Goldenstien Trauma List 6 Flashcards Preview

4-Goldstien list > Goldenstien Trauma List 6 > Flashcards

Flashcards in Goldenstien Trauma List 6 Deck (40)
Loading flashcards...
1

Contraindications to ORIF of scaphoid nonunions (4)

  1. Smoker
  2. Older patient
  3. Progressive carpal arthrosis
  4. Chronic non-union

2

Decision-making factors for treatment of scaphoid nonunions (3)

  1. Location of nonunion
  2. Vascularity
  3. Deformity

3

Radiologic findings of proximal pole AVN in scaphoid nonunions (4)

  1. Bone resorption
  2. Cystic changes
  3. Sclerosis
  4. Low signal on T1 and T2 MRI

4

Complications of surgery for scaphoid nonunions (5)

  1. Persistent nonunion
  2. Hardware malpositioning
  3. Stiffness
  4. Chronic pain
  5. Nerve injury

5

Classification of scaphoid nonunion advanced collapse (4)

  1. Stage I: the osteoarthritis is only localized in the distal scaphoid and radial styloid.
  2. Stage II: the osteoarthritis is localized in the entire radioscaphoid joint.
  3. Stage III: the osteoarthritis is localized in the entire radioscaphoid joint with involvement of the capitolunate joint.
  4. Stage IV: the osteoarthritis is located in the entire radiocarpal joint and in the intercarpal joints. It also may involve the distal radio-ulnar joint (DRUJ).

6

 Indications for ORIF of ulnar styloid fractures (4)

  1. Open injury
  2. Associated with DRUJ instability
  3. Significant displacement
  4. Large fragment involving the base
  5. Intraarticular fragment

7

Complications of DRUJ injuries (5)

  1. Late instability
  2. Post-traumatic arthritis
  3. Ulnocarpal abutment/impaction
  4. TFCC degeneration
  5. ECU tendon subluxation/dislocation

8

Stages of perilunar instability (Mayfield) (4)

  1. Stage I: Scapholunate ligament tear (scapholunate dissociation)
  2. Stage II: capitolunate ligament tear
  3. Stage III: Lunotriquetral ligament tear (perilunate dislocation)
  4. Stage IV: dorsal radiolunate ligament tear (lunate dislocation)

9

Sequence of events in progressive perilunar instability (Mayfield) (7)

  1. Scaphoid extension
  2. Opening of the space of Poirier
  3. Scaphoid failure
  4. Distal row dissociation
  5. Triquetrum hyperextension
  6. Lunotriquetral ligament failure
  7. Dorsal dislocation of the carpus

10

Things to look for on XR of perilunate injuries 

  1. Bones for fracture
  2. Carpal height
  3. Gilula’s lines
  4. Carpal interosseous spaces
  5. Scapholunate and radiolunate angles
  6. Rotatory positions in proximal row

11

Intrinsic muscle releases for hand compartment syndrome (4)

  1. Thenar muscle release
  2. Hypothenar release
  3. Interossei release (2 dorsal incisions)
  4. Carpal tunnel release

12

Complications of nailbed injuries (8)

  1. Hypersensitivity
  2. Cold intolerance
  3. Split nail
  4. Hook nail
  5. Nonadherent nail
  6. Ingrown nail
  7. Ridging
  8. Osteomyelitis

13

Principles of treatment of fingertip injuries with tissue loss (5)

  1. Attempt to maintain length
  2. Prevent joint stiffness/contracture
  3. Preserve nail function if possible
  4. Provide sensate soft tissue to pulp
  5. Enable eventual pain-free use of the finger

14

Indications for replantation in upper extremity traumatic amputations (5)

  1. Thumb (almost any level)
  2. Multiple digit amputations
  3. Metacarpal amputations through the palm
  4. Amputation at the wrist or proximal
  5. Almost anything in a child
  6. Individual digits distal to the FDS insertion (zone I)

15

Contraindications to replantation (5)

  1. Single digit proximal to FDS insertion (zone II)
  2. Multitrauma
  3. Segmental injury/crush/avulsion
  4. Multiple medical comorbidities
  5. Poor rehabilitation potential
  6. Prolonged ischemic time (> 6 hours proximal to the carpus, > 12  warm/24 cold for a digit)

16

Principles of digit replantation surgical technique (8)

  1. Bone shortening and stable fixation
  2. Extensor tendon repair
  3. Flexor tendon repair
  4. Digital artery anastamosis (at least one/digit)
  5. Digital nerve repair
  6. Digital vein anastamosis (2 dorsal/digit)
  7. Skin repair
  8. Fasciotomies as needed

17

Causes of replantation failure (3)

  1. Arterial thrombosis
  2. Venous congestion/thrombosis
  3. Infection

18

Options for surgical treatment of thumb amputations (4)

  1. Replantation (#1 choice)
  2. Revision amputation
  3. Toe-to-thumb transfer
  4. Pollicization

19

Classification of ring avulsion injuries (Urbaniak) (3)

Type 1: circulation adequate

Type 2A: circulation inadequate, no bone/tendon injury

Type 2B: circulation inadequate, bone/tendon injury

Type 3: complete degloving

20

Principles of digit amputation (6)

  1. Preserve functional length
  2. Maintain function and cosmesis
  3. Stable and nontender soft tissue coverage
  4. Preserve sensibility
  5. Avoid symptomatic neuromas
  6. Early mobilization

21

Principles of treatment of high pressure injection injuries (5)

  1. Immediate decompression and mechanical debridement
  2. Wide exploration
  3. Leave wounds open
  4. Multiple debridements as needed
  5. Broad spectrum antibiotics

22

Negative prognostic factors in high pressure injection injuries (5)

  1. Presentation > 10 hours after injection
  2. Pressure > 7000 psi
  3. Oil-based paint
  4. More material
  5. Injection into digit

23

Classification of extensor tendon injuries (9)

Zone I: at the DIP joint

Zone II: over the middle phalanx

Zone III: at the PIP joint

Zone IV: over the proximal phalanx

Zone V: at the MCP joint

Zone VI: over the metacarpal

Zone VII: dorsal wrist

Zone VIII: distal forearm

Zone IX: proximal forearm

24

Classification of mallet finger (zone I extensor tendon injuries) (4)

Type I: closed/blunt trauma ± a small chip fracture

Type II: laceration at or proximal to DIP

Type III: deep abrasion with loss of tendon substance

Type IV: physeal fracture in children

25

Indications for surgical fixation of a mallet finger (4)

  1. Fracture fragment ≥ 30% of the articular surface
  2. Displacement > 2 mm
  3. Volar subluxation of the distal phalanx
  4. Occupation prevents splinting

26

Complications of mallet fingers (9)

  1. Persistent deformity/extensor lag
  2. Secondary swan neck deformity
  3. Post-traumatic DIP arthritis
  4. Skin slough
  5. Nail deformity
  6. Joint incongruity
  7. Infection
  8. Pin failure
  9. Subluxation

27

Causes of boutonniere deformity with zone III extensor tendon injuries (3)

  1. Central slip rupture
  2. Triangular ligament injury/attenuation
  3. Lateral band volar migration

28

Indications for surgical treatment of zone III extensor tendon injuries (central slip rupture) (3)

  1. Avulsion with a bone fragment
  2. Acute injury with volar subluxation of the lateral bands (traumatic boutonniere)
  3. Delayed treatment of a missed central slip injury

29

Poor prognostic factors for delayed treatment of a central slip rupture (3)

  1. PIP contracture > 30°
  2. Failure to regain full extension preoperatively
  3. Age > 45 years

30

Classification of flexor tendon laceration (Verdan) (5)

Zone I: distal to FDS insertion

Zone II: within the fibroosseous tunnel (“no man’s land”)

Zone III: in the palm

Zone IV: within the carpal tunnel

Zone V: proximal to the carpal tunnel