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Flashcards in Goldenstien Trauma List 4 Deck (40)
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1

Contraindications to functional bracing of humeral shaft fractures (5)

  1. Massive soft tissue injury
  2. Bone loss
  3. Polytrauma
  4. Lack of patient cooperation
  5. Inability to obtain/maintain an acceptable reduction
  6. Brachial plexus injury

2

Indications for operative fixation of humeral shaft fractures 

  1. Obesity
  2. Parkinson’s disease
  3. Dependence on ambulatory aids
  4. Non-compliant patient
  5. Polytrauma
  6. Inability to obtain/maintain an acceptable reduction
  7. Segmental fracture
  8. Segmental bone loss
  9. Open fracture
  10. Vascular injury
  11. Bilateral humeral shaft fractures
  12. Floating elbow
  13. Pathologic fracture
  14. Brachial plexus injury
  15. Severe soft tissue injury
  16. Ipsilateral displaced humeral articular fracture
  17. Transverse/short oblique fracture in a young athlete

3

Principles of ORIF of humeral shaft fractures (7)

  • Identify and protect the radial nerve
  • Lag screw fixation whenever possible
  • Broad 4.5mm LCDC plate
  • 8 cortices proximal and distal
  • Address bone defects with:
  1. Acute shortening
  2. Autogenous ICBG
  • Precontour plate to achieve compression on opposite side
  • Maintain soft tissue attachments to bone fragments

4

Disadvantages of plate fixation of humeral shaft fractures (6)

  1. Extensile exposure
  2. Risk to radial nerve
  3. Poor fixation in osteopenic bone
  4. Soft tissue stripping leading to devascularisation of fragments
  5. Stress shielding
  6. Refracture after plate removal

5

Complications of intramedullary nailing of humeral shaft fractures (10)

Antegrade

  1. Rotator cuff injury
  2. Shoulder pain
  3. Prominent hardware
  4. Radial nerve injury

Retrograde

  1. Decreased elbow extension
  2. Heterotopic ossification
  3. Hardware migration
  4. Supracondylar humeral fracture
  5. Elbow pain
  6. Radial nerve injury

6

Indications for external fixation of humeral shaft fractures (6)

  1. Open fractures
  2. Infected nonunions
  3. Burn patients
  4. Segmental bone loss
  5. Vascular injury with acute repair
  6. Severe soft tissue injury

7

Complications of humeral shaft fractures

  1. Infection/osteomyelitis
  2. Malunion
  3. Nonunion
  4. Vascular injury
  5. Radial nerve injury

8

Risk factors for nonunion of humeral shaft fractures (5)

  1. High energy fracture
  2. Transverse fracture
  3. Segmental bone fracture/loss
  4. Inadequate fixation
  5. Medical comorbidities

9

Indications for radial nerve exploration with humeral shaft fractures (3)

  1. Open fractures with radial nerve palsy
  2. sharp Penetrating trauma with radial nerve palsy
  3. Distal 1/3 spiral fractures with palsy after closed reduction (?)

10

Indications for surgical treatment of medial epicondyle fractures (5)

  1. Ulnar nerve symptoms
  2. > 1 cm displacement
  3. intra-articular fragment entrapment of medial epicodyle
  4. Elbow instability
  5. Open fracture
  6. Symptomatic non-union

11

Complications of medial/lateral condyle fractures (5)

  • Malunion
  1. Cubitus valgus – lateral
  2. Cubitus varus – medial
  • Ulnar nerve injury
  • Non-union
  • Degenerative joint disease
  • Instability

12

Classification of supracondylar humerus fractures (6)

  1. High extension
  2. High flexion
  3. Low extension
  4. Low flexion
  5. Abduction (superolateral → inferomedial fracture line)
  6. Adduction (superomedial → inferolateral fracture line

13

Classification of 2-column distal humerus fractures (Jupiter) (6)

  • T-type
  1. High = proximal to or at level of olecranon fossa
  2. Low = transverse component at trochlea
  • Y-type: oblique lines through columns
  • H-type: trochlea is a free fragment
  • Medial lambda: proximal fracture line exits medially
  • Lateral lambda: proximal fracture line exits laterally
  • Multiplane: T-type with a coronal fracture

14

Distal humerus fractures associated injuries (3)

  1. Open fracture
  2. Ipsilateral upper extremity fracture
  3. Ulnar nerve neurapraxia

15

Treatment options for distal humerus fractures (7)

  1. Splinting
  2. Bracing
  3. ORIF
  4. External fixation
  5. Distal humerus arthroplasty
  6. Total elbow arthroplasty
  7. Arthrodesis

16

Indications for nonoperative treatment of distal humerus fractures (3)

  1. Medically unstable elderly patients
  2. Premorbid limitations in arm function
  3. Some non-displaced fractures

17

Steps of ORIF of distal humerus fractures (4)

  1. Reconstruct the articular surface
  2. ICBG for defects as needed
  3. Rigid buttress support with dual plating to connect articular surface to shaft
  4. Intraoperative assessment of ROM and stability and to rule out hardware impingement

18

Principles of ORIF of distal humerus fractures (O’Driscoll) (8)

  1. Every screw in distal fragments should pass through a plate
  2. Engage a fragment on the opposite side fixed to the other plate
  3. Place as many screws as possible in the distal fragments
  4. Screws as long as possible
  5. Each screw should engage as many fragments as possible
  6. Screws should interdigitate to create a fixed-angle construct
  7. Plates should achieve compression at the supracondylar level
  8. Plates must be stiff/strong to resist failure prior to supracondylar union

19

Risk factors for nonunion of distal humerus fractures (6)

  1. Inadequate fixation
  2. Open fracture
  3. Comminution
  4. High energy trauma
  5. Infection
  6. Osteopenia/osteoporosis

20

Complications of olecranon osteotomy in distal humerus fracture treatment (5)

  1. Infection
  2. Nonunion
  3. Hardware failure
  4. Symptomatic hardware
  5. Limitations in forearm rotation (improperly placed hardware)

 

21

Indications for distal humerus replacement in distal humerus fractures (3)

  1. Younger patients (< 65)
  2. Severely comminuted fracture that cannot be reconstructed
  3. Non-surgical treatment is not an acceptable option

22

Indications for total elbow arthroplasty for distal humerus fracture (3)

  1. Elderly (>65) patients with severe articular comminution and osteoporotic bone
  2. Pre-existing inflammatory joint disease
  3. Low-demand patients

23

Prerequisites for distal humerus arthroplasty in distal humerus fractures (2)

  1. Ability to stabilize at least one of the columns
  2. Intact or repairable collateral ligaments

24

Indications for elbow arthrodesis for distal humerus fracture (5)

  1. Painful post-traumatic arthritis in a young labourer
  2. Severe bone or soft tissue loss
  3. Chronic, persistent infection
  4. Concomitant neurologic injury
  5. Failed TEA

25

Complications of intraarticular distal humerus fractures

  1. Stiffness (#1)
  2. Heterotopic ossification
  3. Ulnar nerve injury
  4. Infection
  5. Failure of fixation
  6. Post-traumatic arthritis
  7. Olecranon non-union
  8. Symptomatic hardware
  9. Nonunion

26

Olecranon fracture classification  (Morrey) (4)

  1. Type I: undisplaced
  2. Type IIA: displaced, non-comminuted
  3. Type IIB: displaced, comminuted
  4. Type III: unstable, extension into coronoid

27

Indications for surgical treatment of olecranon fractures (2)

  1. Articular displacement > 2 mm
  2. Disrupted extensor mechanism

28

Options for surgical treatment of olecranon fractures (5)

  1. Excision and triceps advancement
  2. Tension-band fixation
  3. Screw fixation
  4. Screw and wire fixation
  5. Plate fixation

29

Complications of olecranon fractures (6)

  1. Symptomatic hardware (#1)
  2. Decreased range of motion
  3. Arthritis
  4. Ulnar nerve neurapraxia
  5. Instability
  6. Failure of fixation

30

radial head Mason Classification (Modified by Hotchkiss and Broberg-Morrey)

  1. Type I: Nondisplaced or minimally displaced (<2mm), no mechanical block to rotation
  2. Type II: Displaced >2mm or angulated, possible mechanical block to forearm rotation
  3. Type III:Comminuted and displaced, mechanical block to motion
  4. Type IV: Radial head fracture with associated elbow dislocation