Trauma

Question 1

Comparing radial head arthroplasty to ORIF in comminuted fractures

Answer 1

for fracture-dislocations and Mason Type III fractures arthroplasty results in:

• greater stability
• lower complication rate
• higher patient satisfaction

Question 2

Proximal Humerus Fractures
Which 3 additional radiographic views should be considered?

Answer 2

apical oblique
Velpeau
West Point axillary

Question 3

List 5 indications for cephalomedullary nail?

Answer 3

• stable fracture patterns
• unstable fracture patterns
• reverse obliquity fractures
• subtrochanteric extension
• lack of integrity of femoral wall

Question 4

Intertrochanteric Fractures
What are 4 indications for arthroplasty?

Answer 4

salvage for failed internal fixation severely comminuted fractures preexisting severe degenerative hip arthritis
severely osteoporotic bone that is unlikely to hold internal fixation

Question 5

List factors that influence implant cutout?

Answer 5

older age
osteoporosis fracture type
quality of reduction
tip-apex distance (TAD)

Question 6

Femoral Neck Fractures none union treatment options?

Answer 6

• valgus intertrochanteric osteotomy
• free vascularized fibula graft (FVFG)
• arthroplasty
• revision ORIF

Question 7

Femoral Neck Fractures
Three recommended views?

Answer 7

AP
cross-table lateral
full-length femur

Question 8

Intertrochanteric Fractures
What are 5 risk factors?

Answer 8

• proximal humerus fractures increase risk of hip fracture for 1 year
• osteoporosis
• advancing age
• increased number of comorbidities
• increased dependency with ADLs

Question 9

Femoral Shaft Fractures
What are 3 reasons for a plate’s inferiority to intramedullary nail fixation?

Answer 9

inferior when compared to IM nailing due to increased rates of:
infection
nonunion
hardware failure

Question 10

Knee Dislocation
What are five indications for open reduction?

Answer 10

• irreducible knee
• posterolateral dislocation
• open fracture-dislocation
• obesity (may be difficult to obtain closed)
• vascular injury

Question 11

Femoral Shaft Fractures

What are the pros of retrograde intramedullary nail fixation?

Answer 11

• technically easier
• allows for addressing other injuries surgically without changing patient position
• allows for direct comparison of rotation and leg length to nonoperative extemity
• union rates comparable to those of antegrade nailing
• no increased rate of septic knee with retrograde nailing of open femur fractures

Question 12

What are 6 findings of compensated shock?

Answer 12

• normotensive
• tachycardia without fever
• cool extremities
• narrowing pulse pressure
• weak peripheral pulses
• delayed capillary refill

Question 13

What is a transolecranon fracture/dislocation and what is the mechanism behind it?

Answer 13

• severe axial load leading to potential instability of the ulnohumeral joint due to severe intra-articular comminution of the olecranon fracture
• considered an anterior dislocation of the elbow (distal humerus is driven through the olecranon)
• there is no disruption of the proximal radioulnar joint

Question 14

Tibial Plafond Fractures

What are 5 goals of pilon ORIF?

Answer 14

• goal is for anatomic reduction of articular surface
• restore alignment
• restore length
• reconstruct metaphyseal shell
• reattach metaphysis to diaphysis

Question 15

The following is commonly seen following malunion of a conservatively-managed calcaneus fracture

Answer 15

• decreased calcaneal height
• increased calcaneal width
• hindfoot varus
• lateral exostosis secondary to lateral wall blow-out
• dorsiflexion of the talus resulting in ankle impingement

Question 16

Coronoid Fractures

Name 3 different techniques for coronoid fixation noting the fracture type they would be considered in?

Answer 16

• cerclage wire or No. 5 suture through ulna drill holes for Type I injuries
• ORIF with retrograde cannulated screws or plate for Type II or III injuries
• ORIF with buttress plate fixation or pins and lateral ligament repair for posteromedial rotatory instability