4Th Year - Trauma - Fractures

Front 1

1. C-spine flexion fx
2. C-spine extension fx

Back 1

Crush, supraspinous ligament rupture, dislocations, fraccture dislocation
2. Odontoid (dens) fracture, hangmans', kinking of posterior long. ligament

Front 2

1. C-spine vertical compression fx
2. Combined extension-flexion fx

Back 2

Fracture of the ring of atlas, burst fracture
2. Whiplash

Front 3

T-spine fx

Back 3

Compression, Burst, Seat-belt (flexion-distraction), fracture dislocation

Front 4

L-spine fx

Back 4

Avulsion of transverse process, compression, flexion-rotation

Front 5

Tile classification is of ?
What fx are there in this group ?

Back 5

Pelvis fx. Avulsion, single bone, complex (ring)

Front 6

Garden classification is of ? Fx ?

Back 6

Femur neck fx. Intracapsular, extracapsular, stable/unstable, displaced/undisplaced/impacted

Front 7

trochanteric fx

Back 7

Pertrochancteric, subtrochanteric, intratrochanteric, avulsion of greater tuborosity

Front 8

1.Femoral condyles fx, 2.Patellar fx

Back 8

Obliqute fx of lateral condyle, Y shaped intercondylar, comminuted.
2. Patella - comminuted, stellate, transverse

Front 9

1. Tibia fx.
2. Fibula fx.
3. Tibia+fibula fx

Back 9

Tibia - Direct trauma, twisting, fatigue.
Fibula - direct, twisting, stress (inferior tibiofibular)
Tibia+fibula -

Front 10

Weber classification is of ?

Back 10

Fractures and fractures-dislocations of the Ankle

Front 11

Bones fractured at the ankle, ligaments torn, forces exerted

Back 11

Bones - Medial, lateral, posterior malleolous. Ligaments - Inferior tibiofibular, medial ligament, lateral collaterla, deltoid(?). Forces - Abduction, adduction, external rotation, vertical compression

Front 12

1. Fx of talus
2. Calcaneum is made of ? type of fx is ?
3. signs of calcaneum fx

Back 12

1. Body of talus, neck, osteochondrol fx
2. Cancelous bone, crushing-comminuted fx, avulsion by achilles
3. Loss of Bohler angle, horseshoe bruise

Front 13

Components of Weber classification

Back 13

1. Height of fibula fx
2. Medial malleolus status
3. Posterior malleolous status
4. Tibiofibular ligament

Front 14

Fractures of toes and metatarsals

Back 14

1. Fifth metatarsal
2. Multiple metatarsals spiral fx
3. Fatigue of metatarsal(March fx, 2nd-3rd metatarsals)

Front 15

1. Grades of acromioclavicular joint disloaction
2. Treatment

Back 15

1. Grade I - undisplaced, II - rupture of acromioclavicular ligament, intact coracoclavicular. III - rupture of both acromioclavicular and coracoclavicular.
2. Kirschner wires with tension, fixation of clavicle to coracoid by screws, Walter plate (w/ hook), Debrecen plate (no hook), Bosworth screws

Front 16

Elbow fx

Back 16

1. Supracondylar
2. Lateral epicondyle
3. Medial epicondyle
4.Intercondylar

Front 17

1. Supracondylar fx complication
2. Medial epicondyle complications
3. Lateral

Back 17

1. Median nerve, brachial artery, malunion, compartment syndrome, myositis, volkmann's
2. Ulnar nerve, growth arrest-varus deformity
3. Growth arrest-valgus, non union, ulnar nerve

Front 18

Lower arm fx.
What is a monteggia fx, what is a galeazzi fx

Back 18

1. Olecranon
2. Coronoid process
3. Head of radius
4. Monteggia
5. Galeazzi
Monteggia - fracture of upper end of ulna with dislocation of head of radius (proximal radioulnar joint.
Galeazzi - mirror image, fractured radius with disloaction of distal radioulnar joint

Front 19

Colles' fracture

Back 19

Distal radius, Dinner fork deformity --> Backward angulation, backward displacement, radial deviation, supination, proximal impaction. All those of the distal fragment

Front 20

Complications of Colles' fracture

Back 20

1. CRPS
2. Median nerve
3. Rupture of extensor pollicis longus tendon
4. Malunion

Front 21

Scaphoid fx

Back 21

1. Waist (neck) of scaphoid
2. Scaphoid tubercle

Front 22

Fractures of fingers and metacarpals

Back 22

1.5th metacarpal neck fx (almost always by punching)
2.5th metacarpal oblique / comminuted fx
3. Bennets' fracture - oblique 1st metacarpal fx extending into CMP joint
4. Multiple metacarpal fx
5. Finger - Juxtaepiphyseal fx
6. Interphalangeal fx dislocation

Front 23

1. Complications of femoral neck fx
2. Reasons for high rate of complications of intracapsular femoral neck fx
3. Blood supply to femoral head

Back 23

1. Aseptic necrosis, non-union, OA
2. Blood supply is cut, increaesd capsular pressure, femoral head very mobile inside capusle
3. Thru the capsule, thru the medullary cavity, tiny portion from Ligamentum teres

Front 24

1. Treatment of intracpaulsr femoral neck fx
2. Treatment of extracapsular femoral neck fx
3. Treatment for undisplaced/impacted femoral neck fx

Back 24

1.IF (Several pins - parallel, crossed nails, DC screw and plate), Hemoarthroplasty, Arthroplasty, Bipolar arthroplasty
2+3. Conservative, Protected weight bearing, after 8 weeks physiotherapy

Front 25

Posterior dislocation of the hip - signs, tx, complications

Back 25

1. Signs- shorter leg, internally rotated, Tx - reduction under anasthesia + light traction for 6 weeks, or open reduction if large fragment. Complications - Sciatic nerve neurapraxia, damage to femoral head, damage to acetabulum, AVN, OA

Front 26

Anterior dislocation of hip - differences from posterior, complications

Back 26

Differences from posterior - less common, caused by abduction and causes external rotation, does not fx acetabulum.
Complications - AVN, OA, no sciatic problems

Front 27

Central fracture-dislocation of hip - difference from other dislocations, complications

Back 27

Capsule remains intact, but acetabulum always fx - sometimes comminuted. Occurs by a lateral blow to the femur. Complications - severe hemorrhage, OA

Front 28

Differences between pertrochanteric and intratrochanteric fx from femoral neck fx

Back 28

Per and intra occur by sharp twisting injury with trauma, unlike femoral neck which can occur by trivial slight trauma. Femoral neck fx do not occur in joints affected by OA and these do (?). Per/intra almost always unite because of the strong muslce support, but they are very unstable and prone to malunion unless IF

Front 29

1. Treatment / prog of per/intra trochanteric fx
2. Subtrochanteric causes, treatment, prog

Back 29

1. Tx - IF with dynamic hip screw or intramedullary hip screw. Prog - read above, bad
2. Causes - usually pathological, as in Paget,s metastases. Tx - IF iwht nail-plate or intramedullary implant

Front 30

Femur shaft fx - leg is..?, complications

Back 30

Leg looks shorter and fatter, complications - Hemorrhage (serious !), infection, non-union, mal-union, nerve injury

Front 31

Conservative treatment for femur shaft fx

Back 31

Traction by a Steinmann pin thru upper tibia, does not work above midshaft of femur and may shorten leg. Support in Thomas or Povey splint

Front 32

Operative tx for femur shaft fx

Back 32

IF - intramedullary nail with locking nails to control rotation. Inserted thru proximal or distal femur (NOT OPEN !!), either reamed or unreamred.

Front 33

Treatment of supracondylar fx

Back 33

Difficult to treat conservativly. Use IF with long blade plate. Intramedullary implant also available.
If comminuted - use external fixation or traction + bone grafting

Front 34

Treatment of condylar fx

Back 34

Undisplaced - aspiration+4 weeks of traction, later cast
Displaced - Accurate reduction very important to prevent valgu/varus and OA. Use ORIF.
T/Y shaped fractures --> compression screw plate

Front 35

Treatment of Patella comminuted fx, treatment of patella stellate fx

Back 35

Comminuted - removal of patella
Stellate - conservative. aspiration+3 weeks in long cast

Front 36

1. ACL tears are associated with ?
2.Tx of ACL ?
3. Tx of Medial collateral ?
4. Tx of ACL+Medial collateral

Back 36

1. Medial collateral tears
2. Conservative only. Aspiration+hamstrings strengthening+cast for pain relief
3. Leg cast brace for 6 weeks
4. Immobilization in cast for 6 weeks
NOTE - there is surgical treatment for ACL tears consisting of grafts from Patellar tendon. Very difficult. Long rehab.

Front 37

Fx of the lateral condyle of the tibia

Back 37

1. Split of the lateral tibial plateau
2. Depressed plateau fracture
3. Depression +impaction of the lateral tibial plateau

Front 38

Lateral collateral ligament tear is associated with ?

Back 38

damage to common peroneal nerve

Front 39

Signs of menisci lesions
2. Tx

Back 39

Due to twisting force with the knee flexed, swelling due to hemarthrosis, atrophy and weakeness of quadriceps, restriction in flexion/extension
2. Arthroscopy - excision of fragment, open menisectomy

Front 40

Maisonneuve fx is ?

Back 40

Spiral fx at upper fibula + tibia fracture at ankle

Front 41

Sign of fibula fx is ? Tx ?

Back 41

Sign - painful dorsiflexion, tc - if undisplaced fx no immobilization required

Front 42

Causes of fatigue fx in the Tibia, tx, relation to fibula

Back 42

Runners, ballet dancers. Tx - same as tibia+fibula. Intact fibula actualy disrupts healing of tibia as it keeps it apart. Might need to cut fibula.

Front 43

Complications of tibia+fibula fx

Back 43

Non union, delayed union, malunion, vascular damage, soft tissue damage, compartment syndrome

Front 44

Rules for treatment of tibia+fibula fx. 2 - which kinds of tibia+fibula fx are unstable ?

Back 44

Stable - cast immobilization
Unstable - IF
Contaminated and unstable - EF
2. Spiral fx, segmental, boot-top, contaminated

Front 45

Pott's fracture is ?

Back 45

Loosely applied to any fracture-disloaction of the ankle

Front 46

Weber type A ankle fracture-dislocations

Back 46

Fibula - transverse fracture at or below ankle joint
Medial malleolus - intact or sheared
Posterior malleolous+tibiofibular ligament - intact

Front 47

Webet type B

Back 47

Fibula - spiral fracture at level of syndesmosis
Medial malle - intact of avulsion
Posterior malleolus - intact of avulsion
Tibiofibular ligament - intact

Front 48

Weber type C

Back 48

Fibula - fracture higher than syndesmosis
Medial malle - transverse fracture
Posterior malle - Lateral fragment
Tibiofibular ligament - always disrupted

Front 49

Ankle - abduction injury tx, adduction injury tx

Back 49

Abduction - usually IF as cast is unreliable due to initial swelling. Adduction - Cast for the pain, if large fragment avulsion use fixation

Front 50

Ankle - external rotation injury tx, vertical compression injury tx

Back 50

External rotation - IF to restore tibiofibular joint
Vertical compression - due to sharp upward movement that causes a comminuted fx - use bone grafts + plating

Front 51

Treatment for calceneal fx

Back 51

Conservative - rest, keep foot elevated, protect from weight bearing from 6 weeks
Operative - Open reduction and bone grafting if comminuted. Pin+cast for 1 month for avulsion (?)

Front 52

Tx for talus fx

Back 52

Conservative - cast in neutral position for 6-8 weeks
Surgical - ORIF with cancellous bone leg screws, then protect leg in cast for 3-4 weeks

Front 53

Complications of fx at neck of Talus

Back 53

Skin necrosis, non union, aseptic necrosis, OA of subtalar and talonavicular joints

Front 54

Tx of 5th metatarsal fracture / avulsion of 5th styloid

Back 54

Bandage/cast for pain relief

Front 55

Tx of undisplaced fx of base of metatarsals, displaced. Tx for shaft of metatarsals fx

Back 55

Plaster for 3 weeks, then active exercises.
Displaced - open reduction and fixation with pins/screws. Shaft - same

Front 56

Treatment of phalanges fx

Back 56

Treat as severe soft tissue injury - disregard the bones. Elevate foot till swelling subsides. NOTE - rotational deformities should be reduced by securing the toe to its neighbour

Front 57

Signs of anterior/posterior sternoclavicular dislocation, tx, why is posterior more dangerous ?

Back 57

Signs - anterior : fall with strecthed arm or on the shoulder, prominence of the joint. Posterior : indentation of the joint.
Tx - anterior: apply posterior and lateral traction + sling for 2 weeks. if Unstable - ORIF. DO NOT use nails in upper mediastinum.
Posterior: Downward presing force on the shoulder. Posterior more dangerous as clavicle may compress trachea or great vessels

Front 58

Tossy is a classifciation of ?

Back 58

Tossy - sublux/disloc of acromiclavicular joint.

Front 59

Signs of acromioclavicular disloc/sublux, grades

Back 59

Signs - acromial end of clavicle displaced upwards and backwards. Shoulder falls inwards and down. Grades - I - undisplaced, ice, sling, bla
II - Capsule torn, but coracoclavicular or coracoacromion intact. Conservative tx still.
III - coracoclavicular also torn, should er is depressed. Use ORIF in adults and slings in children.

Front 60

ORIF options for grade III tossy acromioclavicular joint sublux/disloc

Back 60

Kirschner wires, fixation of clavicle to coracoid via screws, Walter plate (hooked), debrecen plate (unhooked), Boseworth screws.

Front 61

Complications of anterior glenohumeral disloc

Back 61

Damage to axillary nerve, damage to axillary artery (check sensory to outer deltoid), joint stiffness, recurrent dislocs

Front 62

Methods to reduce glenohumeral anterior disloc

Back 62

MUA, Hanging arm, Hippocrates, Kocher

Front 63

Signs of posterior glenohumeral disloc. Tx.

Back 63

Arm internally rotated. Light bulb appearance on XR. Tx- pull the arm forward and externally rotate

Front 64

Aftercare of glenohumeral dislocs.

Back 64

Arm bandages across the body fo 3 weeks to prevent recurrent dislocs

Front 65

Diagnosis of surgical neck of humerus fx

Back 65

1. Extensive bruising radiating to elbow.
2. If limb can be moved passively thru a range of motion without severe pain- impacted.

Front 66

Tx of surgical neck of humeurus fx

Back 66

1. Impacted - immobilization for 2 weeks (CHECK !!!)
2. not impacted - sling to hold arm to cheset for 1 week
3. displaced - closed reduction
4. ORIF with kirschner wires, screw plates, T plates

Front 67

Complications of fx of humeral shaft

Back 67

1. Neurovascular damage (check brachioradialis after 6 weeks. If malfunctioning - radial nerve)
2. Malunion (deltoid pulls fragment)
3. Non union (soft tissue interposition)

Front 68

Tx of humeral shaft fx

Back 68

1. ORIF. plate/screw of IM nail inserted from olecranon fossa to avoid damaging shoulder
2. Closed reduction and a cast.
3. EF
4. Children - U shaped plaster, splint...for 3-6 weeks

Front 69

Complications of supracondylar fx of the humerus

Back 69

1.Vascular damage (Brachial artery)
2. Median nerve damage
3. Compartment syndrome
4. Volkmann's contacture
5. Malunioin
6. Myositis

Front 70

Tx of supracondyler humerus fx

Back 70

1.Undisplaced - backslab with elbow flexsed for 3 weeks
2. Displaced - closed reduction with immobilization at 100degree
3. ORIF with wires

Front 71

Complications of medial epicondye fx

Back 71

1. Valgus strain causes strecth on the ulnar nerve
2. Varus deformity and growth arrest

Front 72

Tx of olecranon fx

Back 72

Undisplaced - plaster for 2-3 weeks. Displaced - internal fixation with tension band wiring. Communited fx - excision

Front 73

Complications of ulnar+radius fx

Back 73

Malunion (due to rotational deformity)
Compartment syndrome
Non union
Cross union between the bones - pronation/supination is lost

Front 74

Tx of ulnar+radius fx

Back 74

ORIF preffered -very unstable fx
1. Closed reduction with plaster . NOTE - elbow at right angle, forearm in position between supination/pronation
2. ORIF with metal plates and intramedullary nails

Front 75

Monteggia fx may be confused with a ?

Back 75

Colle's fracture (of distal radius)

Front 76

Tx of a Colle's fracture. 2.Operations for malunion of Colle's

Back 76

Closed reduction by pulling the hand distally with a plaster that does not hold the fingers !.
2. Baldwin - excision of 2cm long ulna, Corrective osteotomy

Front 77

Typical (lower) radius fractures are ?

Back 77

Colles, fracture of radial styloid, Smith, Barton. Children - epiphyseal seperation, greenstick

Front 78

Smith fx is ? Barton fx is ?

Back 78

Smith - Reverse Colle's. If patient lands in flexion, very unstable.
Barton - Fracture line enters the joint so that the anterior lip of radius is displaced proximally

Front 79

Treatment for smith and barton fx

Back 79

Forearm cast with hand supinated and wrist in full extension.

Front 80

Tx and prognosis of a radial greenstick fx

Back 80

plaster for 3 weeks. These fx cannot be mainpulated into perfect position. Angular deformities will be remodelled, but rotational ones will not. Impossible to overcorrect

Front 81

What are the problems with a fracture at the scahpoid waist(neck) ?
What are the signs of a fx there ?

Back 81

problems - not easily seen on XR, prone to malunion, blood supply enters distally so proximal part will undergo AVN, very few clinical signs.
Signs- Tenderness/swelling in anatomical snuff-box and pain on hyperextension.
Therefore - take 4 XR views, and consider every painful snuff-box as a scaphoid fx

Front 82

Tx of scaphoid fx

Back 82

Cast (6 weeks)that immobilizes the wrist, carpo-metacarpal and 1st MCP joints. Cast should hold thumb opposite ring finger and not in abduction

Front 83

What to do if conservative cast results in a pseudoarthrosis of the scaphoid ?

Back 83

Operation and internal fixation with a compression screw to fix segment of scaphoid to the bone.

Front 84

What is Bennet's fracture, why is it unstable ?

Back 84

Bennet's - Fracture of the 1st metacarpal extending into the carpometacarpal joint. Unstable due to - proximal fragment attached to part of the trapezium, fracture line is oblique, distal fragment is attached to strong muscles

Front 85

Tx of Bennet's fracture

Back 85

Reduction, if necessary IF with a screw of a pin into the trapezium

Front 86

Tx of interphalangeal facture-disloc

Back 86

If avulsed fragment includes more than 1/3 of articular surface the fracture is unstable and pin fixation warranted. If less, imoblize in flexion.

Front 87

Tx of multiple metacarpal fx

Back 87

If fragments are displaced, alighment must be restored using Kirscher wires passed thru the intact metacarpals or by using a small bone plate

Front 88

Tendons at lower arm and wrist are sutured with ?

Back 88

Multifilament or monofilament synthetic Bunnel kind of suture material

Front 89

Extensor tendon suture at dorsum of hand ? Middle and end phalanges 2.extension tendon suture ?

Back 89

8 shaped
2. U shaped

Front 90

1.Flexor tendon suture at lower arm, wrist, palm
2.Flexor tendon suture at distal tendon sheath

Back 90

1.Bunnel like multifilament tendon suture
2.Kessler, Kleinert, circular adaptive. Tendon transplant good option as suturing difficult

Front 91

Flexor tendon suture at distal area of No mans' land

Back 91

Suture on the deep flexor tendon supplmented with relief tendon suture. Hand is later fixed in moderately flexed position for 3 weeks

Front 92

Suture material for tendon sutures ?
2. Suturing tendons distal to MCP is by ?
3. Suturing tendons proximal to MCP ?

Back 92

Monofilament 4/0
2. Simple U-stitch
3.Bunnel/Zechner/Keinert-Kesslelr stitch

Front 93

Paronychia is ? tx ?

Back 93

Paraungual (around nail) infection caused by penetrating trauma - usually staph aureus or anaerobes. Tx - incision, drainage, soaking, local gentamycin

Front 94

Felon is ? tx?

Back 94

Felon - Deep infection of finger pad, penetrating truam causing pain, edema, hyperemia..
Tx - midlateral incision - decompartization, drainage, soaking, local AB

Front 95

Kanavel sign is ?

Back 95

Passive extension of hand causes severe pain - sign of tenosynovitis of flexor tendons

Front 96

Tx for Tenosynovitis of flexor tendons ?

Back 96

Incision, drainage, soaking, local and IV Ab

Front 97

Hangmans fracture is ?

Back 97

Spondylolisthesis of C2 over C3

Front 98

6.5mm Cancellous screw is used for ? 4mm ?

Back 98

6.5 cancellous --> Condyle of femur
4mm cancellous --> Medial malleolous, tibial epiphysis

Front 99

Cortex screws are used for , tubular plate is used for

Back 99

4.5, 3.5, 2.7mm for fixation and plates. Tubular plate is used for Radius

Front 100

IM nailing best for ? Ender pins for ?

Back 100

Short / oblique tibia/femur
Ender pins for IM fixation of intertrochanteric fx

Front 101

IM nailing not good for ? Good ..?

Back 101

Comminuted or close to articular surfaces fx. Good - vert strong, does not need external support

Front 102

IF stability - Adaptational ? Movement stable ? Weight bearing ?

Back 102

Adaptational - K wire, need external support. Movement stable - tension band wiring, screw fixation, T-shaped plate, DC plate, reconstruction plates. Weight bearing - IM nailing

Front 103

Rules of primary care of open fractures

Back 103

Within 8 hours, first aid (sterile dressing, fixation), Preven infection, debride wound, osteosynthesis with new gloves, no tension suture, tetanus, AB, immoblization by EF/IF

Front 104

Early / Late complications of open fracture

Back 104

Early - shock, ARDS, nerve injury, fat emoblism, thrombosis, sepsis. Late - Non union, mal union, AVN, Myositis, Volkmann, OA, atrophy of bone

Front 105

Stages of bone formation

Back 105

Hematoma, subperiosteal/endosteal proliferation, Callus, Consolidation, Remodeling

Front 106

4 causes of delayed union

Back 106

Delayed union - Disruption of blood supply, Soft tissue interposition, repeated manipulation after fracture, inadequate reduction/immoblili, too much traction

Front 107

Signs of non union

Back 107

Persistent fracture line cortex to cortex, sclerosis at margins, submarginal cysts, increased pain, swelling...

Front 108

Types of non uninon, 2. Tx for pseudoarthrosis

Back 108

Non infected - hypertrophic (use bone grafting), atrophic (use bone grafting and fxiation).
Infected
2. IM nailing, bone grafting, electrical stimulation

Front 109

Indications for IF

Back 109

Displaced intraatricular fx, reduction cannot be maintained closed, non union, pathological fx

Front 110

Closed reduction examples

Back 110

Distal radius in adults, shaft of tibia/fibula, humeurs. Shaft of longe bones in children