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133 Cards in this Set
- Front
- Back
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are oblique views used to evaluate fx fragment relationships
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no, need functional views (angle and base of gait)
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describe a spiral fx
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-spiral in relation to long axis of bone
-twice as long as the transverse diam of bone in the central area of the fx |
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what pts get greenstick or torus fracture
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children; those that havent acheived full growth
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what is the diff b/w a stress fracture and a pathological fracture
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-pathologic fractures occur in bone that has been weakened by a disease process
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describe a comminuted fx
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-at least 3 fragments and more then 1 fracture line
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does fracture in cancellous vs cortical bone affect healing
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-cancellous has better healing potential bc it has better osteogenic properties, good soft tissue support, good vascularity, good inherent stability compared to cortical bone
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what is needed for primary bone healing
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-rigid internal fixation and excellent anatomical position
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which type of healing has external bone callus formation
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secondary
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what relationships must used when describing a fracture
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-articular in nature
-length -location -angulation rotation -displacement -stability -direction of fracture line |
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mechanism of closed reduction
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-increase the deformity
-distract the fragments -reverse the deformity -GET XRAYS again |
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what is the purpose of increasing the deformity in fracture reduction
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-to relase ST that may be interposed b/w the fragments
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pt presents with crush injury to 2nd toe; subungual hematoma is present, transverse fracture of distal phalanx..what is your next step in tx
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remove the nail plate to examine the nail bed for possible laceration
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nail plate is removed in a 2nd digit crush injury; A 0.5 cm laceration is noted on the nail bed.. now what
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-this is considered an open fracture
-local wound care, tetanus, systemic abx therapy |
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describe rosenthal classification for naild bed tissue loss and distal digit injuries
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Zone 1: distal to distal phalanx
2: distal to lunula 3: proximal to lunula |
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list the directions of nail bed tissue loss
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-dorsal oblique
-transverse -plantar oblique -axial -central/gouge |
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secondary intention healing (allow to granulate in on its own) would be a viable tx for which stage of rosenthal
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zone 1
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pt presents s/p dropping a book on his toe and has a subungual hematoma of 35% of his nail: treatment?
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-avulse the nail
-if > 25-35% of nail plate is involved, removal is reccomended -less then that, evacuate the hematoma with a bovie or hot paper clip |
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MC fx sesamoid
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tibial
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do fractured sesamoids heal well
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no, avascular
-they have a high rate of non unions |
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mechanism of injury for 1st MPJ dislocation
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hyperextension
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describe closed reduction of 1st MPJ dislocation
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-distraction with exaggerated DF followed by PF relocation
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MC fracture type of 5th met
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-avulsion of the tuberosity (Stewert 3)
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location of a true Jones fx
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proximal diaphysis of 5th met
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describe lisfranc ligament
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medial cuneiform to 2nd met base
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if plain films are unequivoval and you still suspect lisfranc, what radiograph should you order
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stress abduction
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Type A Hardcastle
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- total incongruity of the enitre tarso-metatarsal joint
-displacement can be in the sagittal, transverse or combined planes |
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Type B Hardcastle
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-partial incongruity
-B1: medial displacement of 1st met either alone or with other mets -B2: lateral displacement of 1 or more lesser mets, with 1st met unaffected |
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Type C Hardcastle
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-divergent dsiplacement
C1 - total displacement C2 - partial displacement |
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pathognomonic indicator of non-union
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sclerosis of fracture ends
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delayed union versus non union
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-time
-nonunion shows no sign of healing after 9 months -delayed union is not healing at a normal rate for location of fx |
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two types of non union
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-atrophic
-hypertrophic |
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atrophic non union
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-torsion wedge
-comminuted -defect -atrophic |
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hypertrophic non union
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-elephant foot
-horse foot -oligotrophic |
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tx of atrophic non union
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-debride the fx ends adn insert a bone graft with fixation
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what is a pseudoarthrosis
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-false joint formed at a fracture sight due to continued movement
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four phases in the inital asessment of a trauma pt
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-primary survey (injuries that threaten life or limb)
-resusciation (life threatening injuries are tx) -seoncary survey (indepth evaluation) -definitive care (less serious injuries are managed) |
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discuss the primary survery of trauma pt
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ABCDE
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when maintaining an airway in trauma pt; what should you assume until proven otherwise
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-cervical spine injury
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pt presents with blistering wounds on the dorsum of her foot after spilling coffee....describe the degree and give details
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-2nd degree burn
-partial thickness affecting the epidermis and dermis, but not to the basement membrane |
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rewarming procedure for frostbite
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100-110 F for 20-45 minutes
-this is painful and meds are often needed |
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should u sirgically debride frostbite
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-it is difficult to asess the depth and extent of tissue injury so it is best to avoid early sx debridment
-instead allow tissue to demarcate |
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what are two types of epiphysis
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-pressure epiphysis
-traction epiphysis |
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pressure epihphysis
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-located at the ends of long bones and transmit pressure throught the joint
-provide for longitudinal growth |
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traction epiphysis
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-aka apophysis
-located at the sites of tendon attachment and are non articular -do not contribute to longitudinal growth of bone |
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describe the physis
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-radiolucent cartilaginous plated between the metaphysis and epiphysis
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thurston holland sign
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-flag sign
-seen in SH 2 -traingular shaped metaphyseal fragment is created |
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which SH injuries are considered intra-articular
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3 and 4
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MC and 2nd most common compartment for compression syndrome
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anterior
deep posterior |
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6 P's of compartment syndrome
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1. parasthesis
2. pallor 3. pulses present 4. pain 5. pressure 6. paresis |
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pressure when a fasciotomy should be considered
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30-45 mmHg with clinical symptoms
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deadly complication of compartment syntibdrome
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-myoglobulinuria; occurs secondary to muscle necrosis
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MOI for navi tuber fracture
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-avulsion type fx
-foot is forcibly everted, the TP tendon avulses it |
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Nutcracker syndrome
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-severely displaced navi tuber fracture caused by strong pronatory force will cause compression of calc-cuboid joint producing fx of cuboid or calc
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MOI dorsal avulsion of navi
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-PF with eversion or inversion
-PF,eversion: tibionav lig of the deltoid avulses the navi -PF, inversion: talonav lig becomes stressed nad avulses the navi |
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are dorsal lip navi avulsion fractures intra or extra articular
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intra-articular bc they contain articular cartilage
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avulsion fracture of the medial aspect of the medial cuneiform - what is the cause
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TA
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MC involved articular surface of the calc in fractures
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posterior facet
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what is impinged with lateral displacement of a calc fx
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peroneals
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what study should be best performed to determine the extent of an intra-articular calc fx
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CT
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view to visulaize the anterior process of hte calc
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MO
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what structure MC causes avulsion of the anterior process of the calc
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bifurcate lig
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MOI for anterior superior calc fx
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PF and inversion of the foot
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how are tongue type and joint depression cacl fx differentiated
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by the secondary fracture line
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describe the primary fracture line of a intra-articular calc fx
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-superior to inferior fextending from the vertex of Gissane angle to plantar aspect of the calc
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DIAL A PIMP
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ant lat lesion - DF, inv
post med lesion - PF, inv |
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wafer shaped OCD; mechanism and location
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DF, inv
ant lat |
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shepherds fracture
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posterior lateral process of talus (also Stieda's)
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what structure can be confused for a talar lateral tubercle fracture
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os trigonum
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avulsion fracture of the superolateral aspect of the calc : what caused this
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-inversion ankle injury
-avulsed by the EDB |
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ant drawer signs evaluates the integrity of what structure
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ant talofib lig
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arthrography of ankle reveals dye passing superiorly through the syndesmosis..
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diastasis
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arthrography of ankle reveals dye escaping to the lateral side of the lateral malleolus...
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tear of the lateral collateral ligaments
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avulsion of the distal fibula by the anterior inf tibfib ligament
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wagstaffe
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when should a volkmans fracture be fixated
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if fx is 25-30% of te articular surface
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a high fib fracture is present with no other osseous injuries; what must be ruptured for this fracture to occur
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-ant tib fib ligaments
- interosseous -deltoid |
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transverse fx of fibula at the joint line and vertical med mall fx
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SAD 2
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spiral fx of fibular starting at distal syndesmosis, transverse med mall fx
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SER4
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stage assoc with maisoneuve fx
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PER3
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which lateral lig is extra capsular
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calc-fib
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common missed fractures in ankle sprains
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-base of 5th met
-anterior process of calc -OCD of talus -high fib fracture -posterior lateral distal tibia -EDB avulsion -talar tubercle |
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when is a open fx considered contaminated versus infected
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-open fx is considered infected after 8 hours
-it is considered contaminated before this 8 hours |
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why is hte fact that a wound was due to a farm injury do important
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-clostridium can cause gas gangrene or tetanus
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Type 1 gustillo anderson
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-open fracutre with less then 1 cm
-usually simple fx with no comminution |
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Type 2 gustillo anderson
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-wound greater then 1 cm, minimal comminution and ST coverage
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Type 3 Gustillo anderson
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Include the following:
-open comminuted -high energy injury -farm injury -gun shots -injuries with NV compromise -traumatic amps -open fractures greater then 8 hrs old |
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what is the abx choice for Type 1,2,3 Gustillo open injuries
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1,2: cephalosporin
3: add a aminoglycoside to ceph for gram neg coverage. |
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describe a tendons blood supply
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3 main sources:
1. muscular branches at the myotendinous jxn 2. vessels at the periosteum and bone 3. vessels running in teh mesotenon or paratenon |
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where does the majority of the blood to a tendon come from
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mesotenon and paratenon
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stages in tendon healing for a surgically repaired tendon
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-inflammatory phase for 2 days
-fibroblastic phase day 5 -remodeling from 15-28 days where collagen is laid paralell to the tendon |
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swing phase muscles
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TA
EHL EDL Peroneus Tertius |
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after primary repair of a tendon, when should the pt begin isometric exercises
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3 weeks
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which tendons cross the ankle joint lack a synovial tendon sheath
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-achilles
-plantaris |
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describe the paratenon
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-loose elastic tissue that moves with the tendon
-it covers the tendon from origin to insertion |
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which tendons of the foot share a common synovial sheath
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-PL and PB
-EDL and Peroneus tertius |
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is a tendon transfer effective in a rigid deformity
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no,deformity must be flexible (a muscular imbalance)
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what is the most basic molecule of a tendon
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tropocollagen
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describe the transition of cells at the insertion of tendon to bone
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-collagen fibers ro fibrocartilage
-which become calcified and organized into bone |
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what are the transitional fibers at the insertion of a tendon into bone called
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Sharpeys fibers
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which structure of the tendon is the most proliferative in tendon repair process
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epitenon
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what is a tendon callus and when does it form
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-fibroblastic splint that forms during the first week of tendon healing
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tendon transfer for a rigidly PF 1st met
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none- deformity must be flexible
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when performing MMT, at what position should the muscle be placed
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end range of motion
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pt can move against gravity only, what is their MMT grade
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3, fair
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how does a tendon transfer or lengthening procedure affect tendon strength
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-loss of 1 grade of muscle strength
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effect of prolonged immobilization in the tendon repair process
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-retarded tensile strength
-increase adhesions |
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tendon transfer for spastic triceps
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Murphy; anterior advancement of the achilles
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tendon transfer helpful in correction of hallux varus
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-abductor transferred from medial side to lateral side of hallux
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tendon procedure for reducible hammertoe of the hallux
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Jones
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following tendon repair, when should hte pt return to activity
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4 weeks
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what is the grace period for primary repair of a tendon laceration
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6-8 hours
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describe the innervation of tendons
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3 types:
1. paciniform for touch 2. golgi tendon organs for stretch 3. free nerve endings for pain |
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what is a hibbs and what is done with the distal stumps
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-EDL to lateral foot
-distal stumps of EDL are sutured to the brevis tendons |
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describe the Jones tenosuspesion
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-EHL is transected at the IPJ of hallux
-then rerouted through a medial to lateral drill hole in the head of 1st met and sutured back on itself -distal stump is attached to EHB |
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through what structure must the TP tendon be passed for a drop foot procedure
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through the interosseous memrbane of the leg
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where is the tenodesis site for Hibbs procedure
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-base of 3rd met or lateral cuneiform
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4 types of posterior tibial tendon rupture
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Group 1; avulsion of tendon proximal to navi insertion
2: midsubstance tear around medial mall 3: longitudinal tear w/o rupture 4: tenosynovitis |
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when achilles is ruptured, which fibers are MC ruptured first
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posterior fibers
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Thompson test
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squeeze test for achilles rupture
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can a pt with total achilles rupture perform active PF
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-yes; using the posterior and lateral muscle groups
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pt presents with dorsal medial laceration of foot: describe your exam to rule out EHL laceration
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have pt active DF agianst resistance at IPJ
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can you dx achilles rupture on xray
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yes; blunting of Kagers triangle superiorly
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how is collagen arranged in a tendon
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-paralell orientation
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describe the anatomy of a tendon from most basic to tendon itself
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-tropocollagen forms bundles called filaments
-filaments form fibrils -fibrils form fibers -fibers form fascicle -fascicles are surrounded by endotendon -whole tendon is surrounded by the epitendon |
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what are two variables that Blix refers to on his contractile force curve
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tension versus length
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muscles produce their greatest force at what percentage of their resting length
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120% of their resting length
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when re-approximating the ends of severed tendon what is the desired tension of hte musculotendinous unit
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zero or physiological tension
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at what percentage of a muscles resting length is zero tension present
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60% of their resting length
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how does length of lever arm affect force
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-longer lever arm increases force (more torque can be produced)
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the normal ratio of torque produced by the anterior and posterior compartment is 1:4 how is this descrpancy offset biomechanically
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-the anterior lever arm of the forefoot is long which increases the force of the anterior leg
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what does the proximity of a tendon to a joint axis determine
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-whether the tendons force is stabilizing or rotatory
-the closer the tendon to the joint, the more stabilizing it is -the farther it is, the more rotatory |
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can a tendon synovial sheath repair itself
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yes
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describe the location of a skin incision in relation to a tendon when planning a tendon procedure
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-not directly over the tendon
-paralell to RSTL to prevent scar tissue |
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where are fibers attached in STATT
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-lateral fibers of the TA are sutured to peroneus tertius if present
-if not present, attach to cuboid or PB tendon |
