Goldenstien Trauma List 5 Flashcards Preview

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Flashcards in Goldenstien Trauma List 5 Deck (40)
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1

Stabilizers preventing posterolateral rotatory instability (3)

  1. Lateral ulnar collateral ligament
  2. Common extensor origin
  3. Joint capsule

2

Indications for surgical treatment of acute elbow dislocations (7)

  1. Open injuries
  2. Neurovascular injury
  3. Irreducible dislocation
  4. Incongruent reduction
  5. Incarcerated bony fragments/soft tissue
  6. Inability to maintain reduction in a safe position
  7. To treat associated fractures

3

Complications of elbow injuries in adults (4)

  1. Neurovascular injury
  2. Post-traumatic stiffness
  3. Heterotopic ossification
  4. Recurrent instability

4

Risk factors for heterotopic ossification in elbow injuries (5)

  1. Increasing severity of injury
  2. Delayed reduction of dislocation
  3. Forced passive motion
  4. Associated head injury
  5. Associated burns

5

Classification of Monteggia fractures (4)

  1. Type I: anterior (60%)
  2. Type II: posterior (15%)
  3. Type III: lateral
  4. Type IV: with proximal radius fracture

6

Causes of malreduction of the radial head in Monteggia fractures (3)’

  1. Non-anatomic reduction of the ulna
  2. Interposed annular ligament/capsule
  3. Intraarticular osteochondral fragment

7

Complications of Monteggia fractures (4)

  1. PIN palsy
  2. Redislocation/subluxation
  3. Proximal radioulnar synostosis
  4. Loss of ROM

8

Indications for surgical treatment of forearm shaft fractures (4)

  1. > 10° of angulation or > 50% shaft displacement
  2. Open fractures
  3. Both bones forearm fracture
  4. Polytrauma

9

Indications for acute bone grafting of forearm fractures (3)

  1. Comminution involving > 1/3 of the diaphyseal cortex
  2. Segmental bone loss
  3. Severe open fractures with poor local biology

10

Complications of forearm fractures (8)

  1. Compartment syndrome
  2. Nerve injury
  3. Infection
  4. Non-union
  5. Malunion
  6. Radioulnar synostosis
  7. Refracture after hardware removal

11

Risk factors for nonunion of forearm fractures

  1. Open fracture
  2. Comminution
  3. Segmental fractures
  4. Segmental bone loss
  5. Inadequate fixation
  6. Both bones fractures

12

Risk factors for refracture after hardware removal (3)

  1. Large plates
  2. Removal before 18 months
  3. No immobilization post-removal

13

Risk factors for radioulnar synostosis after surgical treatment of forearm fractures (13)

  1. Same level fracture of both bones
  2. Proximal 1/3 fractures
  3. Open fractures
  4. High energy injury
  5. Associated head injury
  6. Associated burns
  7. Delayed surgery
  8. Single incision surgery
  9. Insufficient stabilization
  10. Faulty plate location
  11. Screws projecting into the interosseous gap
  12. Primary corticocancellous bone grafting (especially if in contact with interosseous membrane)
  13. Cast immobilization post-osteosynthesis

(Injury, pre-op, operative, post-op)

14

Poor prognostic factors for outcome after synostosis resection (4)

  1. Proximal location
  2. Large synostosis
  3. Severity of the initial injury
  4. Later timing of resection

15

Radiographic signs of DRUJ instability in Galeazzi fractures (4)

Ulnar styloid fracture

Ulnar head dislocation on a true lateral XR

Widened DRUJ on PA XR

≥ 5 mm of radial shortening

16

Classification of distal radius fractures (Frykman) (8)

  1. Type I: extraarticular
  2. Type II: type I with an ulnar styloid fracture
  3. Type III: enters radiocarpal joint
  4. Type IV: type III with an ulnar styloid fracture
  5. Type V: enters radioulnar joint
  6. Type VI: type V with an ulnar styloid fracture
  7. Type VII: enters both radiocarpal and radioulnar joints
  8. Type VIII: type VII with an ulnar styloid fracture

17

Risk factors for distal radius fractures (5)

  1. Decreased bone mineral density (femoral neck osteopenia/osteoporosis)
  2. Female
  3. Ethnicity (Caucasian)
  4. Heredity (family history of osteoporosis)
  5. Early menopause

18

Distal radius fractures associated injuries (8)

  1. Carpal fractures
  2. Medial nerve injury
  3. TFCC injury
  4. Carpal ligament injury
  5. Tendon injury
  6. Open fracture
  7. DRUJ injury

19

Causes of median nerve injury with distal radius fractures (3)

  1. Direct contusion
  2. Mechanical deformation
  3. Abnormally high pressures in the carpal tunnel

20

Treatment of median nerve compression with distal radius fractures (4)

  1. Elevation
  2. Release of constricting bandages/casts
  3. Closed/open reduction of deformity
  4. Surgical decompression

21

Indications for carpal tunnel release in distal radius fractures (3)

  1. Symptoms don’t improve after closed reduction/dressing removal
  2. Symptoms are progressive
  3. Symptoms lasting longer than 6 hours

22

Things to look for on radiographs of distal radius fractures (11)

PA

  1. Radial shortening/comminution
  2. Ulnar styloid fracture
  3. Radial inclination
  4. Lunate facet depression
  5. Scapholunate dissociation
  6. Gilula’s lines

Lateral

  1. Volar tilt
  2. Metaphyseal comminution
  3. Volar cortex displacement
  4. Scapholunate angle
  5. Position of the DRUJ

23

Indications of unstable distal radius fractures (8)

  1. Older age
  2. Both volar and dorsal metaphyseal comminution
  3. Radial shortening > 5 mm
  4. Articular depression > 2 mm
  5. Dorsal tilt > 20°
  6. Displaced articular margin fractures (Barton’s, Smith’s, Chauffeur’s)
  7. Fractures that displace during cast immobilization
  8. Loss of  ≥ 5° of radial inclination

24

Indications for surgical intervention for distal radius fractures (5)

  1. Open fracture
  2. Associated median nerve compromise
  3. ≥ 2 mm articular step or gap
  4. ≥ 5 mm radial shortening
  5. ≥10° dorsal tilt

25

Indications for ORIF for distal radius fractures

  1. Articular margin fractures   (Barton’s, Smith’s, Chauffeur’s)
  2. Complex intraarticular fractures
  3. Die-punch fractures
  4. Polytrauma

26

Options for surgical treatment of distal radius fractures (4)

  1. Percutaneous interfocal pinning
  2. Percutaneous intrafocal (Kapandji) pinning
  3. External fixation
  4. ORIF

27

Advantages of volar vs. dorsal plating of distal radius fractures (4)

  1. Large bone surface for plate application
  2. Plate protected by pronator quadratus
  3. Anatomic reduction of thick volar cortex gives significant stability
  4. Lower risk of tendon rupture

28

Complications of external fixation of distal radius fractures (9)

  1. Superficial radial nerve injury
  2. Extensor tendon injury
  3. CRPS
  4. Pin loosening
  5. Pin tract infections
  6. Pin breakage
  7. Delayed union
  8. Carpal tunnel syndrome (“cotton loder” position)
  9. Finger stiffness

29

Complications of distal radius fractures (7)

  1. Malunion (#1)
  2. Nonunion
  3. Tendon irritation/rupture
  4. CRPS
  5. Carpal tunnel syndrome
  6. Compartment syndrome
  7. DRUJ instability

30

Consequences of malunion of distal radius fractures

Extraarticular

  1. DRUJ incongruity
  2. Ulnocarpal impingement
  3. Midcarpal instability

Intraarticular

  1. Arthritis