Trauma and Orthopedic Surgery: PART V

Question 1

________________hip dislocations account for 90% of hip dislocations and typically follow a dashboard injury.

Answer 1

Posterior hip dislocations account for 90% of hip dislocations and typically follow a dashboard injury.

Question 2

What is the pipkin classification system?

Answer 2

it is used for the classification of femoral head fractures

Question 3

What was the most likely mechanism of injury for this patient?

Answer 3

uncommon but often associated with a posterior hip dislocation following a dashboard injury. A patient with an MVA dashboard injury may present with a femoral head fracture and hip dislocation.

Question 4

What neurovascular complication must you worry about with femoral head injuries ?

Answer 4

Sciatic nerve injuries, Common signs include a sensory deficit over the lower leg and foot (except the medial malleolus and medial foot, as these are innervated by the saphenous nerve) in addition to hamstring muscle weakness.

Question 5

What is the garden classification?

Answer 5

Its for the classification of femoral neck fracture

Question 6

Avulsion of this bony landmark due to forceful contraction of the gluteus medius and minimus

Answer 6

greater trochanteric fracture

Question 7

avulsion of this bony landmark due to forceful contraction of the iliopsoas muscle

Answer 7

lesser trochanteric fracture

Question 8

Greater trochanteric fracture would present with worsening pain with what motion

Answer 8

local pain exacerbated by abduction

Question 9

lesser trochanteric fracture would present with what kind of pain

Answer 9

Lesser trochanteric fracture: groin pain, which radiates to the knee or posterior thigh and worsens with hip flexion and rotation

Question 10

What is the approach to treatment for patients with intertrochanteric fracture?

Answer 10

Nonsurgical for high risk patients, Dynamic hip screw (DHS) for stable fractures
Intramedullary nail (Gamma nail) for stable or unstable fractures, fractures extending into the subtrochanteric region, or reverse oblique fractures
Arthroplasty may be considered for comminuted fractures, pathological fractures, or if other surgical modalities fail.

Question 11

Hip pain which radiates to the knee, Shortened, internally rotated (adducted) hip, Sciatic nerve injury or peroneal nerve injury (branch of the sciatic nerve)

Answer 11

poosterior hip disloaction

Question 12

Why must you watch for change in mental status, dyspnea, hypoxia, petechiae, or fever in a patient with a femoral shaft fracture?

Answer 12

Beware of symptoms associated with fat emboli: change in mental status, dyspnea, hypoxia, petechiae, or fever.

Question 13

In a patellar dislocation, it almost always dislocates medially or laterally?

Answer 13

laterally

Question 14

What test do we use for patella dislocation?

Answer 14

Apprehension test

Question 15

Osteochondral fractures

Answer 15

A type of fracture on the articular surface of a joint, which affects both the cartilage and the underlying subchondral bone. The bony fragment may be small and thin and can be missed on radiograph. Most frequently occurs in the patella following an acute patellar dislocation.

Question 16

Lipohemarthrosis

Answer 16

The presence of fat and blood in a joint, resulting from bone marrow leakage into the joint space (e.g., after trauma or surgery). Lipohemarthrosis in the context of trauma suggests an underlying fracture.

Question 17

Lipohemarthrosis typically suggests

Answer 17

Lipohemarthrosis: suggests osteochondral fracture

Question 18

Positive Lachman test (most sensitive test)

Answer 18

ACL tear

Question 19

Unhappy triad

Answer 19

simultaneous injury of the ACL, MCL, and medial meniscus

Question 20

Test for PCL tear

Answer 20

posterior drawer test

you can also look for posterior sag sign

Question 21

weak or absent dorsalis pedis and posterior tibial artery pulses in the setting of a knee dislocation tells us that this artery was likely injured

Answer 21

popliteal

Maintain a high level of suspicion for vascular injury, as popliteal artery injury may be present despite palpable pulses.

Question 22

What nerve injuries must you be cognicent of in a knee dislocation?

Answer 22

Common peroneal or tibial nerve injury

Superficial peroneal nerve injury affects sensation in the back of the feet and toes as well as the lateral surface of the legs. It also affects pronation of the foot. Deep peroneal nerve injury affects sensation in the area between the first and second toes. It affects movement of the foot and toe extensors as well, causing a foot drop and high-stepping gait.

A type of peripheral nerve dysfunction usually caused by tibial fracture or tarsal tunnel syndrome. Common signs include a sensory deficit over the sole of foot and impaired plantar flexion.

Question 23

Positive test: A floating or swimming patella that can be pressed down toward the femur resulting in a palpable tap suggests a ___________________

Answer 23

knee effusion

Question 24

The Achilles tendon is the largest tendon in the human body and provides the attachment of the converged _______________ and _________________ muscles to the calcaneus.

Answer 24

The Achilles tendon is the largest tendon in the human body and provides the attachment of the converged soleus and gastrocnemius muscles to the calcaneus.

Question 25

A positive _______________may be followed by an ultrasound or MRI to confirm the Achilles tendon rupture.

Answer 25

Achilles tendon rupture

Question 26

In a patient with a patellar dislocation and a concurrent osteochondral fracture, ______________________ is the initial procedure indicated to either repair the osteochondral defect or remove the intraarticular fragment if a repair cannot be performed. Following removal of the fragment, reduction is performed intraoperatively, and the knee is flexed and extended through its entire range of motion.

Answer 26

knee arthroscopy

Question 27

What is apley test used for?

Answer 27

Meniscal injury

Question 28

_____________________ is caused by entrapment or enlargement of one of the plantar digital nerves, in this patient likely the medial plantar nerve, and typically manifests with neuropathic pain in the plantar aspect of the foot that is exacerbated by palpation. The condition is commonly seen in individuals who wear narrow or high-heeled footwear and is characterized by the presence of Mulder sign and Tinel sign.

Answer 28

intermetatarsal neuroma

Question 29

How would a patient's leg present with a femoral neck fracture?

Answer 29

external rotation more likely than internal rotation

Question 30

Posterior hip dislocaations require what managment?

Answer 30

Emergency closed reduction (not open), usually carried out under procedural sedation, is the recommended treatment for simple posterior hip dislocation. This intervention should be performed as soon as possible (usually within 6 hours) to improve blood flow to the femoral head and thus minimize the risk of complications (e.g., osteonecrosis, degenerative joint disease).

Question 31

How do we fix club foot?

Answer 31

Repositioning and serial casting is the recommended treatment for patients with club foot. On clinical exam, the deformity cannot be passively corrected, indicating that intervention will be necessary to prevent future gait disorders. If repositioning and casting are initiated within 24 hours and continued through musculoskeletal development, the prognosis for this patient is excellent and surgery can likely be avoided.