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232 Cards in this Set

  • Front
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SECTION 6: TRAUMA
SECTION 6: TRAUMA
49. Gunshot Wounds and Open Fractures
49. Gunshot Wounds and Open Fractures
The distinction between low- and high-velocity gunshot wounds is the speed of the projectile: low-velocity is <_______ ft/sec; high-velocity is >_______ ft/sec.
The distinction between low- and high-velocity gunshot wounds is the speed of the projectile: low-velocity is <2,000 ft/sec; high-velocity is >2,000 ft/sec.
Shotgun blasts can inflict either high- or low-energy injuries, depending on _____ (shot pattern), load (pellet size), and _______ from the target.
Shotgun blasts can inflict either high- or low-energy injuries, depending on chote (shot pattern), load (pellet size), and distance from the target.
Low-velocity gunshot wounds can be treated similar to a _____ ________, with antibiotics and débridement of the entrance and exit skin edges.
Low-velocity gunshot wounds can be treated similar to a closed fracture, with antibiotics and débridement of the entrance and exit skin edges.
Indications for surgical débridement of low-velocity gunshot wounds include bullet fragments in the __________ or _____ space, _______ disruption, _______ contamination, a _______ bullet fragment on the _____ or ______, _______ hematoma, severe _______ damage, ____________ syndrome, or ____________ contamination.
Indications for surgical débridement of low-velocity gunshot wounds include bullet fragments in the subarachnoid or joint space, vascular disruption, gross contamination, a palpable bullet fragment on the palm or sole, massive hematoma, severe tissue damage, compartment syndrome, or gastrointestinal contamination.
High-velocity gunshot wounds should be treated like ______-energy injuries.
High-velocity gunshot wounds should be treated like high-energy injuries.
Open fractures should be treated with emergent _______ _________ and fracture ____________.
Open fractures should be treated with emergent surgical débridement and fracture stabilization.
Gustilo grades __ and ___ open fractures can be treated with a first-generation cephalosporin, grade ___ with cephalosporin and an aminoglycoside, and farm injuries similar to grade III with the addition of ________.
Gustilo grades I and II open fractures can be treated with a first-generation cephalosporin, grade III with cephalosporin and an aminoglycoside, and farm injuries similar to grade III with the addition of penicillin.
_____________ cultures are not considered necessary for open fractures.
Intraoperative cultures are not considered necessary for open fractures.
For open fractures, _______ _________ provides protection from further soft-tissue injury.
For open fractures, fracture stabilization provides protection from further soft-tissue injury.
For Gustilo grade III fractures, the indications for ____ _______ versus amputation are controversial.
For Gustilo grade III fractures, the indications for limb salvage versus amputation are controversial.
50. Evaluation of the Trauma Patient
50. Evaluation of the Trauma Patient
A major trauma victim is an individual who has potentially _____- and/or ____-threatening injuries and requires hospitalization.
A major trauma victim is an individual who has potentially life- and/or limb-threatening injuries and requires hospitalization.
The goal of prehospital care is to minimize preventable ______.
The goal of prehospital care is to minimize preventable deaths.
Field triage requires rapid decisions based on ________, ________, ________ of injury, and ___________ factors.
Field triage requires rapid decisions based on physiologic, anatomic, mechanism of injury, and comorbidity factors.
During the initial treatment of a trauma patient, the diagnosis and treatment of _________ injuries takes priority over a sequential, detailed, definitive workup.
During the initial treatment of a trauma patient, the diagnosis and treatment of critical injuries takes priority over a sequential, detailed, definitive workup.
The primary survey is a systematic effort to quickly identify _____-________ injuries.
The primary survey is a systematic effort to quickly identify life-threatening injuries.
The most common source of shock in a trauma patient is __________ shock.
The most common source of shock in a trauma patient is hypovolemic shock.
Resuscitation begins with a bolus of ___ L of ________ that can be repeated once if the vital signs are not restored to normal.
Resuscitation begins with a bolus of 2 L of crystalloid that can be repeated once if the vital signs are not restored to normal.
It is difficult to determine which patients are in __________ shock and which patients have been fully ________.
It is difficult to determine which patients are in compensated shock and which patients have been fully resuscitated.
Initial radiographic evaluation includes _____ radiograph, lateral ___-____, and AP _____.
Initial radiographic evaluation includes chest radiograph, lateral C-spine, and AP pelvis.
The _______ deficit or _______ level on admission is predictive of complication rates and mortality.
The base deficit or lactate level on admission is predictive of complication rates and mortality.
51. Hand and Wrist Fractures and Dislocations, Including Carpal Instability
51. Hand and Wrist Fractures and Dislocations, Including Carpal Instability
In index and long finger MCP fractures, ___° to ____° of angulation is acceptable; in fractures of the ring and little fingers, ____° to ____° of angulation is acceptable.
In index and long finger MCP fractures, 15° to 20° of angulation is acceptable; in fractures of the ring and little fingers, 30° to 40° of angulation is acceptable.
The main deforming force in a Bennett fracture is provided by the __________ ______ ______. In a “baby Bennett” fracture, it is the _____ _____ ___________.
The main deforming force in a Bennett fracture is provided by the abductor pollicis longus. In a “baby Bennett” fracture, it is the extensor carpi ulnaris.
In complex MCP dislocations, the metacarpal head is caught between the ______ ______, _______ __________, _________, and ____ pulley.
In complex MCP dislocations, the metacarpal head is caught between the volar plate, flexor tendon, lumbrical, and A1 pulley.
Bennett fractures are best viewed on the __________ (____________) view.
Bennett fractures are best viewed on the Robert (hyperpronated) view.
Dorsal PIP joint dislocations may lead to _______________ deformity. Volar PIP joint dislocations may lead to ____________ deformity.
Dorsal PIP joint dislocations may lead to pseudoboutonnière deformity. Volar PIP joint dislocations may lead to boutonnière deformity.
Nondisplaced scaphoid waist fractures, as verified by CT, can be treated with cast immobilization in a long arm-______ ______ ________, which has been shown to produce the smallest amount of internal scaphoid motion. Indications for surgery include any displacement, a radiolunate angle >___°, associated _________ ligamentous injuries, and ___________ pole fractures.
Nondisplaced scaphoid waist fractures, as verified by CT, can be treated with cast immobilization in a long arm-thumb spica cast, which has been shown to produce the smallest amount of internal scaphoid motion. Indications for surgery include any displacement, a radiolunate angle >15°, associated perilunate ligamentous injuries, and proximal pole fractures.
The SLAC pattern of arthritis progresses from the radioscaphoid joint to the scaphocapitate joint to the capitolunate joint.
The SLAC pattern of arthritis progresses from the radioscaphoid joint to the scaphocapitate joint to the capitolunate joint.
Surgical indications for distal radius fractures include loss of reduction following attempt at closed treatment and/or excessive shortening (≥__ mm), dorsal angulation ≥__°, loss of radial inclination >__°, or ≥__ mm articular displacement.
Surgical indications for distal radius fractures include loss of reduction following attempt at closed treatment and/or excessive shortening (≥5 mm), dorsal angulation ≥15°, loss of radial inclination >10°, or ≥2 mm articular displacement.
In the setting of isolated radial styloid fractures, ________ __________ injuries must be suspected.
In the setting of isolated radial styloid fractures, intercarpal ligament injuries must be suspected.
52. Fractures of the Humeral Shaft and Distal Humerus
52. Fractures of the Humeral Shaft and Distal Humerus
Most humeral shaft fractures can be treated ______________.
Most humeral shaft fractures can be treated nonsurgically.
Indications for surgical management of humeral shaft fractures include ________ injury, severe ____-_______ injury, _____ fracture, ______ elbow, concomitant ____-_________ elbow injury, and ______ fractures.
Indications for surgical management of humeral shaft fractures include vascular injury, severe soft-tissue injury, open fracture, floating elbow, concomitant intra-articular elbow injury, and pathologic fractures.
__________-_____ supracondylar fractures account for most supracondylar fractures
Extension-type supracondylar fractures account for most supracondylar fractures
Intramedullary nailing of humeral shaft fractures is associated with a higher rate of _________ _________.
Intramedullary nailing of humeral shaft fractures is associated with a higher rate of shoulder pain.
The “terrible triad” of elbow injuries involves fractures of the __________, ________, and _______ _____/_____.
The “terrible triad” of elbow injuries involves fractures of the olecranon, coronoid, and radial head/neck.
For patients with a concomitant _______ ______ injury who do not require surgical treatment, electromyography/nerve conduction velocity studies should be performed ___ weeks postinjury. For those who require surgical treatment, exploration is done at the time of surgery.
For patients with a concomitant radial nerve injury who do not require surgical treatment, electromyography/nerve conduction velocity studies should be performed 6 weeks postinjury. For those who require surgical treatment, exploration is done at the time of surgery.
_____ ______ ________ should be considered in low-demand elderly individuals who sustain a complex distal humerus fracture.
Total elbow arthroplasty should be considered in low-demand elderly individuals who sustain a complex distal humerus fracture.
The ligament of __________ extends from the supracondylar process to the medial epicondyle.
The ligament of Struthers extends from the supracondylar process to the medial epicondyle.
In general, intercondylar fractures are managed surgically with _______ and _______ plate fixation.
In general, intercondylar fractures are managed surgically with medial and lateral plate fixation.
The chevron-type olecranon osteotomy should be pointed ______ to minimize fracturing of the olecranon fragment.
The chevron-type olecranon osteotomy should be pointed distal to minimize fracturing of the olecranon fragment.
53. Pelvic, Acetabular, and Sacral Fractures
53. Pelvic, Acetabular, and Sacral Fractures
Pelvic Fractures
Pelvic Fractures
Pelvic fractures in young adults result from _____-energy injuries and are often associated with other life-threatening injuries.
Pelvic fractures in young adults result from high-energy injuries and are often associated with other life-threatening injuries.
Rapid, provisional fixation of unstable pelvic fractures can be performed in the trauma bay with _______ of the _______ _______.
Rapid, provisional fixation of unstable pelvic fractures can be performed in the trauma bay with application of the pelvic binder.
Pelvic binders can remain in place during further diagnostic tests such as ________; if necessary, a portion of the binder can be cut to allow for vascular access.
Pelvic binders can remain in place during further diagnostic tests such as angiography; if necessary, a portion of the binder can be cut to allow for vascular access.
Open pelvic fractures may require a diverting __________.
Open pelvic fractures may require a diverting colostomy.
External fixators can be used for definitive treatment of ________ pelvic injuries but not unstable ________ injuries.
External fixators can be used for definitive treatment of anterior pelvic injuries but not unstable posterior injuries.
Diagnostic peritoneal lavage performed in a patient with a pelvic fracture should be done _________, as an ___________ lavage can give a false-positive result due to tracking hematoma.
Diagnostic peritoneal lavage performed in a patient with a pelvic fracture should be done supraumbilical, as an infraumbilical lavage can give a false-positive result due to tracking hematoma.
Patients with pelvic fractures have a high incidence of DVT (___% to _____%) and pulmonary embolism (up to ___%).
Patients with pelvic fractures have a high incidence of DVT (35% to 50%) and pulmonary embolism (up to 10%).
Acetabular Fractures
Acetabular Fractures
The area within the ___° roof arc angle corresponds with the superior ___ mm of the acetabulum on CT scan.
The area within the 45° roof arc angle corresponds with the superior 10 mm of the acetabulum on CT scan.
Secondary congruence of _____-________ fractures may allow successful nonsurgical management.
Secondary congruence of both-column fractures may allow successful nonsurgical management.
___________ ________ of acetabular fractures can greatly assist fracture reduction.
Intraoperative traction of acetabular fractures can greatly assist fracture reduction.
Marginal impaction is often seen with posterior wall fractures and should be __________ and ______ _________.
Marginal impaction is often seen with posterior wall fractures and should be elevated and bone grafted.
Untreated _______-__________ lesions have a high rate of infection.
Untreated Morel-Lavallee lesions have a high rate of infection.
Heterotopic ossification is common, especially with the _____ ___________ and _______-_____________ approaches.
Heterotopic ossification is common, especially with the extended iliofemoral and Kocher-Langenbeck approaches.
Sacral Fractures
Sacral Fractures
Sacral fractures are often difficult to fully visualize on plain radiographs; thus, ___ is helpful in defining the fracture.
Sacral fractures are often difficult to fully visualize on plain radiographs; thus, CT is helpful in defining the fracture.
Percutaneous treatment is reserved for fractures in which any ________ or ___ displacement can be reduced in a closed manner.
Percutaneous treatment is reserved for fractures in which any vertical or AP displacement can be reduced in a closed manner.
Sacral root injury is most common with zone ___ injuries.
Sacral root injury is most common with zone 3 injuries.
Overcompression of fractures involving zone ___ should be avoided.
Overcompression of fractures involving zone 2 should be avoided.
Percutaneous fixation is unreliable in patients with _____________ bone.
Percutaneous fixation is unreliable in patients with osteoporotic bone.
54. Hip Dislocations and Femoral Head Fractures
54. Hip Dislocations and Femoral Head Fractures
Hip Dislocations
Hip Dislocations
Assess _______ stability, ______-________ fragments, and ________ reduction on postreduction CT scan of the hip.
Assess hip stability, intra-articular fragments, and concentric reduction on postreduction CT scan of the hip.
Check postreduction CT scan for ________ ________ of the posterior wall.
Check postreduction CT scan for marginal impaction of the posterior wall.
Assess need for internal fixation on postreduction CT scan. Identify size of ________ ________ fragment and ________ involvement. Anything over ___% involvement of the posterior wall is an indication for fixation.
Assess need for internal fixation on postreduction CT scan. Identify size of posterior wall fragment and dome involvement. Anything over 25% involvement of the posterior wall is an indication for fixation.
Good relaxation is required with attempted closed reduction of ________ hip dislocations. Avoid forceful reduction, which can lead to femoral ________ or ________ fractures.
Good relaxation is required with attempted closed reduction of posterior hip dislocations. Avoid forceful reduction, which can lead to femoral head or neck fractures.
Document the ________ examination before and after reduction.
Document the neurologic examination before and after reduction.
In most patients, osteonecrosis is evidenced at 1 year following injury. Arthritis can develop later.
In most patients, osteonecrosis is evidenced at 1 year following injury. Arthritis can develop later.
Check the ipsilateral ________ in posterior dislocations to assess for ligamentous or other injury.
Check the ipsilateral knee in posterior dislocations to assess for ligamentous or other injury.
Femoral Head Fractures
Femoral Head Fractures
Assess good quality radiographs with ________ views pre- and postreduction for femoral ________ fractures. Diagnosis can be made on postreduction CT scan.
Assess good quality radiographs with Judet views pre- and postreduction for femoral head fractures. Diagnosis can be made on postreduction CT scan.
There is no need for prereduction CT scan, and leaving the hip dislocated for a longer period can lead to further damage to the femoral head blood supply or possible ________ nerve injury.
There is no need for prereduction CT scan, and leaving the hip dislocated for a longer period can lead to further damage to the femoral head blood supply or possible sciatic nerve injury.
It is important to identify whether the femoral head fracture is ________ (weight bearing) or ________.
It is important to identify whether the femoral head fracture is suprafoveal (weight bearing) or intrafoveal.
Usually a ________-________ approach to the hip is used for fixation, with a periacetabular ________ to preserve blood supply.
Usually a Smith-Petersen approach to the hip is used for fixation, with a periacetabular capsulotomy to preserve blood supply.
Femoral head fracture is easier to see and fix through an ________ approach with countersunk or headless screws.
Femoral head fracture is easier to see and fix through an anterior approach with countersunk or headless screws.
With a large posterior wall fracture (________ type 4), a ________-________ approach can be used with subluxation or dislocation of the femoral head. This will allow access to the femoral head for fracture reduction and fixation.
With a large posterior wall fracture (Pipkin type 4), a Kocher-Langenbeck approach can be used with subluxation or dislocation of the femoral head. This will allow access to the femoral head for fracture reduction and fixation.
Small fragments or ________ ________ fractures can be excised through a posterior approach when associated with a posterior wall fracture.
Small fragments or foveal avulsion fractures can be excised through a posterior approach when associated with a posterior wall fracture.
Decreased ________ rotation is commonly seen after femoral head fractures, but this may not be a clinical problem or cause disability.
Decreased internal rotation is commonly seen after femoral head fractures, but this may not be a clinical problem or cause disability.
55. Fractures of the Hip
55. Fractures of the Hip
Fractures of the Femoral Neck
Fractures of the Femoral Neck
Fractures of the femoral neck can result from direct or indirect force (fall onto the ________ thigh or a ________ force).
Fractures of the femoral neck can result from direct or indirect force (fall onto the proximal thigh or a rotational force).
The main blood supply to the femoral head comes from the ________ ________ ________ artery.
The main blood supply to the femoral head comes from the medial femoral circumflex artery.
The structure at risk during the anterior approach to the hip is the ________ ________ ________ nerve.
The structure at risk during the anterior approach to the hip is the lateral femoral cutaneous nerve.
The Y ligament of Bigelow resists hip ___________.
The Y ligament of Bigelow resists hip hyperextension.
Pathologic fractures of the femoral neck should be treated with ________ or ________.
Pathologic fractures of the femoral neck should be treated with hemiarthroplasty or THA.
Screw fixation below the level of the ________ ________ increases the risk of subtrochanteric femur fracture.
Screw fixation below the level of the lesser trochanter increases the risk of subtrochanteric femur fracture.
Intertrochanteric Fractures
Intertrochanteric Fractures
A TAD <___ mm should be maintained when placing the lag screw of a plate or nail device.
A TAD <25 mm should be maintained when placing the lag screw of a plate or nail device.
Lesser trochanteric fractures are often associated with ________ ________.
Lesser trochanteric fractures are often associated with tumor metastasis.
________ ________ ________ should be treated with an intramedullary nail or a fixed-angle plate.
Reverse obliquity fractures should be treated with an intramedullary nail or a fixed-angle plate.
Subtrochanteric Fractures
Subtrochanteric Fractures
When using an open technique, ________ dissection should be avoided.
When using an open technique, medial dissection should be avoided.
56. Fractures of the Femoral Shaft and Distal Femur
56. Fractures of the Femoral Shaft and Distal Femur
Femoral Shaft Fractures
Femoral Shaft Fractures
Always closely evaluate the patient with a femur fracture for ________ ________.
Always closely evaluate the patient with a femur fracture for associated injuries.
________ ________ (within the first 24 hours) of femur fractures minimizes the complication rates and can decrease the length of stay.
Early stabilization (within the first 24 hours) of femur fractures minimizes the complication rates and can decrease the length of stay.
Bilateral femur fractures have a mortality rate of up to ___%.
Bilateral femur fractures have a mortality rate of up to 25%.
The infection rate for open femur fractures is significantly lower than that of ________ ________ fractures.
The infection rate for open femur fractures is significantly lower than that of open tibia fractures.
________ deformities may occur if the leg is not properly positioned on the fracture table.
Rotation deformities may occur if the leg is not properly positioned on the fracture table.
A ________ ________, ________ IM nail is the standard of care for femoral shaft fractures.
A statically locked, reamed IM nail is the standard of care for femoral shaft fractures.
The ________ ________ should be based on surgeon preference.
The starting point should be based on surgeon preference.
At least ________ ________ screws, one proximal and one distal, should be used for all fractures.
At least two interlocking screws, one proximal and one distal, should be used for all fractures.
Before the patient wakes up, AP pelvic radiographic imaging should be performed to rule out a femoral ______ fracture; limb ________ and ________ should be evaluated and the knee should be checked for ligamentous injuries.
Before the patient wakes up, AP pelvic radiographic imaging should be performed to rule out a femoral neck fracture; limb rotation and length should be evaluated and the knee should be checked for ligamentous injuries.
Conversion of an external fixator to an IM nail should occur within the first ____ weeks to minimize the risk of infection.
Conversion of an external fixator to an IM nail should occur within the first 2 weeks to minimize the risk of infection.
Distal Femur Fractures
Distal Femur Fractures
The origin of the ________ characteristically pulls the distal fragment into flexion.
The origin of the gastrocnemius characteristically pulls the distal fragment into flexion.
A bump or radiographic ________ strategically placed under the deformity may assist with reduction.
A bump or radiographic triangle strategically placed under the deformity may assist with reduction.
Closely evaluate preoperatively for a coronal plane ________ fracture.
Closely evaluate preoperatively for a coronal plane Hoffa fracture.
If using a long percutaneous plate, ________ ________ of the plate placement on the femur may be difficult. Consider making an incision to ensure proper placement proximally on the femur.
If using a long percutaneous plate, proximal visualization of the plate placement on the femur may be difficult. Consider making an incision to ensure proper placement proximally on the femur.
When using a bridging external fixator, place the external fixator pins away from the ________ ________ location.
When using a bridging external fixator, place the external fixator pins away from the planned plate location.
The goal of surgical treatment should be ________ ________ to permit early mobility.
The goal of surgical treatment should be stable fixation to permit early mobility.
Even with locking plate fixation, failures have been reported. The need for ________ ________, therefore, should not be ignored in those fractures where it is warranted.
Even with locking plate fixation, failures have been reported. The need for bone grafting, therefore, should not be ignored in those fractures where it is warranted.
A ________ ________ should be considered for very distal periprosthetic surpracondylar femur fractures.
A locked plate should be considered for very distal periprosthetic surpracondylar femur fractures.
57. Knee Dislocations and Patella Fractures
57. Knee Dislocations and Patella Fractures
The actual incidence of knee dislocations is likely higher than reported because of ________ ________.
The actual incidence of knee dislocations is likely higher than reported because of spontaneous reduction.
Typically, at least ________ of the four main knee ligaments (ACL, PCL, LCL, MCL) are disrupted with knee dislocation.
Typically, at least three of the four main knee ligaments (ACL, PCL, LCL, MCL) are disrupted with knee dislocation.
Vascular injury is common with knee dislocation (reported range ___% to ___%).
Vascular injury is common with knee dislocation (reported range 20% to 60%).
Arteriography should be performed if the ABI is <____.
Arteriography should be performed if the ABI is <0.9.
Timing and extent of ligament repair/reconstruction is controversial, but there is general agreement that repair of the ________ ligaments (including the _____) should be performed in the acute period.
Timing and extent of ligament repair/reconstruction is controversial, but there is general agreement that repair of the lateral ligaments (including the PLC) should be performed in the acute period.
The patella is the largest ________ bone in the body.
The patella is the largest sesamoid bone in the body.
The patella functions to increase the mechanical advantage of the ________ ________.
The patella functions to increase the mechanical advantage of the quadriceps tendon.
________ ________ ________ should be assessed to determine the status of the retinacular extension around the patella.
Active knee extension should be assessed to determine the status of the retinacular extension around the patella.
Bipartite patella (present in ___% of the population; most often found in the ________ region) may be mistaken for a fracture.
Bipartite patella (present in 8% of the population; most often found in the superolateral region) may be mistaken for a fracture.
Nonsurgical treatment of patella fractures assumes an ________ ________ mechanism.
Nonsurgical treatment of patella fractures assumes an intact extensor mechanism.
58. Tibial Plateau and Tibia-Fibula Shaft Fractures
58. Tibial Plateau and Tibia-Fibula Shaft Fractures
________ compromise may be present in high-energy fracture patterns.
Skin compromise may be present in high-energy fracture patterns.
If there will be a delay in surgical intervention after tibial plateau fracture, consider use of temporary ________ ________ fixation if the limb is shortened or subluxated.
If there will be a delay in surgical intervention after tibial plateau fracture, consider use of temporary spanning external fixation if the limb is shortened or subluxated.
Identify and repair all ________ damage intraoperatively.
Identify and repair all meniscal damage intraoperatively.
Bicondylar tibial plateau fractures require ________ ________ fixation or ________ fixation with a ________ plate.
Bicondylar tibial plateau fractures require dual plate fixation or unilateral fixation with a locking plate.
________ ________ incision should be avoided for bicondylar tibial plateau fractures because of the high rate of wound slough.
Anterior midline incision should be avoided for bicondylar tibial plateau fractures because of the high rate of wound slough.
Failure to identify impending compartment syndrome is the most serious complication after _____-______ ________ fractures.
Failure to identify impending compartment syndrome is the most serious complication after tibia-fibula shaft fractures.
Immediate postoperative ________ is preventable with careful surgical technique and awareness of this potential complication, particularly with nailing of proximal or distal tibia fractures.
Immediate postoperative malalignment is preventable with careful surgical technique and awareness of this potential complication, particularly with nailing of proximal or distal tibia fractures.
Methods to prevent malalignment during tibial nailing include ________ ________, ________ ________, ________, and ________ plating.
Methods to prevent malalignment during tibial nailing include blocking screws, provisional plating, distractors, and fibular plating.
A more lateral proximal entry site should be considered to avoid ________ with a proximal one-third fracture.
A more lateral proximal entry site should be considered to avoid valgus with a proximal one-third fracture.
59. Foot Trauma
59. Foot Trauma
Metatarsal and Phalangeal Fractures
Metatarsal and Phalangeal Fractures
________ of first metatarsal fractures is poorly tolerated and is an indication for reduction and fixation.
Displacement of first metatarsal fractures is poorly tolerated and is an indication for reduction and fixation.
More than ___ mm of displacement, ___° of angulation, or multiple metatarsal fractures are indications for fixation of second, third, or fourth metatarsal fractures.
More than 3 mm of displacement, 10° of angulation, or multiple metatarsal fractures are indications for fixation of second, third, or fourth metatarsal fractures.
________ displacement of metatarsal fractures can lead to callosity.
Plantar displacement of metatarsal fractures can lead to callosity.
________ displacement of metatarsal fractures can lead to transfer metatarsalgia under adjacent metatarsals.
Dorsal displacement of metatarsal fractures can lead to transfer metatarsalgia under adjacent metatarsals.
The proximal fifth metatarsal has poor blood supply at the ________ junction ___ to ___ cm distal to the base. Jones fractures occur at this ________ junction.
The proximal fifth metatarsal has poor blood supply at the metadiaphyseal junction 1.5 to 2.5 cm distal to the base. Jones fractures occur at this metadiaphyseal junction.
High-level athletes may undergo acute fixation of Jones fractures with a screw to avoid delay in the return to activity because of ________.
High-level athletes may undergo acute fixation of Jones fractures with a screw to avoid delay in the return to activity because of nonunion.
Diaphyseal stress fractures of the fifth metatarsal can be caused by ________ foot deformities or peripheral neuropathies.
Diaphyseal stress fractures of the fifth metatarsal can be caused by cavovarus foot deformities or peripheral neuropathies.
Proximal phalanx fractures of the hallux are treated surgically for ________ or ________ _____-________ injuries.
Proximal phalanx fractures of the hallux are treated surgically for angulation or displaced intra-articular injuries.
Medial _____________ for nonunion may result in hallux valgus deformity.
Medial sesamoidectomy for nonunion may result in hallux valgus deformity.
Lateral sesamoidectomy for nonunion may result in hallux ________ deformity.
Lateral sesamoidectomy for nonunion may result in hallux varus deformity.
Dislocations of the Foot
Dislocations of the Foot
Medial subtalar dislocations may be irreducible if the talar head buttonholes through the ________ ________ ________, ________ ________ ________, or ________ capsule, or with interposition of the ________ tendons.
Medial subtalar dislocations may be irreducible if the talar head buttonholes through the extensor digitorum brevis, inferior extensor retinaculum, or talonavicular capsule, or with interposition of the peroneal tendons.
Lateral subtalar dislocations may be irreducible if the ________ ________ tendon, ________ ________ ________, or FHL is ________.
Lateral subtalar dislocations may be irreducible if the posterior tibial tendon, flexor digitorum longus, or FHL is interposed.
Subtalar dislocations are close-reduced by ________ the knee to relax the gastrocnemius-soleus complex, recreating the deformity, ________ ________ the foot, and ________ the talar head.
Subtalar dislocations are close-reduced by flexing the knee to relax the gastrocnemius-soleus complex, recreating the deformity, plantar flexing the foot, and pushing the talar head.
CT is indicated for subtalar dislocations, given the high rate of ________ ________.
CT is indicated for subtalar dislocations, given the high rate of associated fractures.
First MTP joint dislocations may be irreducible because of buttonholing through the ________-________ ________ complex.
First MTP joint dislocations may be irreducible because of buttonholing through the sesamoid-short flexor complex.
Irreducible first MTP joint dislocations are treated through a ________ approach.
Irreducible first MTP joint dislocations are treated through a dorsal approach.
Lesser MTP joint dislocations may be irreducible because of ________ through the ________ plate.
Lesser MTP joint dislocations may be irreducible because of buttonholing through the plantar plate.
Irreducible lesser MTP joint dislocations are treated through a ________ approach.
Irreducible lesser MTP joint dislocations are treated through a dorsal approach.
Chopart joints are the ________ and ________ joints. These joints should be reduced promptly to avoid skin necrosis.
Chopart joints are the talonavicular and calcaneocuboid joints. These joints should be reduced promptly to avoid skin necrosis.
Isolated tarsal dislocations are rare but are treated with prompt reduction to avoid skin ________.
Isolated tarsal dislocations are rare but are treated with prompt reduction to avoid skin necrosis.
Compartment Syndromes
Compartment Syndromes
The foot has a total of _____ compartments that comprise ____ main groups: the ________, ________, ________ interosseous, and ________ central compartments.
The foot has a total of nine compartments that comprise four main groups: the medial, lateral, four interosseous, and three central compartments.
The central compartment includes the ________ ________, or calcaneal compartment, which communicates with the ________ ________ compartment of the leg.
The central compartment includes the deep central, or calcaneal compartment, which communicates with the deep posterior compartment of the leg.
Compartment syndromes result from bleeding and ______ that increase the tissue interstitial pressures.
Compartment syndromes result from bleeding and edema that increase the tissue interstitial pressures.
Interstitial pressures above the ________ pressure lead to venous occlusion.
Interstitial pressures above the capillary pressure lead to venous occlusion.
Irreversible myoneural necrosis and fibrosis occur after ___ hours.
Irreversible myoneural necrosis and fibrosis occur after 8 hours.
Loss of ___-________ ________ and ________ touch are more sensitive signs of compartment syndrome than loss of ________ sensation. Loss of pulses and capillary refill are unreliable signs.
Loss of two-point discrimination and light touch are more sensitive signs of compartment syndrome than loss of pinprick sensation. Loss of pulses and capillary refill are unreliable signs.
Pain with passive ________ results from stretch of the intrinsic muscles, resulting in decreased ________ volume and increased pressure.
Pain with passive dorsiflexion results from stretch of the intrinsic muscles, resulting in decreased compartment volume and increased pressure.
Clinical symptoms are the main indication for compartment release. Pressures greater than __ mm Hg or within __ mm Hg of diastolic pressure have been advocated as indications for release in equivocal cases.
Clinical symptoms are the main indication for compartment release. Pressures greater than 30 mm Hg or within 30 mm Hg of diastolic pressure have been advocated as indications for release in equivocal cases.
____ ______ incisions can be used to release all nine foot compartments.
Two dorsal incisions can be used to release all nine foot compartments.
Alternatively, a ________ approach can be used to release all nine compartments. The ________ approach is more commonly used in conjunction with dorsal incisions to ensure release of the ________ ________ compartment.
Alternatively, a medial approach can be used to release all nine compartments. The medial approach is more commonly used in conjunction with dorsal incisions to ensure release of the deep central compartment.
Fractures of the Talus
Fractures of the Talus
The talus is __% covered by cartilage and the ________ ________ ________ is the only muscle attachment.
The talus is 70% covered by cartilage and the extensor digitorum brevis is the only muscle attachment.
The blood supply to the body is mostly from the artery of the ________ canal, a branch of the ________ ________ artery.
The blood supply to the body is mostly from the artery of the tarsal canal, a branch of the posterior tibial artery.
The blood supply to the neck is mostly from the artery of the ________ ________, a branch formed from the ________ ________ and ________ arteries.
The blood supply to the neck is mostly from the artery of the tarsal sinus, a branch formed from the anterior tibial and peroneal arteries.
The ________ artery supplies the medial body.
The deltoid artery supplies the medial body.
Posttraumatic ________ is the most common complication of talar neck fracture.
Posttraumatic osteoarthritis is the most common complication of talar neck fracture.
________ occurs with increasing frequency as the Hawkins classification for a talar neck fracture increases in severity.
Osteonecrosis occurs with increasing frequency as the Hawkins classification for a talar neck fracture increases in severity.
Open reduction and internal fixation is required for all ________ talar neck fractures. Open reduction and internal fixation is usually performed through a combined ________ and ________ approach.
Open reduction and internal fixation is required for all displaced talar neck fractures. Open reduction and internal fixation is usually performed through a combined anterolateral and anteromedial approach.
The Hawkins sign is subchondral osteopenia seen at __ to __ weeks postoperatively after fixation of a talar neck fracture and indicates revascularization and a better prognosis.
The Hawkins sign is subchondral osteopenia seen at 6 to 8 weeks postoperatively after fixation of a talar neck fracture and indicates revascularization and a better prognosis.
Varus malunion after a talar neck fracture can lead to loss of ________.
Varus malunion after a talar neck fracture can lead to loss of eversion.
Lateral process fractures of the talus are commonly seen in snowboarders as a result of a ________-________ rotation mechanism.
Lateral process fractures of the talus are commonly seen in snowboarders as a result of a dorsiflexion-external rotation mechanism.
Fractures of the Calcaneus
Fractures of the Calcaneus
Approximately ___% of patients with an intra-articular calcaneal fracture have an associated lumbar spine injury.
Approximately 10% of patients with an intra-articular calcaneal fracture have an associated lumbar spine injury.
Approximately ___% of patients with an intra-articular calcaneal fracture have an associated foot compartment syndrome.
Approximately 10% of patients with an intra-articular calcaneal fracture have an associated foot compartment syndrome.
A ________ fragment containing the sustentaculum is seen with intra-articular fractures of the calcaneus. This constant fragment is stabilized by ligaments and capsular attachments, making it a useful reference during open reduction and internal fixation.
A superomedial fragment containing the sustentaculum is seen with intra-articular fractures of the calcaneus. This constant fragment is stabilized by ligaments and capsular attachments, making it a useful reference during open reduction and internal fixation.
The management of ________ type II, III, and IV fractures remains controversial.
The management of Sanders type II, III, and IV fractures remains controversial.
Negative prognostic factors for the surgical treatment of Sanders type ___ and ____ fractures include severity, advanced age, male sex, obesity, bilateral fractures, multiple trauma, and worker’s compensation.
Negative prognostic factors for the surgical treatment of Sanders type II and III fractures include severity, advanced age, male sex, obesity, bilateral fractures, multiple trauma, and worker’s compensation.
Malunion of calcaneal fractures can result in ________, ________, and ________ position. The symptoms include difficulty with shoe wear and peroneal tendon symptoms.
Malunion of calcaneal fractures can result in shortening, widening, and varus position. The symptoms include difficulty with shoe wear and peroneal tendon symptoms.
Malunions that result in talar dorsiflexion with loss of talar declination angle to less than _____° can limit ankle dorsiflexion.
Malunions that result in talar dorsiflexion with loss of talar declination angle to less than 20° can limit ankle dorsiflexion.
Malunions of the calcaneus are treated with lateral ________. Fusion is also added for subtalar arthritis.
Malunions of the calcaneus are treated with lateral exostectomy. Fusion is also added for subtalar arthritis.
Tension band fixation can be used to avoid failure of screw fixation in avulsion fractures of the calcaneal ________.
Tension band fixation can be used to avoid failure of screw fixation in avulsion fractures of the calcaneal tuberosity.
Anterior process fractures occur with ________ and ________ of the bifurcate ligament.
Anterior process fractures occur with inversion and avulsion of the bifurcate ligament.
Midfoot Fractures
Midfoot Fractures
The ________ ________ has limited blood supply and is susceptible to stress fractures.
The central navicular has limited blood supply and is susceptible to stress fractures.
The tarsometatarsal joints are constrained by the recessed articulation of the ________ metatarsal.
The tarsometatarsal joints are constrained by the recessed articulation of the second metatarsal.
The Lisfranc ligament runs from the _____ of the second metatarsal to the ________ cuneiform.
The Lisfranc ligament runs from the base of the second metatarsal to the medial cuneiform.
The lateral fourth and fifth tarsometatarsal joints have ___° to ___° of ________ motion, whereas the medial three tarsometatarsal joints have little motion.
The lateral fourth and fifth tarsometatarsal joints have 10° to 20° of sagittal motion, whereas the medial three tarsometatarsal joints have little motion.
Lisfranc fracture-dislocations can occur with direct application of force or indirectly through ________ ________ and ________ on a ________, ________ ________ foot.
Lisfranc fracture-dislocations can occur with direct application of force or indirectly through axial loading and twisting on a fixed, plantar flexed foot.
Plain radiographs may show a fleck of bone in the proximal ________ ________ interspace. This fleck sign represents the avulsed Lisfranc ligament.
Plain radiographs may show a fleck of bone in the proximal first metatarsal interspace. This fleck sign represents the avulsed Lisfranc ligament.
Homolateral dislocation of the tarsometatarsal joints may be associated with a compression injury to the ________.
Homolateral dislocation of the tarsometatarsal joints may be associated with a compression injury to the cuboid.
________ instability can be associated with Lisfranc injuries and should be reduced and fixed.
Intercuneiform instability can be associated with Lisfranc injuries and should be reduced and fixed.
Up to ____% of Lisfranc injuries are missed acutely. Weight-bearing or stress radiographs can be used to rule out injury.
Up to 30% of Lisfranc injuries are missed acutely. Weight-bearing or stress radiographs can be used to rule out injury.
Fusion of the fourth and fifth tarsometatarsal joints is poorly tolerated, and resection arthroplasty is used in conjunction with fusion of the ________ ________ joints for missed or late reconstruction of Lisfranc injuries.
Fusion of the fourth and fifth tarsometatarsal joints is poorly tolerated, and resection arthroplasty is used in conjunction with fusion of the medial tarsometatarsal joints for missed or late reconstruction of Lisfranc injuries.
60. Fractures of the Ankle and Tibial Plafond
60. Fractures of the Ankle and Tibial Plafond
The talar dome is wider ________ than ________.
The talar dome is wider anteriorly than posteriorly.
The superficial deltoid arises from the ________ ________ and the ________ ________ from the posterior colliculus of the medial malleolus.
The superficial deltoid arises from the anterior colliculus and the deep deltoid from the posterior colliculus of the medial malleolus.
According to the Ottawa ankle rules, ankle radiographs are indicated if the patient has an ankle injury and is older than __ years, unable to bear weight, or has tenderness at the ________ edge or tip of either malleolus.
According to the Ottawa ankle rules, ankle radiographs are indicated if the patient has an ankle injury and is older than 55 years, unable to bear weight, or has tenderness at the posterior edge or tip of either malleolus.
Fractures of the fibula are usually fixed _____ to the medial malleolus, lateral malleolus, or syndesmosis in order to obtain length
Fractures of the fibula are usually fixed prior to the medial malleolus, lateral malleolus, or syndesmosis in order to obtain length
Exceptions to the fibula first rule include (1) extensively comminuted fibular fractures in which stabilization at the ________ side first may facilitate positioning of the ________ within the mortise an d(2) ________-________ injuries.
Exceptions to the fibula first rule include (1) extensively comminuted fibular fractures in which stabilization at the medial side first may facilitate positioning of the talus within the mortise an d(2) supination-adduction injuries.
An SER type ____ injury is associated with an unstable short oblique fracture at the distal fibula and a medial malleolus fracture or deltoid ligament disruption.
An SER type IV injury is associated with an unstable short oblique fracture at the distal fibula and a medial malleolus fracture or deltoid ligament disruption.
Posterior malleolar fractures involving >___% of the articular surface should be reduced and stabilized.
Posterior malleolar fractures involving >25% of the articular surface should be reduced and stabilized.
Tibial plafond (pilon) fractures result from either ________ compression or ________.
Tibial plafond (pilon) fractures result from either axial compression or shear.
Internal fixation of high-energy tibial plafond fractures usually should be achieved approximately 2 weeks after the injury, preceded by a period of temporary ________ fixation.
Internal fixation of high-energy tibial plafond fractures usually should be achieved approximately 2 weeks after the injury, preceded by a period of temporary external fixation.
The ________ ________ nerve may be injured when using an ________ approach to treat a tibial plafond fracture.
The superficial peroneal nerve may be injured when using an anterolateral approach to treat a tibial plafond fracture.
61. Nonunions, Osteomyelitis, and Limb Deformity Analysis
61. Nonunions, Osteomyelitis, and Limb Deformity Analysis
Nonunions
Nonunions
Stable fixation is of extreme importance in treating all nonunions. Particular attention should be paid to the elimination of shear in nonunions with a large degree of fracture ________.
Stable fixation is of extreme importance in treating all nonunions. Particular attention should be paid to the elimination of shear in nonunions with a large degree of fracture obliquity.
It is best to achieve as stable a fixation as possible to allow for joint mobilization above and below a nonunion. These limbs have already been through much trauma, and hence the ________ regions are prone to stiffness.
It is best to achieve as stable a fixation as possible to allow for joint mobilization above and below a nonunion. These limbs have already been through much trauma, and hence the periarticular regions are prone to stiffness.
A healthy, well-vascularized soft-tissue envelope is necessary for healing of tenuously vascularized ________ bone ends. The generous use of free or rotational muscle transfers enhances the healing environment by bringing in more vascular access.
A healthy, well-vascularized soft-tissue envelope is necessary for healing of tenuously vascularized diaphyseal bone ends. The generous use of free or rotational muscle transfers enhances the healing environment by bringing in more vascular access.
If union fails despite optimal treatment, one should look for ________ or other ________ problems that are inhibiting fracture healing.
If union fails despite optimal treatment, one should look for metabolic or other endogenous problems that are inhibiting fracture healing.
Osteomyelitis
Osteomyelitis
For a successful cure, all necrotic bone and soft tissue must be meticulously ________.
For a successful cure, all necrotic bone and soft tissue must be meticulously débrided.
Proper dead-space management and ____-________ coverage are equally important to achieve a satisfactory outcome.
Proper dead-space management and soft-tissue coverage are equally important to achieve a satisfactory outcome.
Properly stage the host and the ______ ________ at the beginning of treatment so that an appropriate treatment plan can be established.
Properly stage the host and the bone involvement at the beginning of treatment so that an appropriate treatment plan can be established.
Limb Deformity Analysis
Limb Deformity Analysis
The types of deformity that can exist in a limb are angulation, translation, length, and rotation. ________ is generally measured clinically, whereas the other parameters are measured on appropriate radiographs.
The types of deformity that can exist in a limb are angulation, translation, length, and rotation. Rotation is generally measured clinically, whereas the other parameters are measured on appropriate radiographs.
Translation deformities can be as deleterious to limb alignment as ________ deformities. Translation deformities can be either ________ or ________ to an angulatory deformity, and it is important to recognize this.
Translation deformities can be as deleterious to limb alignment as angulatory deformities. Translation deformities can be either compensatory or additive to an angulatory deformity, and it is important to recognize this.
Because angulation is a phenomenon independent of translation, an apparent site of deformity might not actually be the true CORA. Therefore, this site must be precisely determined by making the measurements on _____ radiographs.
Because angulation is a phenomenon independent of translation, an apparent site of deformity might not actually be the true CORA. Therefore, this site must be precisely determined by making the measurements on long radiographs.