Goldenstien Trauma List 8 Flashcards Preview

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Flashcards in Goldenstien Trauma List 8 Deck (40)
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1

Classification of sacral fractures (Denis) (3)

- Zone 1: fracture lateral to sacral foramina (6% risk of neurologic injury)/most common (50%)

- Zone 2: fracture through foramina

- Zone 3: fracture medial to foramina into central sacral canal/highest rate of neurologic deficit (60%)

2

Complications of sacral fractures (4)

  1. Neurologic injury
  2. Malunion
  3. Chronic pain
  4. Infection (with surgery)

3

Classification of acetabulum fractures (Letournel) (10)

- Simple/elementary

  1. o Posterior column
  2. o Posterior wall
  3. o Anterior column
  4. o Anterior wall
  5. o Transverse

- Associated/complex

  1. o Posterior column/posterior wall
  2. o Transverse/posterior wall
  3. o T-shaped
  4. o Anterior column/posterior hemitransverse
  5. o Both columns

4

Acetabular fracture associated injuries (9)

  1. Head injury
  2. Spine injury
  3. Chest injury
  4. Abdominal injury
  5. Urogenital injury
  6. Other fractures
  7. Nerve injury
  8. Morel-Lavallee lesion
  9. Knee ligament injury

 (Proximal → distal)

5

Things to look for on CT scans of acetabular fractures (6)

  1. Posterior pelvic ring injuries
  2. Fractures of the quadrilateral plate
  3. Marginal impaction
  4. Rotation of articular fragments
  5. Intra-articular loose bodies
  6. Femoral head fractures

(Posterior → anterior)

6

Indications for surgical treatment of acetabular fractures (5)

  1. Articular incongruity ≥ 1 mm
  2. Posterior wall fracture with instability (> 20%)
  3. Loss of congruency between femoral head and dome
  4. Intra-articular loose bodies
  5. Marginal impaction

7

Relative contraindications to surgical treatment of acetabular fractures (7)

  1. Advanced age
  2. Medical comorbidities
  3. Morbid obesity
  4. Associated soft tissue/visceral injuries
  5. Contaminated wound
  6. Delay in treatment > 4 weeks
  7. DVT with contraindication to IVC filter

(Patient, injury, complications)

8

Indications for nonoperative treatment of acetabular fractures (8)

  1. Non-ambulatory patient
  2. Elderly patient with comminuted fracture
  3. Severe osteoporosis
  4. Local/systemic infection
  5. Displaced fracture with a large portion of the dome intact (> 10mm, > 45° roof-arc angles)
  6. Secondary congruence
  7. Non-displaced/minimally displaced fractures
  8. Posterior wall fracture without instability

(Patient, injury)

9

Complications of acetabular fractures (8)

  1. Post-traumatic arthritis (#1)
  2. Wound infection
  3. Nerve injury
  4. Heterotopic ossification
  5. Venous thromboembolism
  6. Soft tissue complications
  7. Osteonecrosis
  8. LFCN injury

10

Negative prognostic factors of acetabular fractures (6)

  1. Femoral head injury
  2. Marginal impaction
  3. Fracture-dislocation
  4. Delay in treatment > 3 weeks
  5. Residual displacement > 2 mm
  6. Surgery by an inexperienced individual

11

Classification of hip dislocation (comprehensive) (5)

Type I: no significant fractures, no post-reduction instability

Type II: irreducible dislocation without associated significant fractures

Type III: unstable hip post-reduction or incarcerated labrum/cartilage/bone

Type IV: associated acetabular fracture with hip instability

Type V: associated femoral head/neck fracture

12

Hip dislocation associated injuries (8)

  1. Pelvic fracture
  2. Acetabular fracture
  3. Femoral head/neck fracture
  4. MFCA injury
  5. Sciatic nerve injury
  6. Femur fracture
  7. Patella fracture
  8. Knee ligament injury

(Proximal → distal)

13

Indications for surgical treatment of hip dislocations (5)

  1. Irreducible dislocation
  2. Nonconcentric reduction
  3. Post-reduction instability
  4. Associated acetabular/femoral fracture requiring surgery
  5. Intraarticular loose bodies

14

Potential blocks to reduction of hip dislocation (4)

  1. Inadequate anaesthesia/muscle relaxation
  2. Interposed soft tissue (capsule, SER)
  3. Interposed bone fragments (femoral head, posterior wall)
  4. Labrum

15

Complications of hip dislocations (7)

  1. Sciatic nerve injury
  2. Avascular necrosis
  3. Post-traumatic arthritis
  4. Recurrent instability
  5. Chronic pain
  6. Infection (with surgery)
  7. Venous thromboembolism

16

Risk factors for recurrent instability following a hip dislocation (5)

  1. Femoral version
  2. Acetabular version
  3. Soft tissue impingement
  4. Labral avulsions
  5. Capsular laxity

17

Classification of femoral head fractures (Pipkin) (4)

  1. Type I: fracture below the fovea capitis
  2. Type II: fracture above the fovea capitis
  3. Type III: associated femoral neck fracture
  4. Type IV: associated acetabular fracture

18

Indications for surgical treatment of femoral head fracture (4)

  1. Articular step > 1 mm
  2. Intraarticular loose bodies
  3. To allow early ROM with associated fractures
  4. Polytrauma patient

19

Goals of surgical treatment of femoral head fractures (5)

  1. Restore articular congruity
  2. Restore hip stability
  3. Treat associated fractures
  4. Remove loose bodies
  5. Preserve femoral head blood supply

20

Complications of femoral head fractures (4)

  1. Degenerative joint disease
  2. Osteonecrosis (highest with type III)
  3. Recurrent dislocation
  4. Sciatic nerve injury (20%)

21

Classification of femoral neck fractures (Garden) (4)

  1. Type I: incomplete valgus impacted
  2. Type II: complete undisplaced
  3. Type III: partially displaced varus
  4. Type IV: completely displaced

22

Classification of femoral neck fractures (Pauwel’s) (3)

Type I: up to 30° from horizontal

Type II: 30-50° from horizontal

Type III: > 50° from horizontal

23

Components of the Leadbetter maneuver for closed reduction of femoral neck fractures (4)

  1. Flexion with mild adduction
  2. Traction in-line with the femur
  3. Internal rotation
  4. Circumduction to abduction and extension while maintaining internal rotation

24

Principles of surgical stabilization of femoral neck fractures (4)

  1. Preoperative medical stabilization
  2. Rapid, anatomic reduction
  3. Stable internal fixation
  4. Early postoperative mobilization

25

Radiographic features of an adequate reduction of a displaced femoral neck fracture

- Neck-shaft angle 130-150 deg

- < 10 degrees of anterior/posterior angulation

- Garden’s alignment index

  • o Primary compressive trabeculae 160-180 degrees on AP
  • o Primary compressive trabeculae 160-180 degrees on lateral

- < 5 mm translation on AP and lateral

- S-shaped contour of the head-neck junction

26

Complications of femoral neck fractures (8)

- Non-union

- Osteonecrosis

- Loss of fixation

- Malunion

- Femoral neck shortening

- Thromboembolic disease

- Subtrochanteric fracture

- Death

27

Indications for THA for femoral neck fracture (5)

  1. Older patient
  2. High activity level
  3. Pre-existing arthritis
  4. Low risk for dislocation
  5. Able to comply with postoperative restrictions

28

Classification of intertrochanteric fractures (Evan’s) (4)

Type I: 2-part

Type II: 3-part

Type III: 4-part

Type IV: reverse obliquity

29

Radiographic findings of unstable intertrochanteric hip fractures (3)

  1. Posteromedial comminution
  2. Subtrochanteric extension
  3. Reverse obliquity pattern

30

Principles of surgical treatment of intertrochanteric fractures (4)

  1. Restoration of normal neck-shaft alignment
  2. Medial cortical contact
  3. Controlled collapse during healing
  4. Early mobilization