Fractures From Millers And Other Sources

Front 1

Colton type I

Back 1

Avulsion of Olecranon tip

Front 2

Colton II
Olecranon fracture

Back 2

Mid-groove (Intra-articular)

A-D from simple oblique->transverse->comminuted

A & B Ok with tension band, C & D plating

Front 3

Colton III
Olecranon fracture

Back 3

Fracture dislocations
More distal
Brachialis pulls distal fragment ventrally

Front 4

Colton IV
Olecranon fracture

Back 4

Comminuted fracture

Front 5

Tension band - olecranon fracture

Back 5

> 1-2 mm displacement + minimal fragmentation

70 % migration/prominent hardware

Front 6

Plate fixation - olecranon fracture

Back 6

Oblique or comminuted
Long plate if type III

Front 7

Radial head fracture

Back 7

Mason I - undislocated
Mason II - dislocated
Mason III - comminuted caput radii
Mason IV - III + dislocation/other fractures

Front 8

Coronoid fractures

Back 8

Tip + < 50 % - conservative
> 50 % - ORIF
Antermedial facet - O'Driscoll - ORIF

Front 9

Proximal humerus fracture

Back 9

Neer: dislocated > 1cm (0.5 cm Tub. Majus) or > 45 degrees
2-part - ORIF
3-part - ORIF
4-part - hemiarthroplasty
Valgus impaction
Head split/dislocation

> 8 mm calcar spared -> higher chance of preserved circulation

Front 10

Supracondylar humerus fracture

Back 10

Flexion - rare
Extension
type I - undisplaced
type II - displaced, post. cortex contact
type III - displaced, no bone contact
type IV - same as III but periost broken

If vascular compromise - reposition + reassess

Child injury

Complications: AIN most common (OK sign), PIN 2:nd

Front 11

Holstein-Lewis fracture

Back 11

Distal 1/3 humerus fracture - more common with radial injury

Conservative treatment even in radial palsy, unless open/floating elbow/pathologic/polytrauma

Front 12

Monteggia

Back 12

Fractured ulna, dislocated radial head
Type I - radii dislocated upwards
Type II - radii dislocated downwards
Type III - radii dislocated laterally
Type IV - radius also fractured

All ORIF

Galeazzi/Monteggia - GRUM

Front 13

Galeazzi

Back 13

Radial fracture and caput ulnae dislocated at DRU-joint

Front 14

DISI

Back 14

Carpal instability, angle between scaphoideum and lunatum > 70 degrees
Dorsal angle - triquetrum pulls

Also ring sign over scaphoideum

Causes: scaphoideum fracture, Kienbocks disease, scapholunar ligament disruption

Front 15

VISI

Back 15

Volar DISI - carpal instability
SL angle < 30 degrees
Scaphoideum pulls volarly

Regular angle 30-60 degrees

Front 16

Pipkin classification

Back 16

Femoral head fracture - related to hip dislocation

Pipkin I - Below lig. teres/fovea
Pipkin II - Above lig. teres/fovea
Pipkin III & IV - incl. lig. teres + fem. neck

Assoc. with fractures acetabulum

Front 17

Garden classification

Back 17

Garden I - incomplete fracture, valgus
Garden II - complete fracture - nondisplaced - no angulation in trabecular lines
Garden III - incomplete displacement - varus, rotated
Garden IV - completely displaced

III-IV = displaced
> 20 degrees posterior tilt is also a significant risk factor for reoperations (Palm et. al, 2009, Acta Orth.)

Front 18

Tip-Apex Distance (TAD)

Back 18

Placement of the collum screw tip in femoral head should be < 25 mm from the apex for minimum risk of failure

Front 19

Femoral shaft fractures are associated with

Back 19

< 10 % have fem. neck fractures, commonly missed (50 %)

Should be treated with screws/plate + retrograde nailling if dislocated, if no dislocation then recon antegrade nailing is OK

Front 20

Femoral nailing in supine position increases risk for

Back 20

internal rotation

compare with contralateral limb

Front 21

Watson's test

Back 21

Scapholunar dissociation

Pressure over volar pole of scaphoideum when at the same time moving from ulnar deviation to radial deviation. Positive if pain + dorsal subluxation of scaphoideum

Front 22

TFCC-injury

Back 22

Estimated that 1/3 have remaining symptoms

Common in assoc. with dist. radius fractures

Test in:
* maximum pronation - dorsal part
* neutral and radial deviation - ulnocarpal ligaments
* meximum supination - volar part

Front 23

Pelvic injury

Back 23

Young & Burges classification:
* Lateral compression
* Anteroposterior compression
* Vertical shear
+ Combined

ORIF if:
> 2.5 cm symph. widening
S1-lig. disruption (ant + post)
Vertical instability
Sacral fracture with > 1 cm displacement

Front 24

Tscherne

Back 24

0: minimal violence, simple fractures
I: skin abrasion, larger ankle distorsion
II: risk for compartment, ex. diafyseal tibia fracture when hit by a bumper
III: major trauma, separation of subcutaneous fat, compartment, vascular injury etc

Front 25

Gustillo Andersen

Back 25

Grade I: < 1 cm
Grade II: 1-10cm
Grade III: > 10 cm _or_ high energy
A - periosteal stripping but adequate tissue for coverage
B - extensive periosteal stripping and requires flap
C - vascular injury requiring vascular repair

Front 26

Most common shaft fracture

Back 26

Tibia

Front 27

Nonoperative indications for diafyseal tibia fractures

Back 27

Low energy
< 1-2 cm shortening
< 5 degrees varus/valgus
< 10 degrees flexion/extension
> 50 % cortical apposition

Front 28

Reudi-Allgöwer

Back 28

Tibial plafond fracture

Type I - Nondisplaced
Type II - Displaced
Type III - Comminuted

Front 29

Lauge-Hansen

Back 29

Ankle fractures

Supination-Adduction
Supination-External (eversion) rotation (most common)
Pronation-Abduction
Pronation-External rotation
Pronation-Dorsiflexion

Front 30

One millimeter talar shift decreases

Back 30

40 % of tibiotalar contact area

Front 31

Sanders classification

Back 31

Based on coronal CT-scan

2-4 number of fracture fragments involving the posterior facet
A-C higher letter the closer the fracture is to the medial side (sustentaculum tali)

Front 32

Jefferson fracture

Back 32

Burst fracture of the C1

50 % without any significant neurologic involvement

Intact tranverse ligament?
- Atlas lateral border > 6.9 mm lateral of dens lateral border

Typical of head hitting the roof during accident

Front 33

Odontoid fractures

Back 33

Type I - avulsion of the alar ligament
Type II - fracture at the base of the process
Type IIA - comminuted at the base
Type III - extends into the body

High rate of non-union II & IIA (fibrous union)

Controversial with type II fractures:
2 mm fracture gap - ORIF
> 5 mm displacement - ORIF

Collar for I but for III no good evidence...

Front 34

Hangman fracture

Back 34

C2 spondylolisthes fractures type I & IA acc. to Levine classification

Hyperextension

Stiff collar

Front 35

Chance fracture

Back 35

Anterior compression of the vertebra

Distraction + flexion mechanism - seatbelt injury

> 17 % kyphosis -> indicative of post. lig. injury and surgery might be considered

Front 36

Denis classification of the spine

Back 36

3 column theory - 2 columns = unstable

Anterior column - anterior 2/3 of vertebral body + anterior l.lig.
Middle column - posterior 1/3 of vertebral body + posterior l.lig.
Posterior column - pedicles, spinous processes, lig. flaxum, transverse process etc

Front 37

Burst fractures - thoracolumbar - surgery indications

Back 37

> 30 degrees kyphosis (some say > 20 degrees)
> 50% loss of vertebral body height
> 50% canal compromise
incomplete cord injury

Front 38

Böhler angle

Back 38

20-40 degrees

Between posterior facet ant the anterior line from tub. calcani and post. facet

Decreased in both extra- and intra-articular calcanal fractures

Front 39

Medial clavicle fracture

Back 39

5-8 % of clavicle fractures

ORIF if posterior - rare

Front 40

Middle clavicle fracture
ORIF indications

Back 40

Strong: Open fracture, skin tenting
Debatable: > 2 cm shortening, no contact in two planes, intermediate fragment - Z-fragment

Front 41

Lateral clavicle

Back 41

Neer type II A & B, V - ORIF
Affected coracoclavicle ligaments - 50 % non-union

10-15 % of all fractures

Front 42

Proximal humerus fracture of valgus impaction type - treatment

Back 42

ORIF (Osteosutures)

Front 43

Comparing prox. humerus plating & nailing

Back 43

Plating: Screw cutout
Nailing: RCT-trouble, injury to radial nerve

Front 44

Humerus fracture - surg. indications

Back 44

Open fracture, vascular injury, plexus injury
>20 degree valg/var.
>30 degree flexion/extension
Soft tissue interposition

Front 45

Roger's line in supracondylar fracture

Back 45

Ventral line along humerus

If capitellum is behind the line > 30 degrees dislocation = ORIF

Front 46

Tibial condyle fracture ORIF

Back 46

Shatzker IV-VI
> 3 mm depression
> 5 mm widening
Unstable in varus/valgus

Front 47

Calcaneus fracture - tounge type

Back 47

ORIF acute due to risk of posterior skin problems