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Flashcards in Goldenstien Trauma List 3 Deck (40)
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1

Causes of compartment syndrome (7)

Intrinsic

  1. Fracture
  2. Ischemia-reperfusion
  3. Rhabdomyolysis
  4. Space occupying processes (abscess/hematoma)

Extrinsic

  1. Tight wound closure
  2. Tight dressings/splints/casts
  3. Circumferential burns (eschar)

2

Cierny classification of osteomyelitis (4)

  1. Type I: medullary
  2. Type II: superficial
  3. Type III: localized
  4. Type IV: diffuse

3

Cierny host types (3)

  1. A: little/no immunocompromise, normal response to infection
  2. B: mild systemic/local immunocompromise, impaired response to infection
  3. C: severe immunocompromise, no response to infection

4

XR findings of osteomyelitis (6)

  1. Soft tissue swelling (earliest)
  2. Trabecular destruction/lysis
  3. Cortical destruction
  4. Periosteal reaction
  5. Involucrum formation
  6. Sequestrum

5

Indications for surgical debridement of osteomyelitis (4)

  1. Presence of an abscess
  2. Presence of a sequestrum
  3. Presence of metallic implants
  4. Refractory cases

6

Possible indications for removal of implants (8)

  1. Pain at the implant site
  2. Risk of late infection
  3. Implant dislodgement/migration
  4. Stress-shielding
  5. Implant corrosion
  6. Implant-induced metal hypersensitivity
  7. Tumorigenesis
  8. Teratogenesis

7

IM nail hoop stresses decreased by (4)

  1. Posterior start point
  2. Slotted nails
  3. Thin-walled nails
  4. Titanium nails

8

IM nail stiffness increased by (5)

  1. Interlocking
  2. Increased nail diameter
  3. Increased wall thickness
  4. Open sections (slotted)
  5. Stainless steel nail (vs. titanium)

9

Types of plate fixation (5)

  1. Compression (static)
  2. Tension band (dynamic compression)
  3. Neutralization
  4. Buttress
  5. Bridging

10

Ways to maximize screw pullout strength (4)

  1. Larger outer diameter
  2. Smaller root diameter
  3. Finer pitch
  4. Increased bone density

11

Rule of 7 70’s for brachial plexus injury (Narakas) (7)

  1. 70% caused by motor vehicle accidents
  2. 70% involve motorcycles/bicycles
  3. 70% have multiple injuries
  4. 70% of brachial plexus injuries are supraclavicular
  5. 70% have at least one root avulsion
  6. 70% with a root avulsion have a lower plexus (C7-T1) root avulsion
  7. 70% with a lower root avulsion develop chronic pain

12

Findings of preganglionic brachial plexus injury (5)

  1. Horner’s syndrome
  2. Scapular winging (serratus anterior or rhomboids)
  3. Diaphragmatic paralysis
  4. Early neuropathic pain
  5. Preserved sensory nerve action potentials

13

Components of early nonoperative management of brachial plexus injuries (3)

  1. EMG at 6 weeks and 3 months
  2. Early referral to plastic surgery
  3. Splinting
  4. Physiotherapy to prevent contractures
  5. Antagonist botox injections
  6. Neuromodulating medications for pain control

(E.E.S.P.A.N.)

14

Options for surgical treatment of brachial plexus injuries

  1. Exploration and primary repair
  2. Neuroma excision and cable grafting
  3. Neurotization (root avulsions)
  4. Tendon transfers
  5. Free innervated muscle transfer
  6. Arthrodesis
  7. Amputation

15

Surgical priorities when treating brachial plexus injuries (3)

#1 – elbow flexion

  1. Nerve transfer
  2. Tendon transfer

#2 – stable shoulder

  1. Nerve transfer
  2. Arthrodesis

#3 – hand function

  1. Nerve transfer
  2. Tendon transfer/tenodesis
  3. Arthrodesis
  4. Free innervated muscle transfer

16

Decision-making factors regarding peripheral nerve repair (5)

  1. Age of the patient (#1)
  2. Patient expectations
  3. Rehabilitation potential
  4. Type and severity of nerve injury
  5. Alternate reconstruction options

17

Good prognostic factors for outcome of peripheral nerve injury (5)

  1. Younger age (< 20)
  2. Sharp, clean wounds
  3. Early repair (10-14 days)
  4. Direct repair
  5. Healthy, clean, vascular bed

18

Poor prognostic factors for outcome of peripheral nerve injury (5)

  1. Age > 20
  2. Blast or rupture injury
  3. Delayed repair (> 14 days)
  4. Segmental defect
  5. Infected or scarred bed

19

Principles of nerve repair (5)

  1. Healthy, vascular bed
  2. Tension-free repair
  3. 8-0 suture to gauge tension then 9-0/10-0
  4. Appropriate orientation of the nerve
  5. Postoperative immobilization for 3 weeks

20

Methods of determining correct nerve orientation (3)

  1. External topography
  2. Fascicular arrangement
  3. Vascular anatomy

21

Methods of dealing with nerve gaps

  1. Shorten the bone
  2. Neurolysis
  3. Transposition
  4. Nerve graft
  5. Bioactive conduits

22

Types of nerve repairs (3)

  1. Basic epineural suture (digital/sensory nerves)
  2. Group fascicular repair (major mixed peripheral nerves)
  3. Conduit repair (single function nerves with short gaps)

23

Classification of glenoid fractures (Mayo) (5)

  1. Type I: anteroinferior glenoid rim, body intact
  2. Type II: superior 1/3-1/2 of glenoid with coracoid, body intact
  3. Type III: inferior/posteroinferior glenoid, body intact
  4. Type IV: inferior glenoid with extension into body
  5. Type V: type IV plus additional coracoid, acromion or free superior articular fragment

24

Injuries associated with scapular fractures (12)

  1. Head injury
  2. Skull fractures
  3. Cervical spine injuries
  4. Brachial plexus injuries
  5. Arterial injury (not aorta)
  6. Clavicle fractures
  7. Rib fractures
  8. Pneumo/hemothorax
  9. Pulmonary contusions
  10. Intraabdominal injury
  11. Pelvic fractures
  12. Extremity fracture

(Proximal → distal)

25

Indications for ORIF of scapula fractures (5)

 

glenohumeral instability

  1. > 25% glenoid involvement with subluxation of humerus
  2. > 5mm of glenoid articular surface step off or major gap
  3. excessive medialization of glenoid

displaced scapula neck fx

  1. with > 40 degrees angulation or 1 cm translation

open fracture

loss of rotator cuff function

coracoid fx with > 1cm of displacement

 

26

Indications for ORIF of glenoid fossa fractures (3)

  1. > 5 mm displacement of the articular surface
  2. Displacement with subluxation of the humeral head
  3. > 25% involvement of the glenoid
  4. excessive medialization of glenoid

27

Indications for ORIF of glenoid neck fractures (3)

  1. > 1 cm of medial displacement
  2. > 40° angulation of the glenoid
  3. Floating shoulder

28

Injuries associated with scapulothoracic dissociation (3)

  1. Axillary artery disruption
  2. Brachial plexus injury (90%)
  3. Clavicle fracture (50%)

29

Classification of clavicle fractures (11)

Group I – middle third (80%)

Group II – distal third (15%)

  • Type I: minimally displaced, LATERAL to the intact coracoclavicular ligaments
  • Type II: displaced, medial to CC ligaments
  • Type III: intraarticular with AC ligament injury
  • Type IV: displaced with periosteal avulsion/rupture
  • Type V: comminuted

Group III – medial third

  • Type I: minimally displaced, ligaments intact
  • Type II: displaced, ligaments ruptured
  • Type III: intraarticular
  • Type IV: physeal separation
  • Type V: comminuted

30

Deforming forces acting on midshaft clavicle fractures (3)

  1. Superior pull of sternocleidomastoid
  2. Inferior weight of the arm
  3. Medial pull of pectoralis major