Goldenstein Trauma List 2 Flashcards Preview

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Flashcards in Goldenstein Trauma List 2 Deck (40)
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1

External fixator stability increased by (9)

  1. End-to-end contact of fracture fragments (#1)
  2. Larger diameter pins (#2)
  3. Larger diameter rods
  4. Increased number of pins
  5. Increased number of rods
  6. Pins in different planes
  7. Rods in different planes
  8. Decreased bone-rod distance
  9. Increased spacing between pins

2

Circular external fixator stability increased by (9)

  1. Olive wires
  2. More wires
  3. Increased wire tension
  4. Larger diameter wires and half pins
  5. Decreased ring diameter
  6. Increased number of rings
  7. Decreased spacing between adjacent rings
  8. 2 central rings close to the fracture site
  9. Wires/pins crossing at 90°

3

Tscherne grading of soft tissue injury (4)

  • Grade 0: Minimal soft tissue damage
  • Grade 1: superficial abrasion/contusion
  • Grade 2:Deep abrasion, muscle contusion and/or contaminated skin
  • Grade 3: severe degloving, crushing, compartment syndrome or vascular injury

4

Gustilo classification of open fractures (5)

I: clean wound < 1 cm

II: clean wound 1-10 cm

IIIA: clean wound > 10 cm, contaminated wound or extensive injury that can be closed primarily

IIIB: needs flap for coverage

IIIC: arterial injury

5

ER treatment of open fractures (5)

  1. Splint
  2. Tetanus
  3. Antibiotics
  4. Neurovascular exam
  5. Dressing

(S.T.A.N.D.)

6

Tetanus-prone wounds (6)

  1. > 6 hours old
  2. Irregular configuration
  3. Depth > 1 cm
  4. Due to a projectile injury, crush, burn or frostbite
  5. Devitalized tissue
  6. Gross contamination

7

Indications for tetanus booster (3)

  1. Any wound with an incomplete or unknown immunization history
  2. Any wound with a complete initial series but > 10 years since last booster
  3. Tetanus prone wound with complete initial series and > 5 years since last booster

8

Indication for tetanus immunoglobulin (1)

Tetanus prone wound with an incomplete initial series or unknown immunization history

9

Indications for prophylactic antibiotics (4)

  1. Open fractures
  2. Bone exposed
  3. Hardware placed
  4. Large hematoma

10

Signs of muscle viability:

  1. Contractility
  2. Color
  3. Consistency
  4. Capacity to bleed

(4 C’s)

11

Signs of vascular injury (10)

Hard (5):

  1. Absent pulses
  2. Pulsatile bleeding
  3. Expanding hematoma
  4. Bruit
  5. Thrill

Soft (5):

  1. Diminished pulses
  2. Decreased capillary refill
  3. Hypesthesia
  4. Decreased leg temperature
  5. Pallor

12

Fracture complications

Early systemic (5)

  1. Venous thromboembolism
  2. Fat embolism syndrome
  3. MOSF
  4. ARDS
  5. Shock

Early local (5)

  1. Open wounds
  2. Hemorrhage
  3. Fracture blisters
  4. Skin necrosis
  5. Infection

Late systemic (2)

  1. Venous thromboembolism
  2. Sepsis

Late local (7)

  1. Infection
  2. Delayed union
  3. Non-union
  4. Malunion
  5. Post-traumatic arthritis
  6. CRPS
  7. Heterotopic ossification

13

Indications for bone growth stimulators (4)

  1. Delayed union
  2. No infection
  3. No/minimal deformity
  4. Stable internal fixation

14

Contraindications to bone growth stimulators (3)

  1. Synovial pseudarthrosis
  2. Mobile non-union
  3. Fracture gap > 1 cm

15

Causes of fracture non-union (5) systemise\local

  1. Poor patient (local/systemic)
  2. Inadequate stability
  3. Fracture gap
  4. Loss of blood supply
  5. Infection

16

Classification of fracture non-union (4)

Septic

Aseptic

  • Hypertrophic
  • Oligotrophic
  • Atrophic

17

Principles of atrophic non-union treatment (4)

  1. Apposition of viable bone ends
  2. Stable internal fixation
  3. Grafting to fill defects/provide biology
  4. Preservation/creation of healthy/well-vascularized soft tissue envelope

18

Principles of septic non-union treatment (5)

  1. Remove infected/devitalized tissue
  2. Apposition of viable bone ends
  3. Stabilization of fracture
  4. Preservation/creation of healthy/well-vascularized soft tissue envelope
  5. Local and systemic antibiotics

19

Indications for acute deformity correction (3)

  1. Modest deformities
  2. Mobile/atrophic non-unions
  3. Small bone defects

20

Indications for gradual deformity correction (4)

  1. Large deformities
  2. Associated limb length discrepancy requiring lengthening
  3. Associated segmental defect requiring bone transport
  4. Stiff/hypertrophic non-unions

21

Management of segmental bone defects (4)

  1. Acute limb shortening
  2. Delayed limb shortening
  3. Defect reconstruction
  4. Amputation

22

Reconstruction of segmental bone defects (4)

  1. Autograft
  2. Allograft
  3. Bone graft substitutes
  4. Distraction osteogenesis

23

Advantages of acute limb shortening (6)

  1. Short treatment time
  2. Lowest complication rate
  3. Fracture healing starts immediately
  4. Improved stability
  5. Facilitation of wound closure
  6. Excellent residual limb function

24

Advantages of autogenous cancellous grafting (4)

  1. Widely applicable
  2. Easy to perform
  3. Low cost
  4. Osteoconductive and osteoinductive

25

Disadvantages of autogenous cancellous grafting (4)

  1. Donor site morbidity
  2. Slow, unreliable incorporation
  3. No structural support
  4. Not applicable for large defects

26

Indications for distraction osteogenesis (4)

  1. Limb lengthening
  2. Deformity correction
  3. Hypertrophic non-unions
  4. Segmental bone loss

27

Advantages of distraction osteogenesis (4)

  1. Appropriate for large defects
  2. Immediate stability/weight bearing
  3. Can address concomitant angular deformity
  4. Allows for care of soft tissues

28

Disadvantages of distraction osteogenesis (4)

  1. Prolonged treatment time
  2. Pin tract infection
  3. Specialized equipment/training
  4. Psychosocial impact of external fixator

29

Principles of distraction osteogenesis (9)

  1. Lengthen through metaphysis whenever possible
  2. Low-energy corticotomy/osteotomy
  3. Minimal soft tissue stripping
  4. Stable external fixation
  5. Latency period
  6. Distraction of 0.25 mm 3-4x/day
  7. Neutral fixation interval during consolidation
  8. Normal physiologic use of the extremity
  9. Limit lengthening to 20% of bone length per period

30

Indications for free vascularized fibular grafting (3)

  1. Conventional bone grafting has failed
  2. Large defects
  3. Poor soft tissue bed