Orthopedics Flashcards
This deck covers Chapters 42-51 in Rosens, compromising all of orthopedics and plastic surgery.
List 4 indications for consultation with orthopedics
- Long bone fractures
- Joint fracture
- Joint violation
- Neurovascular compromosie
List 8 different descriptors for a fracture
- Bone
- Location on bone
- Open/Closed
- Direction of fracture line
- Simple/Comminuted
- Angulation
- Displacement
- Type: Avulsion, Compression, Pathologic, Stress
List 6 causes for weakened bones.
- Cancer
- Hyper PTH
- Giant Cell Tumour
- Echondromata
- Cysts
- Osteomalacia
- Osteogenesis Imperfecta
- Scurvy
- Rickets
- Paget’s
Describe the 5 steps involved with fracture healing
- Hematoma
- Inflammatory
- Soft Callus
- Hard Callus
- Remodeling
Define:
- Delayed union
- Malunion
- Non-union
- Delayed union - longer than usual healing
- Malunion - residual deformity remains
- Non-union - failure to unite
List 4 characteristics of nutrient arteries that can help differentiate them from a fracture line.
- Thin
- Angulated through cortex
- Only one side of the cortex
- Less radiolucent
- Sharply marginated
How do you classify and manage open fractures?
Gustillo
- Grade I - <1 cm
- Ancef 2g IV
- Grade II - 1-10 cm
- Ancef 2g IV +/- Gentamycin 5 mg/kg IV
- Grade IIIA - >10 cm + soft tissue stripping
- Grade IIIB - >10 cm + periosteal stripping
- Grade IIIC - >10 cm + vascular injury
- Ancef 2g IV + Gentamycin 5 mg/kg IV
How much blood loss is associated with these fractures?
- Radius/Ulna
- Humerus
- Tib/Fib
- Femur
- Pelvis
- Radius/Ulna
- 150 cc
- Humerus
- 250 cc
- Tib/Fib
- 500 cc
- Femur
- 1000 cc
- Pelvis
- 2000 cc
Define and describe three types of nerve injury.
- Neuropraxia
* Stretch inhibiting neurotransmission - Axonotmesis
* Axon damaged, intact epineurium - Neurotmesis
* Axon and epineurium damaged
What nerve is commonly injured in these injuries:
- Distal radius
- Elbow injury
- Shoulder dislocation
- Sacral fracture
- Acetabular fracture
- Anterior hip dislocation
- Posterior hip dislocation
- Femoral shaft fracture
- Knee dislocation
- Lateral tibial plateau fracture
- Distal radius - Median
- Elbow injury- Median/Ulnar
- Shoulder dislocation - Axillary
- Sacral fracture - S1-S5
- Acetabular fracture - Sciatic
- Anterior Hip dislocation - Femoral
- Posterior Hip dislocation - Sciatic
- Femoral shaft fracture - Femoral nerve
- Knee dislocation - Tibial/Fibular
- Lateral tibial plateau fracture - Fibular
What are the 6 P’s of compartment syndrome?
- Pain (out of proportion/on passive stretch)
- Paresthesia
- Paralysis
- Poikilothermic
- Pulseless
- Pallor
List 8 causes of compartment syndrome
- Vascular injury, Coagulation D/O, OAC
- Reperfusion
- Fracture
- Convulsion
- Exercise
- Burn
- Intra-arterial drug injection
- Interstitial infusion
- Snakebite
- DVT
- Tight casts
Name 5 anatomic compartments in the lower extremity that are more prone to compartment syndrome?
Leg
- Anterior (MCC)
- Lateral
- Deep posterior
- Superficial posterior
Thigh
- Quadriceps
Buttock
- Gluteal
Name 4 anatomic compartments in the upper extremity that are more prone to compartment syndrome?
Hand
- Interosseous
Forearm
- Dorsal
- Volar
Arm
- Deltoid
- Biceps
What pressures are concerning for compartment syndrome?
Normal = 0 mmHg
Concern = >30 mmHg or within 30 of MAP/dBP
Tx:
- Fasciotomy
- Don’t raise limb above heart
Name the adverse outcome associated with:
- Open Fracture
- Injury with Vascular Disruption
- Pelvic Fracture
- Hip Dislocation
- Compartment Syndrome
- Open Fracture
- Osteomyelitis
- Injury with Vascular Disruption
- Amputation
- Pelvic Fracture
- Exsanguination
- Hip Dislocation
- AVN femoral head
- Compartment Syndrome
- Ischemic contracture, amputation, AKI
Name 5 bones prone to AVN
- Femoral head
- Navicular
- Talus
- Scaphoid
- Lunate
- Capitate
What are the signs/symptoms of fat embolism syndrome?
- Neuro - confusion, coma, stupor (edema)
- Cardio - hypotension
- Resp - ARDS
- Heme - thrombocytopenia
- Derm - petechial rash
- Other - fever, jaundice
What are fracture blisters? Where do they occur? Do they impact management?
Tense bullae formed after high-energy injury
Location
- Usually ankle, elbow, foot, knee
Treatment:
- Cover with poviodine soaked sterile dressing
- Requires delay in Sx or approach not over the blister
List 6 complications of fractures and 6 complications of immobility
Fractures
- Pain
- Hemorrhage
- Vascular injury
- Nerve injury
- Compartment syndrome
- AVN
- Fat embolism syndrome
- Reflex dystrophy
- Volkmann’s ischemic contracture
- Non-union
- Malunion
Immobility
- Pneumonia
- DVT
- PE
- UTI
- Wound infection
- Decubitus ulcer
- Muscle atrophy
- Stress ulcers
List 5 complications of casting
- Compartment syndrome
- Burn
- Pressure sore
- Pruritic dermatitis
- Bacterial/Fungal infection
What is damage control orthopedic surgery?
Surgery meant to stop bleeding and aid resuscitation with attempts at definitive repair taken later when more stable
Define subluxation and dislocation
Subluxation
- Partial loss of continuity of a joint surface
Dislocation
- Complete loss of continuity of a joint surface
Characterize the various degrees of sprains
1st Degree
- Minor tearing/overstretching of some fibers
2nd Degree
- Partial-thickness tear
3rd Degree
- Complete thickness tear
Describe the Ottawa Ankle/Foot Rules with respect to inclusion criteria, exclusion criteria, and the rule.
Inclusion
- Adults (validated later in children)
- Any mechanism of a blunt ankle injury
Exclusion
- Children
- Pregnant
- Isolated skin injury
- Injury >10d ago or R/A of the same injury
Rule
- Ankle
- Pain in the malleolar zone with any one of:
* Inability to WB 4 steps on scene AND in ED
* Pain along post. 6 cm of the med/lat malleolus - Foot
- Pain in the midfoot zone with any one of:
* Inability to WB 4 steps on scene AND in ED
* Pain along the base of the 5th MT
* Pain along the navicular
Describe the Ottawa Knee Rules with respect to inclusion criteria, exclusion criteria, and the rule.
Inclusion
- Adults (validated later in children)
- Any mechanism of blunt knee injury
Exclusion
- Children
- Pregnant
- Isolated skin injury
- Paraplegia
- Multi-system trauma
Rule
- Age >55
- Isolated fibular head pain
- Isolated patellar pain
- Inability to flex >90 degrees
- Inability to WB 4 steps in ED and initially
Characterize the various degrees of strain
1st Degree
- Minor tear or musculotendinous unit
2nd Degree
- Partial tear
3rd Degree
- Complete tear
List 5 risk factors for tendonitis
- Male
- Older
- Obesity
- Poor flexibility
- Training error
- Improper equipment use
- DM
- RA
- SLE
- Steroids
- Fluoroquinolones
- Overuse (occupation)
List 4 ultrasound findings of tendonitis
- Loss of fibrillar echotexture
- Focal tendon thickening
- Diffuse thickening
- Microruptures
- Focal hypoechoic area
- Ill-defined borders
Identify the following:

Stener Fracture
- Avulsion of the ulnar corner of the base of the proximal phalanx of the thumb
- Can get trapped in the aponeurosis of the adductor pollicis and require surgical release
Treatment
- Thumb spica cast (leave IP joint free)
- Plastics OP referral
Identify the following:

Boxer’s Fracture
- Fracture of the 4th or 5th metacarpal neck
- Closed fist injury
Treatment
- Reduction if >50-60 degrees angulation
- Buddy Tape vs Ulnar Gutter
- Plastics OP referral
Identify the following:

Bennett’s Fracture
- Oblique 2-part fracture through the base of 1st MC with dislocation of the radial portion
- MCC fracture of the thumb
Treatment:
- Thumb spica splint (IP joint free)
- Plastics OP referral
Identify the following:

Rolando Fracture
- 3-part intra-articular fracture through the base of the 1st MC
- From axial load
Treatment:
- Thumb Spica splint (leave IP free)
- Plastics OP referral
Identify the following:

Colle’s Fracture
- Dorsal displacement and volar angulation of the distal radius
Treatment
- Reduction
- Goals:
- 11 degrees volar tilt (lateral)
- 11 mm radial styloid height (AP)
- >11 degrees of ulnar slant of radius (AP)
- Intra-articular step-off <2 mm
- Splint in radial gutter
- Ortho OP referral
Identify the following:

Smith Fracture
- Volar displacement and dorsal angulation
- *Reverse Colle’s* -RARE
Treatment
- Reduction
- Goals:
- 11 degrees volar tilt (lateral)
- 11 mm radial styloid height (AP)
- >11 degrees of ulnar slant of radius (AP)
- Intra-articular step-off <2 mm
- Splint in radial gutter vs long arm cast (controversial)
- Ortho OP referral
Identify the following:

Barton Fracture
- Intra-articular fracture-dislocation of the distal radius
- Carpal displacement
- Unstable, often requiring surgery
- Can be dorsal or volar, depending on displacement of carpus
Treatment
- Reduce like Colle’s
- Ortho to see in ED (walking wounded)
Identify the following:

Chauffeur’s Fracture
- Solitary fracture of radial styloid
Treatment
- Radial gutter splint
- Ortho OP referral
What is an Essex-Lopresti fracture?
Essex-Lopresti Fracture
- Radial Head Fracture
- DRUJ injury
Treatment
- Splint immobilize for pain
- Ortho to see in ED
Identify the following:

Galeazzi Fracture
- Radial shaft fracture
- DRUJ injury
- Nerve: AIN frequently injured
Treatment
- Reduction if NVI
- Ortho to see in ED
Identify the following:

Monteggia Fracture
- Ulnar fracture
- Radial head dislocation
- Nerve: PIN frequently injured
Treatment
- Reduction if NVI
- Ortho to see in ED
Provide a memory aid for differentiating Monteggia vs Galeazzi
MU GR P AIN
(MUGGER PAIN)
Monteggia = Ulnar Fracture = PIN
Galeazzi = Radius Fracture = AIN
Identify the following:

Nightstick Fracture
- Isolated ulnar shaft fracture
- Commonly a defensive injury
Treatment
- Ulnar gutter splint
- If displaced <50% and <10 degrees of angulation
- Ortho OP referral
Identify the following:

Hill-Sachs Fracture
- Impact fracture of the posterolateral humeral head
- Associated dislocation
Treatment
- Shoulder reduction
- Shoulder Splint
- Ortho OP referral
Identify the following:

Bony Bankart Lesion
- Fracture of anterior glenoid (plus labrum)
- Associated with shoulder dislocation
Treatment
- Shoulder reduction
- Shoulder splint
- Ortho OP referral
Identify the following:

March Fracture
- Stress fracture of the metatarsal
Treatment
- Hard soled shoe
Identify the following:

Jones Fracture
- Fracture through the base of the 5th MT, into the intermetatarsal joint
- Occurs distal to the peroneus brevis insertion
Treatment
- NWB
- Ortho OP referral
Identify the following:

Aviator Fracture
- Vertical fracture through the talar neck with subtalar dislocation
- High risk of AVN
Identify the following:

Lisfranc Fracture
- Fracture of the tarsometatarsal joint
- Caused by axial load in a plantar flexed foot
Features
- Line from medial 2nd MT to middle cuneiform (AP)
- Widening of 1st/2nd MT space (AP)
- Fleck sign (avulsion here)
- Dorsal displacement of 1st/2nd MT base (Lateral)
- Line from medial 4th MT base to medial cuboid (Oblique)
- Disruption of the medial column line
Treatment
- Ortho to see in ED
Identify the following:

Maisonneuve Fracture
- Fracture of the proximal ⅓ of the fibula
- Associated with deltoid rupture, medial malleolus fracture
- Syndesmosis disruption
- Nerve injury = common fibular (foot drop)
Treatment
- Ortho to see in ED
Identify the following:

Malgaigne’s Fracture
- Fracture of ilium near SI joint w/ symphysis displacement
- OR
- SI dislocation with both ipsilateral pubic rami fractures
- Essential a vertical shear fracture
Treatment
- NWB
- Ortho to see in ED
Identify the following:

Dashboard Fracture
- Posterior rim of acetabulum fractured
- Knee off dashboard drives femoral head back
Treatment
- Ortho to see in ED
Identify the following:

Pott’s Fracture
- Bimalleolar fracture
Treatment
- Ortho to see in ED
Identify the following:

Tillaux Fracture
- Salter-Harris 3 fracture
- Medial growth plate ossifies first
Treatment
- U-slab immobilization
- Ortho OP referral
What is the Weber classification system for ankle fractures?
Fibular fracture description
- A - Below the syndesmosis
- B - At the syndesmosis
- C - Above the syndesmosis
Treatment
- A - WBAT in walking boot
- B - Stress views, ortho in ED if widening
- C - Ortho to see in ED
Identify the following:

Segond Fracture
- Avulsion fracture at the lateral knee
- Commonly associated with ACL tear and meniscal injury
Treatment
- Crutches
- Ortho OP referral
Identify the following:

Chance Fracture
- Burst fracture of vertebrae, commonly lumbar
- Seatbelt injury
- Unstable
- Commonly associated with intra-abdominal injury
Treatment
- Logroll precautions
- Spine to see in ED
- CT Abdo/Pelvis
Identify the following:

Clayshoveler’s Fracture
- Fracture of the tip of the spinous process of the 6th/7th cervical vertebra
- Stable fracture
Treatment
- NSAIDs
- Rest
- Hard collar
- Spine OP referral
Identify the following:

Hangman’s Fracture
- Fracture-dislocation of Axis (C2) and Atlas (C1)
- Hyperextension during rapid deceleration
- Unstable
Treatment
- C-spine collar
- Spine to see in ED
Identify the following:

Jefferson’s Fracture
- Burst fracture of C1
- Axial load
- Unstable
Treatment
- C-spine collar
- Spine to see in ED
Describe the Lefort fractures and management
Lefort Fracture
- I - transmaxillary (horizontal above teeth)
- II - pyramidal from lateral to teeth to nasofrontal suture
- III - craniofacial dislocation, across zygoma and nose through orbits
Treatment
- ABCs
- IV ABx due to sinus violation
- HOB to 30 degrees
- May need to pack anterior nose
- Avoid NG, possible skull base fracture

Outline the Salter-Harris classification system
SALTR
- 1 Straight-through
- 2 Above
- 3 beLow
- 4 Through
- 5 cRush
Identify the following:

Greenstick Fracture
- Fracture through immature bone
- Not through both cortices
Treatment
- Splint
- Ortho OP follow-up
Identify the following:

Torus/Buckle Fracture
- See buckle, but not a break in the cortex
Treatment
- Splint
- Ortho OP referral
List the intrinsic muscles of the hand
Thenar Group
- Abductor pollicis brevis
- Flexor pollicis brevis
- Opponens pollicis
Hypothenar Group
- Abductor digiti minimi
- Flexor digiti minimi
- Opponens digiti minimi
Adductor Pollicis
Interossei (Palmar x3, Dorsal x4)
Lumbricals (4)
What are Kanavel’s signs? What are they for?
Kanavel’s Signs
Flexor Tenosynovitis
- Pain along tendon sheath
- Pain with passive extension
- Held in flexion
- Fusiform swelling
Describe motor and sensory testing of the hand
Radial Nerve
- Motor - thumb extension
- Sensory - 1st dorsal webspace
Median Nerve
- Motor - Opposition of thumb (A-okay)
- Sensory - Palmar distal phalanx of D2
Ulnar Nerve
- Motor - Spread fingers
- Sensory - Palmar distal phalanx of D5
What degrees of angulation are acceptable for metacarpal shaft AND neck fractures?
D2/D3
- Shaft 10 degrees
- Neck 10 degrees
D4
- Shaft 30 degrees
- Neck 30 degrees
D5
- Shaft 40 degrees
- Neck 50 degrees
How do you diagnose a UCL rupture of the thumb? How do you manage this? What is a Stener lesion?
Diagnosis
- Valgus stress test (>35 degrees is abnormal)
- U/S or MRI
Treatment
- Thumb spica cast x4 weeks
Stener’s Lesion
- Avulsion fragment interposed between adductor pollicis
- Needs surgical release
What is the Doyle classification? What is it for?
Doyle Classification - Mallet Finger
- Type I - Closed tendon rupture without avulsion fragment
- Type II - Open tendon laceration
- Type III - Open tendon laceration with tissue loss
- Type IV - Mallet fracture
What are 6 indications and 6 contraindications to digit reimplantation?
Indications
- Multiple digits
- Thumb
- Wrist and Forearm
- Sharp
- Pediatric
- Distal to FDS insertion
Contraindications
- Multiple levels
- Self-inflicted
- Proximal to FDS
- Extreme of age
- Serious underlying disease
- Unstable patient
What are the anatomic borders of the snuff box?
Medial Border (Ulnar)
- EPL
Lateral Border (Radial)
- APL
Proximal Border
- Radial styloid
What are the normal measurements of the radius?
- Radial Inclination
- Radial Height
- Volar Tilt
- Radial Inclination = 12-24 degrees
- Radial Height = 12 mm
- Volar Tilt = 12-24 degrees
Name a classification system for carpal instability. Describe it.
Mayfield Classification
- I - Scapholunate Dissociation
- >3 mm gap between the scaphoid and lunate
- II - Perilunate dislocation
- Lunate articulates with radius, capitate dislocated
- III - Perilunate Dislocation + Triquetral Dislocation
- Triquetrum overlaps lunate/hamate
- IV - Lunate Dislocation
- Piece of pie, spilled teacup

How do you differentiate a DISI vs VISI midcarpal instability?
- Locate lunate on lateral view
- If lunate has dorsal tilt on radius = DISI
- If lunate has volar tilt on radius = VISI
What structure is at risk in midshaft humeral fractures?
Radial Nerve
Provides innervation to triceps and wrist extensors.
Sensation to the dorsum of the hand
What structure is at risk with olecranon fracture?
Ulnar Nerve
Hand intrinsics and ulnar-sided finger/wrist flexors
Sensation to ulnar 1.5 fingers
What structure is at risk with supracondylar fractures?
Median Nerve
Innervates radial sided wrist/finger flexors, thenar eminence
Sensation to radial side of palm
Describe a classification system for supracondylar fractures
Gartland System
- Cortex intact, anterior humeral line off
- Fracture with anterior cortex displacement
- Fracture with posterior cortex displacement (+ Anterior)
Which neurovascular structures are at risk with posterior elbow dislocations?
Median Nerve
Brachial Artery
List the sensory and motor components of the brachial plexus
Brachial Plexus = C5 - T1
- C5 (Deltoid) - Sergeants patch
- C6 (Biceps) - Thumb
- C7 (Thumb Extensors) - D2 tip
- C8 (Finger Flexors) - D5 tip
- T1 (Intrinsic Hand) - Medial upper arm
List myotomes for the following:
- C5-T1
- L2-S1
- C5 - Shoulder abduction
- C6 - Elbow flexion
- C7 - Elbow/Wrist/Finger extension
- C8 - Wrist/Finger flexion
- T1 - Finger abduction
- L2 - Hip flexion
- L3 - Knee extension
- L4 - Ankle dorsiflexion
- L5 - Great toe extensors
- S1 - Plantar flexors
List the 3 types of clavicle fracture? How common are they?
Proximal ⅓ - 5%
- CT if posterior displacement to r/o mediastinal injury
Middle ⅓ - 80%
- >100% displacement or >2cm shortening to ortho
Distal ⅓ - 15%
- Ortho OP referral
Describe a classification system for AC joint separations.
How do you manage each?
Rockwood Classification
- 0-25%
- 25-50%
- 50-100%
* Sling, Ortho OP referral, Analgesia - Posterior
- >100%
- Inferior
* OR
What are the two most common fractures associated with anterior shoulder dislocations?
Hill-Sachs
- Occurs in 40% of 1st timers and 80% of recurrent
- Ortho OP referral
Bony Bankart
- Ortho OP referral
Describe 6 techniques for anterior shoulder reduction
-
Stimson
* Prone, arm hanging off bed -
Traction-Countertraction
* Axial traction with sheet holding body in counter -
Milch
* Abduct and pull on arm, push humeral head in -
External Rotation
* Adduction with ER -
Scapular Manipulation
* Push inferior scapular tip to tilt glenoid into shoulder -
Cunningham
* Place hand on your shoulder, massage muscles -
Spaso
* Flex arm forward, pull axially, twist in ER -
Kocher
* Traction with ER in adduction, then abduct and IR -
FARES
* Traction with oscillating AP + abduction
Name 3 radiographic signs of posterior shoulder dislocation
- Lightbulb sign
- Rim sign
- Loss of half-moon elliptical overlap of head/glenoid
- Posterior displacement on axillary
List 10 red flags for back pain
- Fever
- Trauma
- Age >50
- Steroids
- Cancer History
- IVDU
- Neuro deficit
- Weight loss
- Pain >6 weeks
- Incontinence
- Recent bacterial infection
- Severe pain, despite analgesia
Provide 10 causes for thoracic back pain
- DDD
- Herniation
- Diskitis
- Spinal Hematoma
- Spinal Abscess
- AAA
- Aortic dissection
- Renal colic
- Transverse myelitis
- ACS
- Pericarditis
- Pneumonia
- PE
- PTX
- Biliary Colic
- Pancreatitis
- PUD
Why are the posterior ligaments crucial for pelvic stability?
Name three.
Disruption of these ligaments leads to pelvic instability
- Sacrospinus ligament
- Iliolumbar ligament
- Anterior & Posterior SI ligaments
- Sacrotuberous ligament
Name and describe 2 classification systems for pelvic fractures
Tile’s
- A - stable, posterior arch intact
- Avulsions, Rami fractures, transverse sacral fractures
- B - partially stable, incomplete disruption of posterior arch
- Open book, lateral compression
- C - Unstable, complete disruption of posterior arch
- Vertical shear
Young-Burgess
- AP Compression
- Symphysis diastasis <2.5 cm
- Symphysis diastasis >2.5 cm with sacrospinous and anterior SI ligament disruption
- Symphysis diastasis >2.5 cm with anterior/posterior SI ligament disruption
- Lateral Compression
- I - Sacral crush on one side
- II - Sacral crush with posterior lig. disruption
- III - Severe IR of hemipelvis ‘Windswept pelvis’
- Vertical Shear
- Vertical displacement of symphysis and SI joints
List where you’d expect an avulsion fracture from the forceful contraction of the following muscles:
- Hamstrings
- Abdominals
- Sartorius
- Rectus femoris
- Hamstrings = Ischial tuberosity
- Abdominals = Iliac wing
- Sartorius = ASIS
- Rectus femoris = AIIS
List 5 radiographic clues to posterior arch fractures
- Avulsion of L5 transverse process
- Avulsion of ischial spine
- Avulsion of lower lateral lip of the sacrum
- Displacement of a pubic rami fracture
- Asymmetry of the sacral foramina
Describe the classification of acetabular fractures
Type A
One column (anterior or posterior) fractured
Type B
Transverse fracture (T-shaped), with a portion of acetabulum attached to the proximal ilium
Type C
Transverse fracture (T-shaped) through both anterior and posterior columns with no portion of the acetabulum attached to the axial skeleton
List 8 causes of painful hip without fracture on X-ray
- Hip fracture
- Septic arthritis
- OA
- Bursitis
- Tendonitis
- Transient synovitis
- Referred back pain
- Hemarthrosis
- AVN
- SCFE
- Cancer
- DVT
- Inguinal hernia
Describe 3 ways of detecting subtle hip fractures on x-ray
- Shenton’s Line
- S and Reverse-S curves
- Trabecular Pattern
List 5 ways to reduce a posterior hip dislocation
Captain Morgan
- Strap pt down, knee under their’s, push foot down
Whistler
- Hand under leg, on opposite knee, push foot down
Stimson
- Prone, legs over end of bed, downward & abduct & ER
Allis
- Stand on bed, hip flexed, pull up
Traction-Countertraction
- Supine, leg over your shoulder, using foot to pull down
List 6 risk factors for SCFE
- Male
- Obesity
- Black
- Radiation/Chemotherapy
- Renal osteodystrophy
- Hypothyroidism
- Neglected septic arthritis
List 4 ways to diagnose vascular injury from a knee dislocation
- ABI
- U/S
- CT Angiography
- Angiogram
- OR
How do you manage a knee dislocation?
- Neurovascular exam
- Reduction
- Neurovascular exam
- OR if vascular compromise
- Zimmer
What specific measurement can be used for patella alta?
Insall-Salvati Ratio
Ratio of patella tendon : patellar height
If <0.8, suggests patella baja (quad tendon rupture)
If >1.2, suggests patella alta (patellar tendon rupture)
What is the unhappy triad of knee injuries?
- ACL
- MCL
- Medial meniscus
What is the terrible triad of elbow injuries?
- Elbow dislocation
- Radial head fracture
- Coronoid fracture
List the compartments of the lower leg.
Describe the contents and nerve supply of each.
Anterior
- Deep fibular nerve
- Tibialis anterior, Great toe extensor
Lateral
- Superficial fibular nerve
- Peroneus longus/brevis
Deep Posterior
- Tibial nerve
- TIbialis posterior, great toe flexor
Superficial Posterior
- Sural nerve
- Gastrocnemius, soleus
List 6 ankle fractures that ortho should see in the ED
- Weber B
- Weber C
- Bimalleolar fracture
- Trimalleolar fracture
- Maisonneuve
- Pilon Fracture
- Talar fracture
- Fracture-dislocation
- Open fracture
Identify the following:

Pilon Fracture
- Axial compression
- Intra-articular fracture, very comminuted
- Often open
Treatment
- Assessment of neurovascular status
- Reduction
- Immediate elevation
- Ortho to see in ED
List 5 injuries associated with Pilon fractures
Axial load
- Compression fracture of spine
- Acetabular fracture
- Femoral neck fracture
- Tibial plateau fracture
- Calcaneal fracture
List 6 things on the DDx for a presumed ankle sprain
- Ankle sprain
- Fracture of the base of the 5th MT
- Fracture of the posterior process of the talus
- Fracture of the lateral process of the talus
- Fracture of the anterior process of the calcaneus
- Midtarsal joint (Lisfranc) injury
- Peroneal tendon dislocation
- Lateral collateral ligament sprain
How do you calculate Boehler’s angle?
Angle between:
- Posterior tuberosity –> Apex of posterior facet
- Apex of posterior facet –> Apex of anterior process
Normal = 20 - 40 degrees
Abnormal = <20 degrees

List 4 radiographic abnormalities in Lisfranc injuries.
AP View
- Line from medial 2nd MT to middle cuneiform
- Widening of 1st/2nd MT space
- Fleck sign (avulsion at 1st/2nd MT base)
Lateral View
- Dorsal displacement of 1st/2nd MT base
Oblique View
- Line from medial 4th MT base to medial cuboid
- Disruption of the medial column line