Trauma

Question 1

What position has the lowest effect on compartment syndrome of the lower extremity

Answer 1

30 deg of ankle plantarflexion

Question 2

What percentage of femoral neck fractures are missed with ipsilateral shaft fracture

Answer 2

5% incidence
30% missed

need to use fine cut CT to find it

Question 3

What is the most optimal inferior screw placement for femoral neck fractures

Answer 3

posterior and adjacent to the femoral neck

Question 4

Where can you avoid injury to the femoral nerve for retrograde femoral nailing

Answer 4

A-P proximal to the LT

Question 5

Calculation of ISS and MISS

Answer 5

square of the largest 3 numbers

Question 6

compare medial to lateral subtalar dislocations

Answer 6

medial are more common
lateral are more likely to be open with fractures
medial are more likley to be stable

Question 7

predictor of sacral fracture nonunion

Answer 7

vertical fracture pattern

Question 8

what factor most likley increases mortality in head injury patients

Answer 8

intra-operative hypotension

Question 9

risk of infection in calcaneus fractures

Answer 9

smoking
open
diabetes

Question 10

what parameter in pilon fractures determines poor outcome and return to work

Answer 10

lower level of education

Question 11

gull sign on obturator oblique

Answer 11

posterior wall

Question 12

spur sign on obturator oblique

Answer 12

ABC

Question 13

imaging require for percutaenous column screws

Answer 13

obturator oblique - joint penetration
inlet iliac oblique - position of screw in pubic ramus
inlet obturator oblique - position of screw in iliac table

Question 14

how much saline should you inject to diagnose traumatic arthrotomy of the knee

Answer 14

155 mL

Question 15

indications of pre-ganglionic injury

Answer 15

loss of paraspinal muscles on EMG
horners
positive histamine test
medially winged scapula

Question 16

benefits of blocking screws

Answer 16

obtain and maintain reduction
increase construct stiffness
neutralize translation forces

Question 17

appropriate tibial alignment

Answer 17

50% cortical apposition

Question 18

incidence of vascular injury in knee dislocation

Answer 18

40%

Question 19

leading cause of death in pelvic ring fracture

Answer 19

hemmorhage overall

head injury in lateral compression

Question 20

factors associated with increased mortality in pelvic ring fractures

Answer 20

systolic BP 60 years
increased Injury Severity Score (ISS) or Revised Trauma Score (RTS)
need for transfusion > 4 units

Question 21

risk of anterior S1 plating

Answer 21

L4/5 injury

Question 22

fresh water wounds

Answer 22

cipro

Question 23

salt water wounds

Answer 23

doxycycline or ceftazidime

Question 24

normal syndesmosis widening

Answer 24

decreased tibiofibular overlap 
     normal >6 mm on AP view
     normal >1 mm on mortise view
increased medial clear space 
      normal less than or equal to 4 mm
increased tibiofibular clear space 
      normal

Question 25

most important factor with outcome following amputation or reconstruction

Answer 25

ability to return to work | no difference in treatment

Question 26

factors associated with wound healing

Answer 26

``` albumin > 3.0 g/dL ischemic index > .5 transcutaneous oxygen tension > 30 mm Hg toe pressure > 40 mm Hg ankle-brachial index (ABI) > 0.45 total lymphocyte count (TLC) > 1500/mm3 ```

Question 27

complications of scapulothoracic dissociation

Answer 27

``` flail extremity (50%) - requires ampuation early amputation (20%) death (10%) ```

Question 28

air bag decreases the rate of

Answer 28

closed head injuries facial fractures thoracoabdominal injuries need for extraction

Question 29

indications of adequate resusitation

Answer 29

MAP > 60 HR 7.2 base deficit - normal -2 to +2 pusle pressure > 15

Question 30

parameters to consider DCO

Answer 30

``` ISS >40 (without thoracic trauma) ISS >20 with thoracic trauma multiple injuries with severe pelvic/abdominal trauma and hemorrhagic shock bilateral femoral fractures pulmonary contusion noted on radiographs hypothermia ```

Question 31

when do fix DCO fractures

Answer 31

7-10 days for pelvic fractures within 3 weeks for femur fractures 7-10 days for tibia fractures

Question 32

predictors of good outcomes in acetabular fractures

Answer 32

``` increasing patient age time from injury to surgery (>3 weeks) intraoperative complications femoral head bone or cartilage injury fracture reduction > 1-2mm ```

Question 33

risk factors for spousal abuse

Answer 33

``` younger age shorter length of relationship emotional abuse psychological abuse, sexual abuse drug dependency alcohol dependency ```

Question 34

the medial femoral circumflex is

Answer 34

medial to glut maximus