Flashcards in Low Yield Deck (31):
What antibiotics are indicated for each GA classification? Salt water? Allergic to other abx? Fresh water?
GA I, II- 1st gen cephalosporin (G+)
GA III- 1st gen cephalosporin and aminoglycoside ( G-)
Farm injury- PCN (clostridia)
Allergic to ancef or gent- give fluoroquinolone
Fresh water- fluoroquinolone
Salt water- doxycyline or ceftazadime
What are risk factors for hardware infections?
1) host immunocompetency
2) extremes of age
5) alcohol or tobacco abuse
6) steroid use
9) previous radiation
10) vascular insufficiency
Infected non-union typically presents with what?
Pain at fracture site
After open reduction and internal fixation of long bone fractures, at what time period should C-reactive protein start to decrease?
48hrs; CRP is most predictive of infection during 1st week post-op
Gram positive obligate anaerobe spore forming rod that releases exotoxins
What is first line treatment of gas gangrene?
IV penicillin G and radical surgical debridement
What determines the outcome after a scapulothoracic dissociation?
Neurologic injury; 52% result in flail extremity
Overall 10% mortality rate; early amputation in 20%
What is the classification of capitellum fractures?
Bryan and Morrey:
I- Hahn-Steinthal, coronal split that does not involve the trochlea
II- Kocher-Lorenz, shear fracture that involves mostly articular cartilage with some subchondral bone
III- Boberg-Morrey, comminuted
IV- McKee, coronal shear fracture that involves a large portion of the trochlea (will see "double arc" on lateral xray)
What is the treatment options for capitellum fractures?
1) Posterior splint for 3 wks:
Type I and II 2mm displacement
A to P headless screw
3) Fragment excision:
Type II and III with >2mm displacement
Elderly patients with non reconstructible fxs
What is the most common complication of capitellum fracture?
Other complications are non-union, HO, AVN and ulnar nerve palsy
What is the classification of coronoid fractures?
Regan and Morrey:
I- fracture of the tip
II- 50% of the height
III- >50% of the height
What is the approach to treat an isolated coronoid fracture?
Medial approach through the two heads of FCU
Uses either no 5. ethibond, cerclage wires, retrograde cannulated screws or buttress plate for fixation
What causes early failure of coronoid fractures?
Unrecognized and untreated elbow instability
What is defined as a Monteggia fracture?
Fracture of the proximal 1/3 of the ulna with associated radial head dislocation/instability
What is the classification for Monteggia fractures?
Bado: ("think APL-B)
Type I: Anterior dislocation of the radial head with fracture of ulnar diaphysis at any level with anterior angulation
Type II: Posterior/posterolateral dislocation of the radial head with fracture of ulnar diaphysis with posterior angulation
Type III: Lateral/anterolateral dislocation of the radial head with fracture of ulnar metaphysis
Type IV: Anterior dislocation of the radial head with fractures of both radius and ulna within proximal third at the same level
Failure of the radial head to reduce after ulnar fixation in a Monteggia fracture can be a result of?
1) Malreduction of ulna
2) Interposition of annular ligament
3) Interposition of PIN (rare)
What is the definition of a Galeazzi fracture?
Distal 1/3 radius fracture and injury to DRUJ
What is the incidence of DRUJ instability with distal 1/3 radius fractures?
if radial fracture is 7.5 cm from articular surface; unstable in 6%
Which position is the DRUJ most stable?
In an irreducible DRUJ, what structure is most likely preventing reduction?
What are signs of a DRUJ injury?
1) ulnar styloid fx
2) widening of joint on AP view
3) dorsal or volar displacement on lateral view
4) radial shortening (≥5mm)
In a patient with a dashboard injury resulting in posterior hip dislocation, what is the most likely concomitant injury?
Meniscal tear (~30%)
effusion (37%), bone bruise (33%), and meniscal tear (30%) being the most common findings
What imaging is ordered following a closed reduction of a hip dislocation?
CT pelvis to look for:
1) loose bodies
2) femoral head fx
3) acetabular fx
What is the timing of reduction in a primary hip dislocation?
What complications of hip dislocation have higher incidence with increased time to reduction?
1) femoral head osteonecrosis (5-40%)
2) Sciatic nerve injury (8-20%)
What is the classification for femoral head fractures?
I- Fx below fovea
II- Fx above fovea
III- Type I/II with associated femoral neck fx
IV- Type I/II with associated acetabular fx
In a Pipkin IV femoral head fracture what technique can help preserve the femoral head blood supply?
Greater trochanteric osteotomy with trochanteric flip
What percentage of knee dislocations result in a vascular injury?
Also 25% will have a common peroneal nerve injury as well
What injuries are a/w knee dislocations based on direction of dislocation?
Anterior- (30-50%) most common, intimal tear of politeal a., PCL tear
Posterior- (25%) 2nd most common, complete popliteal rupture
Lateral- (13%) peroneal n., ACL and PCL
Medial- PCL, PLC
What is the treatment algorithm for knee dislocations?
1) Close reduce if deformity (50% spontaneously reduce)
2) Check pulses; if present then ABI
2a: ABI>0.9 then serial checks