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32 Cards in this Set
- Front
- Back
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Into what two directions of deformity does a metaphyseal proximal tibia fracture fall>
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Apex anterior
Apex medial |
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In what two ways should the intramedullary nail starting point be adjusted to minimize deformity risk?
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Slightly more posterior
More lateral |
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What knee position should be maintained while nailing?
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Semi-extended
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If blocking screws are used, where should they be placed?
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Posterior and lateral
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What are two options for maintaining the reduction while nailing?
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Unicortical plate
Temporary external fixator |
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A percutaneous plating technique places what nerve at risk? How?
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Superficial peroneal nerve
Percutaneous insertion of distal screws may result in nerve injury |
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Quick review: What is the most commonly injured vessel with displaced physeal injury of the proximal tibia and resultant compartment syndrome?
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Anterior tibial artery
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Compare the outcomes of external fixator versus nail treatment for open tibia fracture.
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Similar clinical outcomes
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How do overall complication rates compare for both techniques with open fracture?
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IM nail lower overall complication rate
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What is the reported advantage to reaming an open fracture? Open fractures up to what grade can generally be reamed safely?
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Decreased rate of hardware failure
Can ream up to grade IIIB open tibial shaft fracture |
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What is the reported advantage of reaming a closed fracture?
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Better clinical outcomes
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How is "reaming to fit" preformed?
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Ream to 1 mm over isthmic diameter
Insert nail 1 to 1.5 mm smaller than biggest reamer used |
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Which complication of open tibia fracture is more common: nonunion of infection?
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Nonunion
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What are the three reported risk factors for nonunion development with a tibial shaft fracture?
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Open fracture
Persistent gap Transverse fracture pattern |
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If a tibial nonunion develops, what should be the first attempt at treatment? Compare with femoral shaft.
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Dynamization of tibial nail
Dynamization not advocated for femur |
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What is the most common mechanism of hardware failure in nonunion? What fails first?
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Fatigue fracture
Locking screws fail first |
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What is the no.1 complication of IM nailing of the tibia? It is especially common in what patients?
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Knee pain
The young |
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What is the no.1 closed treatment complication?
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Ankle stiffness
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Why are anterior stress fractures particularly difficult to treat?
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Because the anterior tibia is the tension side
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What is the radiographic indication for IM nailing of a tibial stress fracture?
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Plain radiographic "black line" appearance
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Should the nail be reamed or unreamed?
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Reamed
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When should bone grafting be considered?
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If unhealed at 6 months
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What is the preferred approach for bone grafting of a tibial shaft? nonunion? What is the interval?
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Posterolateral (Harmon) approach
Interval between flexor hallucis longus (FHL)/soleus and peroneals |
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What does deep dissection involve?
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Elevate posterior tibialis
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The posterior tibialis protects what two neurovascular structures?
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Posterior tibial artery
Tibial nerve |
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What is the most common complication after open reduction with internal fixation (ORIF) of pilon fracture?
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Post traumatic arthrosis
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What us the postoperative deep infection rated?
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4 to 35%
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What clinical finding best correlates with deep infection development? What clinical finding does not correlate with deep infection development?
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Postoperative skin slough
Whether the fracture was initially open |
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Ina prospective randomized comparison of ORIF versus external fixator with limited ORIF for pilon fracture, which treatment modality had the better short-term outcome score?
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Equivalent
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Which had the greater number of complications?
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ORIF
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Which had the greater number of complications?
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Both groups did poorly long-term, but ORIF outcomes were better long-term
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When placing an external fixator for pilon fracture, how far proximally does the joint capsule extend?
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12.2 mm
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