Orthopedic Fracture Management Overview

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Questions and Answers

What is the treatment for a displaced distal clavicle fracture with a wish to avoid a second procedure?

Both A and B (correct)

Coracoclavicular ligament reconstruction

Small fragment plate fixation

Hemiarthroplasty

What describes the Neer classification?

It describes lateral third distal clavicle fracture.

Which nerve root is at risk of injury with retractor placement on the anterior aspect of the sacrum?

L5 nerve root.

What is the greatest stress factor on lesser tuberosity fixation after hemiarthroplasty?

Passive external rotation. Signup and view all the answers

What is the greatest oxygen requirement per meter walked following prosthesis fitting?

Above-knee amputation (AKA) increases oxygen requirement with each more proximal amputation. Signup and view all the answers

What is the treatment for a trans-olecranon fracture dislocation?

ORIF with plate fixation. Signup and view all the answers

What does APC Type III indicate?

It has the highest risk for the need for transfusion. Signup and view all the answers

What is the restoration focus for both bone fractures?

Restoration of forearm rotation. Signup and view all the answers

What is the next step in treatment for hypertrophic diaphyseal tibial nonunion?

Isolated exchange reamed interlocking nailing. Signup and view all the answers

What is the definition of the talocrural angle of an ankle mortise x-ray?

It is a line perpendicular to the tibial plafond and a line between the tips of the malleoli. Signup and view all the answers

What does an anteromedial marginal impaction of the ankle indicate?

Supination-adduction ankle fracture. Signup and view all the answers

What is the surgical treatment for a Sanders IV intra-articular calcaneus fracture with a mechanical block to dorsiflexion?

Distraction bone block subtalar arthrodesis. Signup and view all the answers

What is referred to as a Hoffa fracture?

Coronal plane fracture of the femoral condyle. Signup and view all the answers

Which radiographic view best ensures screw placement does not exit the posterior aspect of the superior pubic ramus?

Inlet iliac oblique view. Signup and view all the answers

What is necessary to ensure screw placement outside of the joint?

Outlet obturator oblique view. Signup and view all the answers

Gender is a risk factor for elder abuse.

False Signup and view all the answers

What types of ligaments does the IOM that bridges the radius and ulna include?

Central band, accessory band, distal oblique bundle, proximal oblique cord, dorsal oblique accessory cord. Signup and view all the answers

What is the treatment for a comminuted proximal humerus fracture?

Shoulder hemiarthroplasty. Signup and view all the answers

How is the height of the shoulder hemi prosthesis best determined?

By the superior border of the pectoralis major insertion. Signup and view all the answers

Formal physical therapy following distal radius fracture ORIF provides more benefits compared to patient-guided home exercise programs.

False Signup and view all the answers

What is the treatment for a displaced femoral neck fracture?

Bipolar hemiarthroplasty. Signup and view all the answers

What are the advantages of bipolar hemiarthroplasty compared to total hip arthroplasty?

(+) Lower dislocation risk, decreased blood loss and operative time; (-) development of pain in the groin and acetabular erosion. Signup and view all the answers

What defines a both columns acetabular fracture?

All articular segments are detached from the intact portion of the ilium, which remains attached to the sacrum through the SI joint. Signup and view all the answers

What is a Syme amputation?

Ankle disarticulation that is a function-preserving amputation option. Signup and view all the answers

What is a contraindication for Syme amputation?

ABI < 0.5 for the posterior tibial artery. Signup and view all the answers

What soft tissue attachment is maintained by the Chaput fragment in pilon fractures?

Anterior inferior tibiofibular ligament. Signup and view all the answers

What soft tissue attachment is maintained by the Volkmann fragment in pilon fractures?

Posterior inferior tibiofibular ligament. Signup and view all the answers

What are the types of nonunion?

Oligotrophic, atrophic, infected, hypertrophic. Signup and view all the answers

What would happen if an iliosacral screw penetrates through the sacral ala?

It would injure the ipsilateral L5 nerve root. Signup and view all the answers

What is the risk associated with humeral hemiarthroplasty when the humeral head is below the top of the greater tuberosity?

It poses a risk of impingement and loss of abduction and elevation. Signup and view all the answers

What has been associated with a lower incidence of complex regional pain syndrome (CRPS) in patients with distal radius fractures?

Vitamin C administration. Signup and view all the answers

What is the recommended treatment for shortened clavicle fractures greater than 2 cm?

Surgical management is recommended. Signup and view all the answers

What is the treatment for olecranon fractures with significant comminution?

Plate and screw fixation. Signup and view all the answers

What is the rate of anterior knee pain complication after intramedullary nailing of the tibia?

50-75%. Signup and view all the answers

What is the expected outcome of ORIF for a highly comminuted radial head fracture?

Poor outcome, especially if delayed. Signup and view all the answers

What is the delayed treatment for a highly comminuted radial head fracture?

Radial head resection. Signup and view all the answers

What is observed with the radiocapitellar joint during closed reduction of Monteggia fractures?

The annular ligament is interposed in the radiocapitellar joint. Signup and view all the answers

What indicates residual end-organ hypoperfusion in a polytraumatized patient?

Serum lactate greater than 2 mmol/L, base deficit greater than 2, gastric mucosal pH less than 7.30. Signup and view all the answers

Which Risser sign has the greatest velocity of skeletal linear growth?

Risser 0. Signup and view all the answers

What do the Risser grades (0-V) measure?

The progression of ossification in the pelvis. Signup and view all the answers

What malalignments are common in proximal tibial shaft fractures treated with intramedullary nails?

Apex anterior and valgus deformities. Signup and view all the answers

What can be employed to avoid apex anterior and valgus deformities with IM nail for proximal tibial shaft fractures?

Proximal and lateral nail starting point, usage of a femoral distractor, suprapatellar nailing. Signup and view all the answers

What does the ilioinguinal approach provide access to?

The anterior wall and anterior column for fracture fixation. Signup and view all the answers

What nerve is at risk with the ilioinguinal approach?

Lateral femoral cutaneous nerve (LFCN). Signup and view all the answers

What is the Kocher-Langenbeck approach used for?

Access for posterior wall and column fractures. Signup and view all the answers

What does the Watson-Jones approach provide anterolateral access for?

Best for the hip, not the anterior column of the acetabulum. Signup and view all the answers

What visualization does the extended iliofemoral approach provide?

Visualization for both column fractures. Signup and view all the answers

What is the Hardinge approach?

Lateral approach for total hip arthroplasty (THA). Signup and view all the answers

What percentage of normal circulating blood is needed for tachycardia with narrowed BP to present?

15-30% blood loss (stage 2). Signup and view all the answers

What is the most common complication noted in proximal humerus ORIF?

Intra-articular screw penetration. Signup and view all the answers

What is the rate of avascular necrosis (AVN) in valgus impacted 4-part proximal humerus fractures?

Low, due to preserved intraosseous blood supply. Signup and view all the answers

What are the absolute surgical indications for a humeral shaft fracture?

Open fracture, vascular injury, floating elbow, intra-articular extension. Signup and view all the answers

What is the gold standard treatment for a humeral shaft fracture?

Open reduction and internal fixation (ORIF). Signup and view all the answers

What is the treatment for a humeral shaft fracture malunion?

Plate and graft. Signup and view all the answers

What is a Holstein-Lewis fracture?

A fracture of the distal third of the humerus resulting in entrapment of the radial nerve. Signup and view all the answers

What defines a non-operative ulna fracture?

Distal two-thirds. Signup and view all the answers

Study Notes

Clavicle and Fracture Management

Displaced distal clavicle fractures may require small fragment plate fixation and potential coracoclavicular ligament reconstruction to avoid further procedures.
The Neer classification is utilized for categorizing lateral third distal clavicle fractures.
Shortened clavicle fractures greater than 2 cm warrant surgical management to reduce nonunion and malunion risks while improving shoulder function.

Pelvic and Sacral Injuries

L5 nerve root is at risk with retractor placement during Stoppa approach for combined acetabulum-pelvic surgeries.
Anteroposterior and outlet obturator oblique views are crucial for ensuring proper screw placement in the pubic ramus.

Humeral and Shoulder Injuries

Comminuted proximal humerus fractures are typically treated with shoulder hemiarthroplasty.
Optimal height for shoulder hemi prosthesis is determined by measuring from the superior border of the pectoralis major insertion.
Risk of impingement is present when the humeral head is positioned incorrectly during hemiarthroplasty.

Ankle and Foot Trauma

Supination-adduction ankle fractures involve anteromedial marginal impaction and often require an anteromedial surgical approach.
Treatment for Sanders IV intra-articular calcaneus fractures with subtalar joint incongruence includes distraction bone block subtalar arthrodesis to restore hindfoot height and correct relationships.

Tibial and Femoral Injuries

Treatment for hypertrophic diaphyseal tibial nonunion is often isolated exchange reamed interlocking nailing, boasting a high success rate.
Anterior knee pain following intramedullary nailing of the tibia occurs in 50-75% of cases.
Bipolar hemiarthroplasty is indicated for displaced femoral neck fractures.

Nerve Risks and Nonunions

Ipsilateral L5 nerve root injury can result from improper placement of iliosacral screws penetrating sacral ala.
Various nonunion types include oligotrophic, atrophic, infected, and hypertrophic nonunions.

Surgical Indications and Outcomes

Absolute surgical indications for humeral shaft fractures include open fractures, vascular injuries, floating elbow, and intra-articular extension.
Non-operative management is often suitable for certain ulna fractures that are distal two-thirds.
Vitamin C administration is linked to lower rates of complex regional pain syndrome in distal radius fracture cases.

Complications and Fracture Classifications

Complexities such as intra-articular screw penetration are common in proximal humerus ORIF procedures.
Risser sign grades (0-V) indicate the stages of skeletal maturation in children, with Risser 0 correlating with the peak growth velocity.
Holstein-Lewis fractures refer to distal humeral fractures leading to radial nerve entrapment, with most cases resolving spontaneously.

Amputation Procedures

Syme amputation enables terminal weight-bearing but is contraindicated if the ABI is below 0.5 for the posterior tibial artery.

Pain Management and Physical Therapy

Formal physical therapy post-distal radius fracture ORIF shows no significant benefits compared to patient-guided home exercise programs.

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Description

This quiz covers critical concepts in orthopedic fracture management, focusing on clavicle, pelvic, and shoulder injuries. Topics include surgical interventions for fractures, classification systems, and imaging techniques crucial for successful outcomes. Test your knowledge on the latest approaches to treating these common musculoskeletal injuries.