Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Ortho/fracture > Tib, Fib, Ankle > Flashcards

Tib, Fib, Ankle Flashcards

0
Q

4 ligaments that compose the syndesmotic ligament complex:

A

1: anterior inferior tibiofibular ligament
2: posterior inferior tibiofibular ligament (thicker and stronger than anterior)
3: transverse tibiofibular ligament (inferior to posterior)
4: interosseous ligament (distal continuation of the interosseous membrane)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Components of the deltoid ligament complex:

A

Superficial: originate on the anterior colliculus
1: tibionavicular ligament (suspends the spring ligament)
2: tibiocalcaneal ligament (prevents valgus displacement)
3: talotibial ligament (most prominent of the 3)
Deep: deep anterior and posterior tibiotalar (primary medial stabilizer against lateral displacement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 ligaments of the fibular collateral ligament

A

Anterior talofibular, posterior talofibular, calcaneofibular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Radiographic eval of ankle injuries:

A

AP, Lateral, and mortise view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indication of medial or lateral joint disruption with Talar Tilt

A

Difference in width of the medial and lateral aspects of the superior joint space >2 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Positioning of the foot to take mortise view X-ray

A

Foot in 15-20 degrees of internal rotation (to offset the intermalleolar axis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The tibiofibular clear space should be less than how many mm?

A

6 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Approximate degrees of the talocrural angle

A

83 +- 4 degrees (from picture); or between 8 and 15 degrees (angle subtended bt the intermalleolar line and a line parallel to the distal tibial articular surface. Angle should be between 2 to 3 degrees of uninjured ankle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Medial clear space should be equal to the superior clear space between the talus and the distal tibia and less than how many degrees on standard X-ray

A

Less than or equal to 4 mm; greater than 4 indicates lateral talar shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Classification system used for rotational ankle fractures

A

Lauge-Hansen (takes into account 1: the position of the foot at the time of injury, and 2: the direction of the deforming force)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

4 possible position-direction of force combinations with the Lauge-Hansen classification system

A

Supination-adduction
Supination-external rotation
Pronation-adduction
Pronation-external rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Stages of supination-adduction with lauge-Hansen

A

Stage 1: transverse avulsion type fx of the fibula distal to the level of the joint or a rupture of the lateral collateral ligaments
Stage 2: vertical medial malleolar fx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stages of supination-external rotation (40-75% of malleolar fxs)

A

Stage 1: anterior tib-fib sprain +- avulsion fx
Stage 2: typical spiral/short oblique fx of distal fibula
Stage 3: disruption of post tibfib ligament or fx of post malleolus
Stage 4: transverse avulsion fx of medial malleolus or rupture of deltoid ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stages of pronation-external rotation

A

Stage 1: transverse fx of medial malleolus or rupture of deltoid lig
Stage 2: disruption of the ant tibfib lig +- avulsion fx at insertion site, Chaput’s tubercle
Stage 3: spiral fx of distal fib at or above syndesmosis; medial injury with high fib fx
Stage 4: rupture of post tibfib lig or avulsion fx of posterolateral tibia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stages of pronation-adduction with lauge-Hansen classification of rotational ankle fractures

A

Stage 1: transverse fx of medial malleolus or rupture of deltoid lig
Stage 2: rupture of syndesmotic lig or avulsion fx at their insertion sites
Stage 3: transverse or oblique fx of distal fibula at or above level of syndemsosis, producing lateral comminution or butterfly fragment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fx classification based on the level of the fibular fracture

A

Danis-Weber (more proximal the fx, the greater risk of syndesmotic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Maisonneuve fx:

A

Ankle injury with a fx of the proximal third of the fibula. This is a pronation-external rotation type injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Curbstone fx

A

Avulsion fx off the posterior tibia 2/2 tripping mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Maisonneuve fx:

A

Ankle injury with a fx of the proximal third of the fibula. This is a pronation-external rotation type injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

LeForte-Wagstaffe fx

A

Anterior fibular tubercle avulsion fx by ant tibiofibular lig, usually associated with LH SER type fx pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tillage-Chaput fx

A

Avulsion of the ant tibial margin by the ant tibiofibular lig is the tibial counterpart of the LeForte-Wagstaffe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Classic sign for posterior colliculus fx on external rotation view

A

Supramalleolar spike

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Indications for Nonoperative tx of ankle fxs: 3

A

1: nondisplaced, stable fx with intact syndesmosis
2: displaced fx for which stable anatomic reduction of the ankle mortise is achieved
3: unstable, multiple trauma pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Operative tx for lateral malleolar fxs distal to the syndesmosis

A

Lag screw or kirschner wires with tension banding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Operative tx of lateral malleolar fxs at or above the syndesmosis
Combination of lag screws and plate (important to restore length and rotation)
25
Indications for operative fixation of medial malleolus fx (4)
1: concomitant syndesmotic injury 2: persistent widening of the medial clear space following fibula reduction 3: inability to obtain fibular reduction 4: persistent medial fx displacement after fibular fixation
26
Operative tx of medial malleolar fxs
Stabilized with cancellous screws or figure of eight tension banding
27
Indications for fixation of posterior malleolus fx (3):
1: involvement of >25% of the articular surface 2: >2mm displacement 3: persistent posterior subluxation of the talus
28
Operative tx for posterior malleolus fx:
Anterior to posterior lag screw or posteriorly placed plate and/or screws
29
Placement of a syndesmotic screw for stabilization
1.5 to 2.0 cm above the plafond from the fibula to the tibia. Note: either 3 or 4 cortices and either 3.5 or 4.5 mm screws
30
Loss of reduction is reported in what % of unstable ankle injuries treated nonoperatively?
25%
31
Classification for Pilon (plafond) fxs
Ruedi and Allgower
32
Ruedi and Allgower classification:
Type 1: nondisplaced cleavage fracture of the ankle joint Type 2: displaced fracture with minimal impaction or comminution Type 3: displaced fx with significant articular comminution and metaphyseal impaction
33
Goals of operative fixation of Pilon fxs: 4
1: Maintenance of fibula length and stability 2: restoration of tibial articular surface 3: bone grafting of metaphyseal defects 4: stabilizing of the distal tibia
34
Surgical tx for Pilon fxs
ORIF with plate fixation after use of initial spanning external fixation. Avoid incisions of the anteromedial tibia. Use small, precontoured, low profile mini frag screws. Percutaneous approach for plate insertion.
35
Classification system names (2) for tibial plateau fxs
Schatzker and Moore
36
Schatzker classification system of tibial plateau fractures
Type 1: lateral plateau, split fx Type 2: lateral plateau, split depression fx (most common) Type 3: lateral plateau, depression fx Type 4: medial plateau fx Type 5: bicondylar plateau fx Type 6: plateau fx with separation of the metaphysis from the diaphysis
38
Moore classification system
Type 1: split fx of the medial tibial plateau in the coronal plane Type 2: entire condyle fx with the fx line beginning in the opposite compartment and extending across the tibial eminence Type 3: rim avulsion fx (high rate of neurovascular injuries) Type 4: rim compression injury associated with contra lateral ligamentous injury Type 5: four part fx with the tibial eminence separated from the tibial condyles and the shaft
38
Surgical tx for Schatzker types 5 and 6
Plate and screw, ring fixator, or a hybrid fixator.
39
Surgical Tx for Schatzker types 1 through 4
Percutaneous screws or laterally placed periarticular plate; depressed segments should be fixed using a bone tamp
40
Long bone fx with the overall highest rate of nonunion
Tibial shaft
41
Most common locations (2) for tibial stress fxs area where sclerosis is most noticeable? What is a Radiographic sign that is pathognomonic for stress fxs?
Metaphyseal-diaphyseal junction in military recruits and middle third of shaft in ballet dancers. Sclerosis most marked at Posteromedial cortex in metaphyseal-diaphyseal fxs. "Dreaded black line" is pathognomonic
42
Plain Radiographic findings are often delayed for weeks with stress fxs. What imaging is very sensitive for detecting stress fxs early?
MRI
43
Most reliable sign of compartment syndrome
Pain out of proportion to injury
44
Compartment pressure measurements indicating compartment syndrome
Pressure within 30 of diastolic pressure
45
Gustilo and Anderson classification of open fractures
Type 1: clean skin opening 1 cm long, simple transverse or short oblique fxs Type 2: 1 cm to 10 cm with extensive soft tissue damage, minimal to moderate crushing component, simple transverse or short oblique fxs with minimal comminution Type 3: extensive soft tissue damage (>10 cm laceration), including muscles, skin, and neurovascular structures, high energy injury with severe crushing component 3A: extensive soft tissue laceration, adequate bone coverage, minimal periosteal stripping 3B: extensive soft tissue with periosteal stripping and bone exposure requiring soft tissue flap closure, massive contamination 3C: vascular injury requiring repair
46
Isolated injuries to the lateral plateau of the tibia are the most common tibial plateau fracture. What percentage?
55-70% of tibial plateau fractures
47
Fractures involving the medial tibial plateau may be associated with higher incidences of these two types of injuries owing to higher-energy mechanisms
Peroneal nerve and popliteal neurovascular lesions
48
Radiographic eval for tibial plateau fractures
AP and lateral view supplemented by 40 degree internal (lateral plateau) and external rotation (medial plateau); a 10 to 5 degree caudally tilted plateau view can be used to assess articular step off
49
What are 3 additional signs of ligamentous injury seen in tibial plateau fractures?
Avulsion of the fibular head, the Segond sign (lateral capsular avulsion) and Pellegrini-Steata lesion (calcification along the insertion of the MCL)
50
Treatment of nondisplaced or minimally displaced tibial plateau fractures; also for severe osteoporosis
Non-op: protected weight bearing, quad strengthening, progressive passive, active-assisted, and active ROM exercises; partial weight bearing (30-50 lbs) for 8-12 weeks
51
Use of spanning external fixation in tibial plateau fractures:
Temporizing measure to keep soft tissues out to length and provide some degree of fx reduction until definitive surgery
52
Operative treatment principles in tibia fxs, the goal of reconstruction:
Reconstruction of the articular surface, followed be reestablishment of tibial alignment
53
Role of arthroscopy in tibial plateau fxs:
Arthroscopy may be used to evaluate the articular surfaces, the menisci, and the cruciate ligaments; evacuation of hemarthrosis
54
Most common long bone fractures
Tibia and Fibula shaft
55
The nutrient artery of the tibia arises from what artery
Posterior tibial artery - nutrient artery enters the posterolateral cortex distal to the origination of the soleus muscle
56
Poor sensitivity, reproducibility, and interobserver reliability have been reported for most classification systems - what are the descriptive parameters for tibial shaft fxs
Open vs closed; Location: prox, mid, distal third Frag number and position: comminution, butterfly frags Configuration: transverse, spiral, oblique Angulation: varus/valgus, anterior/posterior Shortening, rotation Displacement: % of cortical contact
57
Satisfactory closed reduction of tibial plateau fx
Less than 1 mm step off
58
Surgical indications of tibial plateau fxs (5)
1: reported range of articular depression that can be accepted varies from less than 2 mm to 1 cm 2: instability greater than 10 degrees of the nearly extended knee compared to the contralateral side 3: open fxs 4: associated compartment syndrome 5: associated vascular injury
59
Tscherne Classification of Closed Fxs: classifies soft tissue injury in closed fxs and takes into account indirect versus direct injury mechanisms
Grade 0: Injury from indirect forces with negligible soft tissue damage Grade I: Closed fx caused by low-moderate energy mechanisms, superficial abrasions or contusions of soft tissue overlying the fx Grade II: Closed fx with significant muscle contusion, with possible deep, contaminated skin abrasions associated with moderate to severe energy mechanisms and skeletal injury; high risk for compartment syndrome Grade III: Extensive crushing of soft tissues, subq degloving/avulsion, arterial disruption or established compartment syndrome
60
Non-op tx for isolated, closed, low energy fxs with minimal displacement and comminution
Fx reduction followed by application of a long leg cast with progressive weight bearing: Cast with knee in 0-5 degrees of flexion; after 3-6 weeks long leg cast replaced with patella-bearing cast or fx brace
61
Major limitation seen following non-op tx for tibial shaft fxs
Hindfoot stiffness following casting/bracing
62
Average time to union of tibia/fibula shaft fxs
16 +/- 4 weeks; delayed union = >20 weeks
63
Radiographic signs of nonunion and time parameter for nonunion
Radiographic: sclerotic ends at fx site and persistent gap unchanged for several weeks. Lack of healing 9 months after fx
64
Operative tx of tibia shaft fxs (4)
1: IM nailing - preservation of periosteal blood supply, controls alignment, translation, and rotation. 2: Flexible nails: not really used in US, recommended only in children with open physes 3: Ex Fix 4: Plate and screws: generally reserved for fxs extending into the metaphysis or epiphysis
65
When using IM nailing for tibia fxs you can use locked or nonlocked nails as well as reamed vs unreamed nails. Describe
Locked: rotational control, prevents shortening in comminuted fxs or with significant bone loss Nonlocked: allows impaction at fx site, difficult to control rotation Reamed: excellent IM splinting; larger, stronger nail Unreamed: preserve IM blood supply in open fxs with periosteal stripping; reserved for higher grade open fxs
66
Why are Prox tib fxs a pain? (same problem with distal tib)
Difficult to nail - become malaligned, commonly valgus and apex anterior angulation; can use perq plate to counteract or blocking screws
67
Most common complication associated with IM tibial nailing
Knee pain
68
Radiographic signs of Reflex Sympathetic Dystrophy following Tibia fxs - most common in pts unable to bear weight early and with prolonged cast immobilization
Spotty demineralization of foot and distal tibia and equinovarus ankle
69
Muscle death occurs after how long with compartment syndrome
6-8 hours
70
This is associated with scarrign of extensor tendons or ischemia of posterior compartment muscles
Claw toe deformity
71
Most common location for neurovascular injury with tibial fractures
Occurs as the anterior tibial artery traverses the interosseous membrane of the proximal leg
72
Radiographic eval: injuries about the ankle - 3 indications of syndesmotic injury on AP xray; Indication of medial or lateral disruption on AP:
Tibiofibula overlap of less than 10 mm; Tibiofibula clear space greater than 5 mm is abnormal = syndesmotic injury. Talar tilt: difference in width of the medial and lateral aspects of the superior joint space > 2 mm is abnormal
73
This displaced fx off the anterior articular surface is considered a pilon variant when there is a significant articular fragment
Pronation-dorsiflexion fx
74
Closed fracture reduction for displaced fractures helps to minimize these four things:
Minimizes post-injury swelling, pressure on the articular cartilage, lessens the risk of skin breakdown, and minimizes pressure on the neurovascular structures
75
Indications for ORIF of rotational ankle fractures (4)
Failure to achieve or maintain closed reduction with amenable soft tissue, Unstable fx that may result in talar displacement or widening of the ankle mortise, Fractures that require abnormal foot positioning to maintain reduction (extreme plantar flexion), Open fxs
76
Articulating vs nonarticulating spanning Ex fix for pilon fxs
Nonarticulating (rigid): most commonly used, allows no ankle motion. Articulating allows motion in sagittal plane, which prevents ankle varus and shortening. Theoretically, articulating results in improved chondral lubrication and nutrition owing to ankle motion.
77
Post op mgmt of Pilon fxs
Initial splint placement in neutral dorsiflexion; early ankle and foot motion when wounds and fixation allow; non-weight bearing for 12-16 weeks, then progression to full weight bearing once there is radiographic evidence of healing.
78
Edwards and DeLee classification for syndesmosis sprains:
Type 1: Diastasis involves lateral subluxation w/o fx Type 2: involved lateral subluxation with plastic deformation of the fibula Type 3: posterior subluxation/dislocation of the fibula Type 4: Superior subluxation/dislocation of the talus within the mortise
79
Two clinical tests that can be used to isolate syndesmotic ligament injury
Squeeze test and External rotation stress test
80
Acceptable fracture reduction of Tibial shaft fractures - 6
1. Less than 5 degrees of varus/valgus angulation 2. Less than 10 degrees of anterior/posterior angulation (less than 5 is preferred) 3. Less than 10 degrees of rotational deformity. ER better tolerated than IR 4. Less than 1 cm of shortening 5. More than 50% cortical contact 6. Roughly, the ASIS, center of patella, and base of second prox phalanx should be colinear

Ortho/fracture (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions