• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/27

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

27 Cards in this Set

  • Front
  • Back

Describe the modified Gustilo and Anderson classes of open fractures

I - Clean wound <1cm




II - Clean wound >1cm, w/o extensive soft tissue damage, skin flaps, or avulsions




IIIA - Extensive soft tissue lacs or flaps, but adequate soft tissue coverage of bone OR result from high-energy trauma (regardless of size). Includes segmental or severely comminuted fx.




IIIB - Extensive soft tissue loss w/ periosteal stripping and bony exposure. Massively contaminated.




IIIC - Arterial injury that requires repair (regardless of size of soft tissue wound)

Describe the Tylor and Martin classification of metaphyseal fractures (SUD)

S - stable



U - unstable




D - diaphyseal extension




0 - Extraarticular


1 - <2mm displacement


2 - >2mm displacement



Describe the treatments for the Tylor and Martin classification of metaphyseal fractures (SUD)

Progression S ---> D, tx shifts toward Ex Fix and away from Open Reduction



Progression from 0 --->2 (>2mm displacement), tx shifts toward Open Reduction



How quickly should a femoral shaft fracture be stabilized to avoid complications?

Within 24-48 hours

Who classified Humeral Head fractures?




Describe the classification system.

Neer: Displacement is >1cm, or >45 degrees angulation




1 Part - non-displaced




2 Part - anatomic neck, surgical neck, GT, LT frax




3 Part - Surgical neck w/ either GT, or LT




4 Part - Surgical Neck w/ GT AND LT




Head-splitting - Articular frax




Impression - Articular impaction (reverse Hill Sachs)

Who classified Radial Head fractures?




Describe the classification system.

Mason:




Type I - <2mm displacement




Type II - Partial artucular frax w/ >2mm displacement or angulation




Type III - Complete articular w/ severe comminution




Type IV - Radial Head frax w/ Ulnohumeral dislocation (Fracture-Dislocation)

Who classified Clavicle fractures?




Describe the classification system.

Allman w/ Neer (Group II):




Group I - Middle 1/3 - Displaced vs Nondisplaced




Group II - Lateral 1/3


Type I - lateral to coracoclavicular ligaments (trapezoid, conoid) or interligamentous --> Stable




Type IIA - medial to intact conoid and trapezoid ligament --> Unstable




Type IIB - either between ruptured conoid and intact trapezoid ligament or lateral to both ligaments torn --> Unstable




Type III - Intraarticular extending into AC joint - Conoid and trapezoid intact --> stable




Type IV - physeal fracture --> Stable




Type V - Comminuted - Conoid and trapezoid remain attached to comminuted fragment




Group III - Medial 1/3 - Ant vs. Post displacement



Who classified Femoral Neck fractures?




Describe the classification systems.

Garden:


Type I - Valgus Impacted - nondisplaced


Type II - Complete fracture - nondisplaced


Type III - 50% displaced


Type IV - 100% displaced




Pauwels:


Type I - <30 degrees from horizontal


Type II - 30-50 degrees from horizontal


Type III - >50 degrees from horizontal

Who classified Tibial Plateau fractures?




Describe the classification systems.

Schatzker:




Type I - Lateral split




Type II - Lateral split and depressed




Type III - Just depressed




Type IV - Medial split




Type V - Bicondylar fracture




Type VI - Metaphyseal/Diaphyseal dissociation

Who classified Ankle fractures?




Describe the classification systems.

Lauge-Hansen:




SA - Talofibular sprain or distal fibular avulsion AND Vertical medial malleolus and impaction of anteromedial distal tibia




SER - ATFL sprain, lateral short oblique fibular frax, PTFL (posterior mal avulsion possible), Medial malleolus transverse fracture or disruption of deltoid ligament




PER - Like SER, but with Lateral short oblique or spiral fracture of fibula (anterosuperior to posteroinferior) above the level of the joint




Danis-Weber:


A - infrasyndesmotic (not assoc w/ instability)


B - transsyndesmotic


C - suprasyndesmotic

What is a Tillaux fracture?




How is it distinguished from a Triplane?




Treatment?

Salter-Harris III fx of the distal tibia epiphysis caused by an avulsion of the AITFL

Not Triplane b/c lack of fracture in the posterior distal tibial metaphysis in the coronal plane

Tx: Non-op: IF <2mm displaced: closed reduction, long leg ca...

Salter-Harris III fx of the distal tibia epiphysis caused by an avulsion of the AITFL




Not Triplane b/c lack of fracture in the posterior distal tibial metaphysis in the coronal plane




Tx: Non-op: IF <2mm displaced: closed reduction, long leg cast for 4 weeks, SLC x 2-3 weeks




ORIF: IF >2mm displaced post-closed reduction attempt

What is a Triplane fracture?




What test is necessary to diagnose it?




Treatment?

A complex SH IV fracture pattern with components in all three planes:

Epiphysis fractured in sagittal plane (same as tillaux fracture) and therefore is seen on the AP radiograph

Physis separated in axial plane

Metaphysis fractured in ...

A complex SH IV fracture pattern with components in all three planes:




Epiphysis fractured in sagittal plane (same as tillaux fracture) and therefore is seen on the AP radiograph




Physis separated in axial plane




Metaphysis fractured in coronal plane and therefore is seen on the lateral radiograph




CT Scan necessary to delineate pattern




Tx: Cast IF <2mm displacement




CRPP vs. ORIF if >2mm displacement

What is a Bosworth Fracture?




How is it treated?

Bosworth fracture-dislocation: Posterior dislocation of the fibula behind incisura fibularis




It is irreducible --> ORIF

What is the order of distal tibial physis ossification?

Distal tibia physis order of ossificationcentral > medial > lateral 

Distal tibia physis order of ossificationcentral > medial > lateral

What is the order of elbow ossification center appearance?




Which ossifies last?

CRITOE




C - Capitellum


R - Radial Head


I - Internal (medial) epicondyle


T - Trochlea


O - Olecranon


E - External (lateral) epidondyle




Last to ossify: Medial Epicondyle

What are the tolerances for distal radius closed reduction?

<5mm shortening




<2mm articular step-off




<5 degrees change in radial inclination




Dorsal angulation <5 degrees or within 20 degrees of contralateral side

What are the tolerances for metacarpal fracture closed reductions?

Malrotation - None


Pattern - Stable (not comminuted or intra-articular)




Index and Long Finger: Shaft angulation (10-20), Shortening (2-5mm), Neck angulation (10-15)




Ring Finger: Angulation (30), Shortening (2-5mm), Neck angulation (30-40)




Little Finger: Angulation (40), Shortening (2-5mm), Neck angulation (50-60)

Who classified calcaneus fractures?




Describe the classification system.

Sanders




Type I: Nondisplaced posterior facet (regardless of number of fracture lines)




Type II: One fracture line in the posterior facet (two fragments)




Type III: Two fracture lines in the posterior facet (three fragments)




Type IV: Comminuted with more than three fracture lines in the posterior facet (four or more fragments)

Pediatric Tibial Shaft Fracture Acceptable Alignment

< 5 degrees varus-valgus angulation


< 10 degrees anterior/posterior angulation


> 50% cortical apposition


< 1 cm shortening


< 10 degrees rotational malalignment


If displaced perform closed reduction under general anesthesia

What classification system is used for periprosthetic femur fractures?




Describe the classification.

Vancouver Classification




Type A: Fracture in intertrochanteric region


Type B1: Around or just below stem with well-fixed stem


Type B2: Around or just below stem with loose stem and good bone stock


Type B3: Around or just below stem with poor bone quality or severe comminution


Type C: Well below the prosthesis

What are the treatments for the different types of periprosthetic fractures?

Type A: ORIF if displaced




Type B1: ORIF w/ cerclage and locking plates


Type B2: Revision femoral component (cementless) and fixation of the fracture fragment


Type B3: Femoral component revision w/ proximal femoral allograft or prox femoral replacement




Type C: ORIF with plate. Leave prosthesis alone.

What are the allowances for pediatric both bone fractures?

<10 y/o: angulation >15 degrees, rotation >45 degrees




>10 y/o: angulation >10 degrees, rotation >30 degrees, bayonet apposition




>13 y/o: any both bone forearm fractures

Describe the Glassgow Coma Scale

Eyes


4 - Spontaneous; 3 - To speech; 2 - To pain; 1 - none




Verbal


5 - Responds; 4 - Confused; 3 - Inappropriate words; 2 - Sounds; 1 - none




Commands/Pain


6 - Follows; 5 - Localize pain; 4 - Normal withdrawal from pain; 3 - Abnormal withdrawal from pain, decorticate flexion; 2 - Abnormal, decerebrate extension; 1 - None

What are the treatments for open fractures?

Gustillo-Anderson: Abx within 3 hours




Always - Tetanus booster




Type I and II - I&D and 1st generation Cephalosporin




Type III - Add Gentamycin




Farm Injury - Add PCN for clostridia

What is the increased metabolic demand based on lower extremity amputation level?

Simy - 15%




Transtibial -


Short - 10%


Long - 40%




Transfemoral - 68%




b/l -


BKA + BKA - 40%


AKA + BKA - 112%


AKA + AKA - 200%

What lab values are typical of septic arthritis?




What WBC value is considered septic in prosthetic joints?

WBC Count >10K w/ Left Shift




ESR > 30




CRP >5




Prosthetic Joint w/ 1100 WBCs is considered septic

When is a septic total joint considered acute/chronic?

Acute - 3 weeks - hasn't formed biofilm




Chronic - >3 weeks - formed biofilm