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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) |
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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 |
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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 |
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How quickly should a femoral shaft fracture be stabilized to avoid complications? |
Within 24-48 hours |
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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) |
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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) |
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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 |
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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 |
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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 |
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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 |
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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 cast for 4 weeks, SLC x 2-3 weeks ORIF: IF >2mm displaced post-closed reduction attempt |
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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 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 |
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What is a Bosworth Fracture? How is it treated? |
Bosworth fracture-dislocation: Posterior dislocation of the fibula behind incisura fibularis It is irreducible --> ORIF |
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What is the order of distal tibial physis ossification? |
Distal tibia physis order of ossificationcentral > medial > lateral |
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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 |
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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 |
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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) |
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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) |
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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 |
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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 |
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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. |
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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 |
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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 |
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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 |
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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% |
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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 |
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When is a septic total joint considered acute/chronic? |
Acute - 3 weeks - hasn't formed biofilm Chronic - >3 weeks - formed biofilm |