end-plates noted on radiographs, less vertebral body wedging
23
Q
Supracondylar Humeral Fractures
A
- type I fractures are nondisplaced
- type II fractures have an intact posterior hinge
- type III fractures have complete displacement.
- type IV complete loss of the anterior and posterior periosteal hinge, making it unstable in both flexion and extension.
24
Q
Lateral Condyle Fracture - Pediatric
anatomy of lateral condyle:
- ossification center of lateral condyle appears between 18 mo & two yrs
- it extends medially to form main part of lower articular end of humerus
- lateral epicondyle ossifies at age 13 & fuses w/ capitellum at age 16;
- radial collateral ligament, supinator, & forearm extensors are attached
A
Milch Classification-controversial
- Type I Fracture line is lateral to trochlear groove (less common, elbow is stable as fracture does NOT enter trochlear groove)
- Type II Fracture line extends medially into trochlear groove (more common, more unstable)
Weiss classification Fracture Displacement
- Type 1 <2mm, indicating intact cartilaginous hinge
- Type 2 >2 mm < 4 displacement, intact articular cartilage on arthrogram
- Type 3 >4 mm, articular surface disrupted on an arthrogram
25
Monteggia Fracture - Pediatric Definition radial head dislocation plus proximal ulna fracture or plastic deformation of the ulna without obvious fracture
Bado Classification
* Type I Apex anterior proximal ulna fracture with anterior dislocation of the radial head
* ( most common in peds )
* Type II Apex posterior proximal ulna fracture with posterior dislocation of the radial head
* ( most commont in adults )
* Type III Apex lateral proximal ulna fracture with lateral dislocation of the radial head
* Type IV Fractures of both the radius and ulna at the same level with an anterior dislocation of the radial head (1-11% of cases)
26
Proximal Femur Fractures - Pediatric
Delbet Classification
* Type I Transphyseal (with or without epiphyseal dislocation) \<10% 38%-100%
* Type II Transcervical 40-50% 28% 15%
* Type III Cervicotrochanteric (or basicervical) 30-35% 18% 15-20%
* Type IV Intertrochanteric 10-20% 5% 5%
27
Tibial Eminence Fracture
Modified Meyers and McKeever Classification
* Type I Nondisplaced (\<3mm)
* Type II Minimally displaced with intact posterior hinge
* Type III Completely displaced
* Type III+ Type III fracture with rotation
* Type IV Completely displaced, rotated, comminuted
28
Legg-Calve-Perthes is idiopathic avascular necrosis of the proximal femoral epiphysis in children treatment is typically observed in children less than 8 years of age,
Stages of Legg-Calves-Perthes (Waldenström)
* **Initial** • Infarction produces a smaller, sclerotic epiphysis with medial joint space widening • Radiographs may remain occult for 3 to 6 m
* * **Fragmentation** • Begins with presence of subchondral lucent line (cresent sign) • Femoral head appears to fragment or dissolve • Result of revascularization process with bone resorption producing collapse with subsequent patchy density and lucencies • Hip related symptoms are most prevalent •
* * Lateral pillar classification based on this stage • Can last from 6m to 2y
* * **Reossification** • Ossific nucleus undergoes reossification with new bone appearing as necrotic bone is resorbed • May last up to 18m
* * **Healing or remodeling** • Femoral head remodels until skeletal maturity • Begins once ossific nucleus is completely reossified; trabecular patterns return
29
LCPD
**Lateral Pillar (Herring) Classification**
* Group A
* lateral pillar maintains full height with no density changes identified
* consistently good outcome
* Group B
* maintains \>50% height
* poor outcome in patients with bone age \> 6 years
* B/C Border
* lateral pillar is narrowed (2-3mm) or poorly ossified with approximately 50% height
* recently added to increase consistency & prognosis of classification
* Group C
* less than 50% of lateral pillar height is maintained
* poor outcomes in all patient
30
LCPD
Catterall Classification Group I involvement of the anterior epiphysis only Group II involvement of the anterior epiphysis with a central sequestrum Group III • only a small part of the epiphysis is not involved Group IV • total head involvement
31
LCPD head at risk
**Clinical risk facttor**
F. - Female
O - Obese
O - Older patient
B - Bilateral
S - Stilffness
At risk signs (indicate a more severe disease course)
* Gage sign V-shaped radiolucency in the lateral portion of the epiphysis and/or adjacent metaphysis
* calcification lateral to the epiphysis
* lateral subluxation of the femoral head
* horizontal proximal femoral physics
* metaphyseal cyst added - later to the original four at risk signs described by Catterall
32
(SCFE) is an condition of the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis, and is most commonly seen in adolescent obese males
1. Loder Classification -- based on ability to bear weight
2. Temporal Classification -- based on duration of symptoms; rarely used; no prognostic information
3. Southwick Slip Angle Classification -- based on femoral epipyseal-diaphyseal angle difference
4. Grading System -- based on percentage of slippage
33
Prosthetic Joint Infection
MSIS Criteria
MSIS Criteria
**Major criteria** (diagnosis can be made when [1] major criteria exist)
* 1. Sinus tract communicating with prosthesis
* 2. Pathogen isolated by culture from 2 separate tissue/fluid samples from the affected joint
**Minor criteria** (preoperative diagnosis) The below scores are added together to determine:
≥6 Infected 2-5 Inconclusive
0-1 Not Infected
* Serum Elevated CRP (\>10mg/L) or D-dimer (\>860ng/mL) - 2 points
* Elevated ESR (\>30mm/h) - 1 point
* Synovial elevated synovial WBC (\>3,000 cells/µl) or LE - 3 points
* Positive alpha-defensin - 3 points
* elevated synovial PMN (\>80%) - 2 points
* Elevated synovial CRP (\>6.9mg/L) - 1 point
34
Hip Osteonecrosis
Steinberg Classification (modification of Ficat classification) Images
* 0 normal normal MRI and bone scan I normal abnormal MRI and/or bone scan
* II cystic or sclerosis changes abnormal MRI and/or bone scan
* III crescent sign (subchondral collapse) abnormal MRI and/or bone scan
* IV flattening of femoral head abnormal MRI and/or bone scan
* V narrowing of joint abnormal MRI and/or bone scan
* VI advanced degenerative changes abnormal MRI and/or bone scan
35
Ankle Arthritis
**Takakura Classification**
* Stage I Early sclerosis and osteophyte formation, no joint space narrowing
* Stage II Narrowing of medial joint space (no subchondral bone contact)
* Stage IIIA Obliteration of joint space at the medial malleolus, with subchondral bone contact
* Stage IIIB Obliteration of joint space over roof of talar dome, with subchondral bone contact Stage
* IV Obliteration of joint space with complete bone contact
36
cementing technique
* 1st gen involved the hand mixing of cement in bowels and finger packing
* 2nd gen distal cement restrictor, pulsatile irrigation, packing and drying of the femoral canal followed by retrograde insertion of cement with a cement gun
* 3rd gen vacuum-centrifugation, which further reduces porosity
* 4th gen Distal and proximal centraliser.
37
The Rubin classification
**Epiphysis**
* Hyperplasia - Trevors Disease (epiphyseal osteochondroma)
* Hypoplasia - SED, MED
Physis
* Ollier’s disease - hyperplasia -
* Acondroplasia – hypoplasia (proliferative zone)
Metaphysis -
* HME – hyperplasia
* Osteopetrosis - hypoplasia
Diaphysis
* diaphyseal dysplasia - hyperplasia
* OI - hypoplasia
Fractures occur through **hypertrophic zone**
SUFE occurs through hypertrophic zone (weakened perichodral ring)
Rickets – zone of provisional calcification
38
Milch Classification Type I Fracture line is lateral to trochlear groove (less common, elbow is stable as fracture does NOT enter trochlear groove) Type II Fracture line extends medially into trochlear groove (more common, more unstable)
Fracture Displacement Classification-Weiss, et al Type 1 \<2mm, indicating intact cartilaginous hinge Type 2 \>2 mm \< 4 displacement, intact articular cartilage on arthrogram Type 3 \>4 mm, articular surface disrupted on arthrogram
39
Neers classificaton of distal clavicluar fracture
Type I • fracture is LATERAL to coracoclavicular ligaments • conoid and/or trapezoid ligament remain INTACT • minimal displacement • STABLE Nonoperative Type IIA • fracture occurs MEDIAL to coracoclavicular ligaments • conoid and trapezoid ligment remain INTACT • significant medial clavicle displacement • UNSTABLE • up to 56% nonunion rate with nonoperative management Operative Type IIB • two fracture patterns • (1) fracture occurs either BETWEEN the coracoclavicular ligaments • conoid ligament TORN • trapezoid ligament INTACT • (2) fracture occurs LATERAL to coracoclavicular ligaments • conoid ligament TORN • trapezoid ligament TORN • signficant medial clavicle dispalcement • UNSTABLE • up to 30-45% nonunion rate with nonoperative management Operative Type III • INTRA-ARTICULAR fracture extending into AC joint • conoid and trapezoid ligaments remain INTACT • minimal displacement • STABLE • patients may develop posttraumatic AC arthritis Nonoperative Type IV • PHYSEAL fracture that occurs in the skeletally immature • conoid and trapezoid ligaments remain INTACT • displacement of lateral clavicle occurs superiorly through a tear in the thick periosteum (clavicle pulls out of periosteal sleeve) • STABLE Nonoperative Type V • COMMINUTED fracture pattern • conoid and trapezoid ligaments remain INTACT • significant medial clavicle displacement • usually UNSTABLE Operative
40
Young-Burgess Classification
**Anterior Posterior Compression (APC)**
* APC I Symphysis widening \< 2.5 cm
* APC II Symphysis widening \> 2.5 cm. Anterior SI joint diastasis . Posterior SI ligaments intact. Disruption of sacrospinous and sacrotuberous ligaments.
* APC III Disruption of anterior and posterior SI ligaments (SI dislocation). Disruption of sacrospinous and sacrotuberous ligaments. APCIII associated with vascular injury
**Lateral Compression (LC)**
* LC I Oblique or transverse ramus fracture and ipsilateral anterior sacral ala compression fracture.
* LC II Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent fracture).
* LC III Ipsilateral lateral compression and contralateral APC (windswept pelvis). Common mechanism is rollover vehicle accident or pedestrian vs auto.
**Vertical Shear (VS)**
* Vertical shear Posterior and superior directed force. Associated with the highest risk of hypovolemic shock (63%); mortality rate up to 25%
41
Calcific Tendonitis
three stages of calcification
* **precalcific** - fibrocartilaginous metaplasia of the tendon clinically this stage is pain-free
* **calcific** subdivided into three phases
* formative phase - characterized by cell-mediated calcific deposits +/- pain
* resting phase lacks inflammation or vascular infiltration +/- pain
* resorptive phase characterized by a phagocytic resorption and vascular infiltration , clinically this phase is most painful postcalcific
42
Tsukayama et al Periprosthetic joint infection
* early postoperative infection
* late chronic infection
* acute hematogenous infection
* positive intraoperative cultures
43
CTEV - I am going to manage the patient according to Ponseti technique which depends on two biomechanical concepts to get a correction. First one is the using the viscoelastic property of tendons and ligament using the creep and kinematic coupling in the movement of the foot and ankle. My aim of the treatment is to achieve strong, painless, plantigrade and supple foot.
Shaque Pirani, a Canadian Orthopaedic Surgeon Six “Signs” are Assessed Scored depending on Severity - 0, 0.5, or 1 1. Mid Foot Contracture Score (MFCS) Medial Crease (MC) Curved Lateral Border (CLB) Lateral Head of Talus (LHT) 2. Hindfoot Contracture Score (HFCS) Posterior Crease (PC) Empty Heel (EH) Rigid Equinus (RE)
44
Passivation is a process to protect metals from corrosion by the forming of a surface oxide layer.
Crevice corrosion is often due to mechanically-assisted corrosion, where the unreactive surface layer is damaged exposing the deeper reactive layer.
45
Scaphoid
Herbert and Fisher Classification- based on fracture stability
* Type A- stable, acute fractures
* Type B- unstable, acute fractures (distal oblique, complete waist, proximal pole, trans-scaphoid and perilunate associated fractures)
* Type C- delayed union characterized by cyst formation and fracture widening
* Type D- nonunion
46
* grade 1: hips have less than 50% subluxation;
* grade 2: hips have between 50% to 75% subluxation;
* usually do not have leg length inequality or loss of bone stock;
* w/ low dislocation, femoral head articulates w/ false acetabulum which partially covers the true acetabulum;
* on x-ray there may be 2 overlapping acetabula
* inferior part of the false acetabulum is an osteophyte which is located the level of the superior rim of the true acetabulum
* visible part of the true acetabulum can therefore be missed;
* grade 3: hips have between 75% to 100% subluxation
* complete loss of superior acetabular roof
* may have thin medial wall;
* anterior and posterior columns are intact
* consider medial protrusion technique
* grade 4: hips have more than 100% subluxation;
* true acetabulum is deficient but remains recongnizable;
* if cup is placed at level of true acetabular then a subtrochanteric shortening osteotomy is often required;
THR preoperative considerations:
- center edge angle
- note that revision THR shares many of the problems encountered with the dysplastic hip;
- when the hip is located in the native acetabulum, the acetabulum is often shallow, abducted, and significantly anteverted;
- soft tissue adaptive changes may include hyperlordosis, adduction contracture, and leg length descrepancy;
- risk of component dislocation may be especially prevalent in these patients;
- references:
- Three Patterns of Acetabular Deficiency Are Common in Young Adult Patients With Acetabular Dysplasia
- considerations for alternative procedures:
- in patients less than 45-50 yrs, alternative procedures should always be considered;
- pelvic osteotomy in DDH: (Chiari, Shelf, Ganz, and Penberton osteotomies are considered);
- femoral osteotomy in DDH
[http://www.wheelessonline.com/ortho/thr\_in\_the\_dysplasic\_hip](http://www.wheelessonline.com/ortho/thr_in_the_dysplasic_hip)
47
AVN humerus
Good predictors of ischemia were
* the length of the metaphyseal head extension (accuracy, 0.84 for calcar segments \<8 mm)
* the integrity of the medial hinge (accuracy, 0.79 for disrupted hinge)
* the basic fracture pattern (accuracy, 0.7 for combined types 2, 9, 10, 11, and 12).
48
Lisfrancs injury Radiological criteria
five critical radiographic signs that indicate the presence of midfoot instability
* discontinuity of a line drawn from the medial base of the 2nd metatarsal to the medial side of the middle cuneiform seen on AP view diagnostic of Lisfranc injury
* widening of the interval between the 1st and 2nd ray seen on AP view may see bony fragment (fleck sign) in 1st intermetatarsal space represents avulsion of Lisfranc ligament from the base of 2nd metatarsal diagnostic of Lisfranc injury
* dorsal displacement of the proximal base of the 1st or 2nd metatarsal seen on a lateral view
* the medial side of the base of the 4th metatarsal does not line up with a medial side of cuboid seen on oblique view
* disruption of the medial column line (line tangential to the medial aspect of the navicular and the medial cuneiform) seen on oblique view
49
Dorr Classification
Ratio inner canal diameter 10 cm distal to midportion of lesser trochanter divided by inner canal diameter at midportion of lesser trochanter
* Type A \<0.5 - Cortices seen on both AP and lateral XR Uncemented
* Type B 0.5 to 0.75 Thinning of posterior cortex on lateral XR Uncemented
* Type C \>0.75 Thinning of cortices on both views Cemented
50
Mayer and Mckever
* type I:
* non-displaced & only anterior edge of eminence is sl elevated;
* has a posterior hinge with an elevated anterior portion;
* type II
* partially displaced frx, w/ anterior elevation of the eminence;
* type III A. entire eminence lies above its bed, out of contact w/ tibia;
* this injury type usually occurs in children older than age 10-11 years;
* type III B
* the eminence is rotated as well as out of contact;
* type III frx are most common, accounting for 83 (45 %) of frx;
51
Graff classification
Graf Classfication
Alpha angle. Beta angle. Description
* 1. \> 60° \< 55° normal
* II. 43-60°. 55-77°. delayed ossification
* III. \< 43°. \> 77°. subluxated
* IV. unmeasurable. unmeasurable
52
SNAC wrist
* Stage I - Arthrosis localized to the radial side of the scaphoid and radial styloid
* Stage II - Scaphocapitate arthrosis in addition to Stage 1
* Stage III - Periscaphoid arthrosis (proximal lunate and capitate may be maintained)
53
Rockwood classification of acromioclavicular injuries.
* Type I: neither acromioclavicular nor coracoclavicular ligaments are disrupted.
* Type II: acromioclavicular ligament is disrupted, and coracoclavicular ligament is intact.
* Type III: both ligaments are disrupted.
* Type IV: ligaments are disrupted, and distal end of clavicle is displaced posteriorly into or through trapezius muscle.
* Type V: ligaments and muscle attachments are disrupted, and clavicle and acromion are widely separated.
* Type VI: ligaments are disrupted, and distal clavicle is dislocated inferior to coracoid process and posterior to biceps and coracobrachialis tendons.
54
Hohl and Moore classifiaction
Classification useful for
* true fracture-dislocations
* fracture patterns that do not fit into the Schatzker classification (10% of all tibial plateau fractures)
* fractures associated with knee instability
* Type I. Coronal split fracture
* Type II. Entire condylar fracture
* Type III. Rim avulsion fracture of lateral plateau
* Type IV. Rim compression fracture
* Type V Four-part fracture
55
Ankle Fracture
**Supination - Adduction (SA)**
* Talofibular sprain or distal fibular avulsion
* Vertical medial malleolus and impaction of anteromedial distal tibia
**Pronation - Abduction (PA)**
* Medial malleolus transverse fracture or disruption of deltoid ligament
* Anterior tibiofibular ligament sprain
* Transverse comminuted fracture of the fibula above the level of the syndesmosis
**Supination - External Rotation (SER)**
* Anterior tibiofibular ligament sprain
* Lateral short oblique fibula fracture (anteroinferior to posterosuperior)
* Posterior tibiofibular ligament rupture or avulsion of posterior malleolus
* Medial malleolus transverse fracture or disruption of deltoid ligament
**Pronation - External Rotation (PER)**
* Medial malleolus transverse fracture or disruption of deltoid ligament
* Anterior tibiofibular ligament disruption
* Lateral short oblique or spiral fracture of fibula (anterosuperior to posteroinferior) above the level of the joint
* Posterior tibiofibular ligament rupture or avulsion of posterior malleolus
56
Sanders classification
FRCS
flashcards
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