Trauma Oite 2015

Front 1

Type III supracondylar, pink hand but no palpable pulse. Closed reduction and pinning is done and the hand becomes white and no pulse dopperable or palpable. What do you do?

Back 1

Remove pins, unreduce the fracture, assess perfusion.

Front 2

Closed comminuted distal humerus fracture in a 65 year old woman. Neurapraxia of AIN, PIN and ulnar nerve but perfusion is fine. What should be done to assess the fracture pattern?

Back 2

Traction x rays to assess fracture pattern.

Front 3

6 year old girl fell on outstretched hand. X rays shown. How do you treat?

Back 3

Closed reduction and percutaneous pinning with 2 or 3 lateral pins.

Front 4

Supracondylar humerus fracture in a 6 year old has decreased pulses and underperfused had. Undergoes closed reduction and pinning and pulses are now absent and hand is underperfused. What do you do?

Back 4

Explore the antecubital fossa.

Front 5

24 year old man sustained gunshot wound to right humerus and has complete radial nerve palsy. Treatment should consist of antibiotics and:

Back 5

Immobilization in coaptation splint and observe for return of radial nerve function.

Front 6

What is the mechanism of injury of the fracture pictured here?

Back 6

Lateral compression injury (LC3), resulting in partially unstable left hemipelvis internal rotation and partially unstable right hemipelvis external rotation (open book APC mechanism on the right).

Front 7

50 year old sustains a right femoral neck fracture after a MVC. These x rays are your best attempt at closed reduction. How do you proceed?

Back 7

Open it to obtain better reduction, then internal fixation. Repeated closed reduction attempts increase risk of osteonecrosis of the femoral head.

Front 8

Poorly controlled type I diabetes, neuropathy and patient has bimalleolar fracture pictured here. How do you manage it?

Back 8

ORIF with multiple syndesmotic screws and prolonged period of non-weight bearing. Even if there is no syndesmotic injury, you should place syndesmotic screws. Diabetic ankle fractures should have twice the time of non weight bearing as the general population. (12 weeks).

Front 9

60 year old patient 5 weeks out after left total hip. How do you manage this fracture?

Back 9

This is a Vancouver B2. Proximally unstable based on the stem subsiding. You must revise to a diaphyseal engaging stem with cabling.

Front 10

Describe this fracture pattern.

Back 10

Split depression fracture of the osterolateral tibial plateau. Remember, medial plateau is concave, lateral plateau is convex.

Front 11

Closed injury in a 9 year old with delayed capillary refill and decreased radial artery pulse. How do you treat?

Back 11

Immediate closed reduction and percutaneous pinning and reassess perfusion.

Front 12

Fasciotomies are indicated if the intracompartmental pressure is within ______ mm Hgb of the diastolic blood pressure.

Back 12

indicated if intracompartmental pressure is within 20 mmHg of the diastolic blood pressure.

Front 13

Patient has a scapula fracture. What imaging study would reveal another injury very commonly associated with scapula fractures?

Back 13

CT chest to assess for lung contusions.

Front 14

Man who slipped and fell on ice. Severe knee pain and instability. What treatment is indicated?

Back 14

Patellar tendon repair.

Front 15

Active 69 yo female who fell off a ladder and sustained this femoral neck fracture. What treatment gives the best long-term solution.

Back 15

ORIF compared to THA for femoral neck fracture has, THA has lower revision surgery rate and longer interval to death and higher level of independent living. Also THA compared to hemiarthroplasty has higher patient outcome scores with THA.

Front 16

How do you assess tibial malrotation after IM nailing of a tibial shaft fracture?

Back 16

CT scan. 22% of tibial shaft fractures end up malrotated and 41% exceed 10 degrees.

Front 17

What malunion is most commonly associated wit intramedullary nailing of proximal tibia fractures?

Back 17

Procurvatum and valgus. Try to prevent this by using a more anterior and lateral starting point and using the semi extended position.

Front 18

78 year old, right hand dominant female with osteoporosis sustains a left, comminuted distal humerus fracture and you are planning for total elbow arthroplasty vs internal fixation. What approach should you use?

Back 18

Use posterior triceps sparing approach because if you need to bale to a total elbow, fixation to the ulnar osteotomy is impossible.

Front 19

For the capitellar shear fracture pictured, what is the preferred surgical approach?

Back 19

Use a lateral column extensile incision elevating off the common extensors and the capsule. Keep the forearm pronated to protected the posterior interosseous nerve. Limited Kocher approach does not extend proximally enough.

Front 20

What is the most cost effective treatment for displaced clavicle fractures?

Back 20

Sling management with delayed surgery (if required).

Front 21

Which way of treating the injury pictured has the best clinical outcome and lowest risk for revision surgery?

Back 21

For purely ligamentous lisfranc injuries, arthrodesis has lower risk of revision surgery and better short and mid term outcomes compared to ORIF.

Front 22

What is the most common injury associated with gunshot wounds to the pelvis?

Back 22

perforated viscous resulting peritoneal signs and an acute abdomen. Treat with ex lap. Sigmoidoscopy is indicated if bullet path crosses midline but no peritoneal signs.

Front 23

Describe the anatomical location of the femoral nerve.

Back 23

the femoral nerve is lateral to the artery and vein and is located in the lateral window of the ilioinguinal exposure with the iliopsoas muscle. The femoral artery and vein are encased on a sheath together and can be protected together during the ilioinguinal approach.

Front 24

Where should blocking (poller) screws for proximal metaphyseal tibia fractures be placed to prevent procurvatum and valgus?

Back 24

Always place the blocking screws on the concavity of the deformity, so, place them lateral and posterior to the nail to prevent valgus and procurvatum.

Front 25

After hip hemiarthroplasty for fracture, which test best predicts need for a walking aid 2 years post op?

Back 25

Time up and go test. Time to rise from chair, walk 3 meters, turn around, walk back and sit down.

- 10 seconds = normal

- 11- 20 seconds = normal for frail elderly.

- > 20 seconds = need for further examination and intervention.

Front 26

3 year old child with this injury. No pulses but fingers pink with sluggish cap refill. How do you treat?

Back 26

Reduction and fixation of the fracture with reassessment of perfusion.

Front 27

23 year old basketball player with elbow injury 7 days ago and block to elbow pronation/supination with intraarticular lidocaine injection. How do you treat?

Back 27

Open reduction internal fixation. Use radial head replacement for older patients or when unreconstructable or valgus instability.

Front 28

In patients with high energy femoral shaft fractures, which ipsilateral fracture is present 10% of the time and missed up to 50% of the time.

Back 28

Femoral neck fracture. CT scan is recommended in high energy femoral shaft fracture and negative x rays.

Front 29

Which factor is associated with increased failure rate for treatment of stable IT femur fractures with DHS?

Back 29

Tip apex distance >25 mm = increased risk for screw cutout. There is no biomechanical difference between 2-hole and 4-hole plates.

Front 30

What fixation method will provide the best type of rotational stability for the fracture pictured?

Back 30

Plate fixation of fibula and fixation of posterior mal. This gives more rotational stability than syndesmotic fixation.

Front 31

What x ray view gives best image for determining displacement of medial humeral epicondyle fracture?

Back 31

Distal humeral axial view. This gives a better view than even internal/external oblique views.

Front 32

Titanium is the best implant for internal fixation because its elastic modulus of elasticity is closest to that of bone which is 15 megapascals. What is the modulus of elasticity of titanium?

Back 32

107 megapascals. Although it is the closest, it is not that close.

Front 33

What is the in-hospital mortality and 1-year mortality after hip fracture among elderly people in the US?

Back 33

6% in hospital mortality and 30% 1 year mortality.

Front 34

When comparing an open bimalleolar ankle fracture in a 30 year old with that of a 70 year old, what will be different?

Back 34

They will have an equivalent complication rate. This is excluding cognitive disorders and peripheral vascular disease.

Front 35

For what use is rhBMP-2 FDA approved?

Back 35

Treatment of acute open tibial shaft fractures and patients with L spine DDD..

Front 36

Describe how a bone stimulator promotes healing?

Back 36

Electric and electromagnetic fields increase gene expression for and synthesis of growth factors. Can produce sustained upregulation of growth factors which enhance, but do not disorganize, enchondral bone formation.

Front 37

What is the mean distance from the trices insertion to the bares spot of the ulna that corresponds to where you should make a Chevron osteotomy for distal humeral exposure?

Back 37

Mean distance from triceps insertion to the bare spot on dorsal ulna is 2.1 cm. Chevron osteotomy should be made here. Chevron osteotomy has more inherent stability than a transverse osteotomy.

Front 38

Describe Class I hemorrhage according to ATLS (750mL blood loss).

Back 38

-Slightly anxious

-Normal blood pressure

-Heart rate <100 BPM

-Respirations 14-20/min

-Urine output 30 mL/hour

Front 39

Describe Class II hemorrhage according to ATLS (750 - 1500 mL blood loss or blood volume loss 15- 30%).

Back 39

-Anxious

-Normal blood pressure

-Heart rate > 100 BPM

-Decreased pulse pressure

-Respirations 20-30 per minute

-Urine output 20 -30 mL/ hour

Front 40

Describe Class III hemorrhage according to ATLS (1500 - 2000mL blood loss or 30 - 40% of blood volume).

Back 40

-Confused, anxious

-Decreased Blood Pressure

-Heart rate > 120 BPM

-Decreased pulse pressure

-Respirations 30-40

-Urine output 5 - 15 mL.

Front 41

Describe Class IV hemorrhage according to ATLS (2000 mL blood loss, 40% blood volume loss).

Back 41

-Confused, lethargic

-Hypotension

-Heart rate > 140 BPM

-Decreased pulse pressure

-Respirations 35 per minute

-Negligible urine output.

Front 42

76 year old man with a Vancouver Type C periprosthetic fracture. How do you fix it?

Back 42

Plate with proximal extend 2 canal diameters above the tips of the femoral prosthesis.