lower extremity Fx classification and surgical HY

Question 1

Posterior hip dislocation

Answer 1

Thompson & Epstein

1. insignificant posterior wall fragment
2. single large posterior wall fragment
3. comminuted posterior wall fragment
4. Fracture of acetabular floor
5. Fracture of femoral head

Question 2

Anterior hip dislocation

Answer 2

Epstein

1. Superior dislocation
2. inferior dislocation
   a. nofracture
   b. assoc fx or impaction of femoral head
   c. assoc fx of acetabulum

Question 3

femoral neck fx

Answer 3

garden

1. nondisplaced, incomplete
2. nondisplaced, complete
3. complete with partial displacement
4. completely displaced, trabecular patttern/parallel

Question 4

subroch hip fx

Answer 4

Russel-Taylor

1. fx with an intact piriformis fossa
   1a. lesser troch is attached to prox fragment
   1b. lesser troch is detached from prox fragmet
2. fx extens into piriformis fossa
   2a. stable medial construct (posteromedial cortex)
   2b. comminution of piriformis fossa & lesser troch

Question 5

Femoral shaft fx

Answer 5

Winquist & Hansen

1. minimal/no comminution
2. cortices of both fragments >50% intact
3. 50-100% cortical comminution
4. circumferential comminutin w/ no cortical contact

Question 6

femoral head fx

Answer 6

Pipkin

1. inferior femoral head fx
2. femoral head fx superior to fovea capitis
3. Type 1 or 2 w/ assoc. femoral neck fx
4. type 1 or 2 w/ assoc. acetabular wall fx

Question 7

intertroch fx

Answer 7

Evans

1. stable, posteromedial cortex intact
2. unstable, comminution of post/med cortex
3. reverse obliquity, unstable

Question 8

periprosthetic hip fx

Answer 8

Vancouver
A. Fx in trochanteric, AG(gr troch), AL (lesser troch)
B. Fx around or distal to stem, B1-stable, B2-unstable (loose stem)
C. Well below stem

Question 9

Pilon fx

Answer 9

Ruedi & Allgower

1. nondisplaced fx
2. displaced fx w/ minimal impaction
3. displaced fx w/ articular comminution & metaphyseal impaction

Question 10

tibial plateau fx

Answer 10

Schatzker

1. Lateral plateau, split fx
2. lateral plateau, split depressed fx
3. lateral plateau, depressed fx
4. medial plateau fx
5. bicondyler plateau fx
6. plateau fx w/ separation of metaphysis>diaphysis

Question 11

ankle fx by mechanism

Answer 11

Lauge-Hansen
Supination-Adduction (SA)15%/vertical med mal fx
supination-external rot (SER) 70%/ spiral fib fx AI>PS
Pronation-abduction (PA) 10%/high transverse fib fx
Pronation-external rot (PER) 10%/spiral fib fx AS>PI

Question 12

Ankle fx by fibula fx location

Answer 12

Weber
A. Fibula fx below level of tibial plafond
B. Fibula fx beginning at level of syndesmosis
C. Fibula fx above syndesmosis, assoc. w/ maisoneuve

Question 13

Talar neck fx

Answer 13

Hawkins

1. nondisplaced fx (15% AVN)
2. subtalar dislocation (25-50%)
3. Subtalar & ankle dislocatin (50-100%AVN)
4. Type 3 + talonavicular dislocation (100%AVN)

Question 14

calcaneus fx

Answer 14

Sanders

1. nondisplaced fx
2. 2-part fx, subtkypes A,B,C = lateral, middle, medial
3. 3-part fx w/ central depressed, subtype AB, AC, BC

Question 15

Pelvic fx lateral compression

Answer 15

Young&Burgess
Lateral compression (LC)-transverse puic rami fx + :
1. sacral compression fx
2. iliac wing fx (on side of impact)
3. LC-1 or LC-2, contralateral open book (APC) injury

Question 16

Pelvic fx anterior posterior compression

Answer 16

Young & Burgess
Anterior>Posterior compression (APC) :
Diastasis of pubic symphysis or longitudinal rami fx
1. 2.5cm of symphysis diastasis, disrupted anterior SI ligaments, intact posterior SI ligaments.
3. Complete disruption of symphysis, ant & post SI ligaments, lateral displacement

Question 17

Pelvic fx vertical shear

Answer 17

Young & Burgess
Vertical Shear (VS)- vertical displacement

Question 18

Acetabular Fx

Answer 18

Judet-Letournel
5 elementary
1. posterior wall
2. Posterior column (fx line exists at gr sciatic notch)
3. Anterior wall
4. Anterior column (disrupts iliopectineal line)
5. Transverse (transtectal, juxtatectal, infratectal)
5 associatied
1. posterior column + post wall
2. T-Shaped
3. Transverse + post wall
4. Anterior column + posterior hemitransverse
5. both column (spur sign on obturator oblique view)

Question 19

Periprosthetic femur fx about TKA

Answer 19

Lewis and Rorabeck
type 1. nondisplaced
type 2. displaced
type 3. Loose prosthesis

Question 20

Pelvis x-ray special views

Answer 20

1. obturator oblique: 45 internal rotation/ visualizes anterior column & posterior wall.
2. Iliac oblique: 45 external rotation/ visualizes posterior column, anterior wall, iliac wing.

Question 21

6 anatomic landmarks of pelvis on xray

Answer 21

1. Iliopectineal line (anterior column)
2. Ilioischial line (posterior column)
3. Anterior wall
4. Posterior wall
5. Tear drop
6. Acetabular dome

Question 22

main blood supply to femoral head

Answer 22

ascending branch of medial circumflex

Question 23

surgical approches to pelvis

Answer 23

1. Kocher-langenbach: posterior wall & column, complications sciatic nerve palsy, heterotopic ossification 20%.
2. Ilioinguinal: anterior wall & column, complications lateral femoral nerve 20%.
3. Extended iliofemoral: T-type or transverse fx, complications heterotopic ossification 20-50%.

Question 24

Talus blood supply: main arteries supplying it

Answer 24

posterior tibial artery, dorsalis pedis, perforating peroneal artery.

Question 25

Talus blood supply: name branches off the main arteries and what part they supply

Answer 25

``` Branches: tarsal sinus, tarsal canal, deltoid Tarsal canal (main supply) body, tarsal sinus + deltoid supply head and neck ```

Question 26

Tibial plateau fx operative indications

Answer 26

- all medial or bicondylar plateau fx's - varus/valgus instability - 3mm of articular stepoff - 5mm of condylar widening

Question 27

Tibial plateau fx approaches

Answer 27

lateral: hockey-stick incision, plate is placed anterior and medial to Gerdy's tubercle. Posteromedial: prox medial epicondyle in line with MCL to insertion on tibia, semimembranosus, gracilis, sartorious retracted, medial head of gastroc retracted posterior.

Question 28

Tibial plateau fx plates used for ORIF of different classes

Answer 28

Type 1-4: T or L buttress plates. | Type 5 and 6 fx: LISS locking plates

Question 29

distal tibial closure order

Answer 29

central>medial>lateral>posterior>anterior

Question 30

Subcapital hip fx surgical treatment

Answer 30

percutaneous pinning, inveted triangle. most inferior screw must be above the lesser trochanter

Question 31

ankle fx syndesmotic screw technique

Answer 31

Place 3.5mm syndesmotic screw at 2.5cm above plafond, in PL to AM direction

Question 32

Tibial shaft IM rod starting point

Answer 32

Medial to lateral tibial spine, anterior extra articular