Trauma Classifications Flashcards
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Questions and Answers

What is Gustilo-Anderson Classification and the recommended antibiotics for each category?

  1. < 1cm - Ancef (clean wound); 2. > 1 cm - Adequate soft tissue coverage Ancef + Clinda; 3. Extensive soft tissue loss and comminution - Ancef + Clinda + Aminoglycoside; 3A - adequate periosteal coverage but not soft tissue; 3B - >10cm, excessive soft tissue damage & periosteal stripping, contaminated; 3C - arterial compromise. Add PCN G if farm injury (clostridium).

What compartmental pressure merits fasciotomy and what is the name of the device used?

30 mmHg; Wick Catheter.

What are the 6 P's of compartment syndrome?

Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Pressure.

What is the Rosenthal Classification?

<p>1 - injury + tissue damage distal to distal phalanx; 2 - distal to lunula; 3 - distal to hallux IPJ or lesser DIPJ (usually requires amputation).</p> Signup and view all the answers

What is the Jahss Classification?

<p>1 - dorsal hallux dislocation, intact sesamoid ligament, no fx, difficult to close reduce; 2A - Dorsal hallux dislocation, ruptured sesamoid ligament, no fx; 2B - dorsal dislocation of hallux, ruptured intersesamoid ligament, at least 1 sesamoid fx; 2 Variant - dorsal dislocation of hallux, ruptured separation of bipartite sesamoid.</p> Signup and view all the answers

What is agenesis of the fibular sesamoid called?

<p>Ilfeld's Disease.</p> Signup and view all the answers

What is the Stewart classification for Jones fractures?

<ol> <li>True Jones (occurring at the metadiaphyseal-diaphyseal junction); 2. Intra-articular avulsion fracture; 3. Extra-articular avulsion fracture; 4. Intra-articular comminuted; 5. Extra-articular avulsion of apophysis fx. Mnemonic: EIEIO.</li> </ol> Signup and view all the answers

When should you fixate a Jones fracture?

<blockquote> <p>5 mm displacement or a Stewart 4.</p> </blockquote> Signup and view all the answers

What is the TORG classification for Jones fractures?

<ol> <li>Acute injury - sharp fracture margins, minimal hypertrophy of bone margins; 2. Delayed union - widened fracture line with adjacent radiolucency related to bone resorption; 3. Non-union - obliteration of medullary canal.</li> </ol> Signup and view all the answers

What is the most common bone to have a stress fracture?

<p>2nd metatarsal.</p> Signup and view all the answers

What is the Quenu & Kuss classification for Lisfranc dislocations?

<ol> <li>Homolateral; 2. Isolated (1st ray medial); 3. Divergent (all divergent). Mnemonic: HID.</li> </ol> Signup and view all the answers

ORIF is indicated for a displacement of ________ between the 1st and 2nd metatarsals in a Lisfranc injury.

<blockquote> <p>2 mm.</p> </blockquote> Signup and view all the answers

What is the Hardcastle classification for Lisfranc dislocations?

<p>Type A: Total incongruity in any plane; Type B: Isolated (partial incongruity); B1 - 1st met medial; B2 - lesser mets lateral; Type C: Divergent; C1 - 1st met and 2nd met diverge; C2 - 1st met and all lesser mets diverge.</p> Signup and view all the answers

What is the Watson Jones classification for navicular fractures?

<p>Type 1 - navicular tuberosity fracture; Type 2: dorsal lip avulsion; Type 3: navicular body fractures; 3A: coronal fx; 3B: Dorsolateral to plantar medial with abducted FF; 3C: comminuted with abducted FF; Type 4: Navicular stress fx.</p> Signup and view all the answers

Watson-Jones type 1 is associated with what other bone injury?

<p>Cuboid 'Nutcracker' fracture (occurs with forced abduction).</p> Signup and view all the answers

How much displacement is needed for ORIF in a Cuboid fracture?

<blockquote> <p>5 mm.</p> </blockquote> Signup and view all the answers

What artery supplies most of the talar body?

<p>Artery of the Tarsal Canal.</p> Signup and view all the answers

What is the Hawkin's classification for talar neck fractures?

<p>I - Non-displaced 0-13%; II - displaced with STJ dislocation (50% AVN); III - displaced fx with STJ &amp; ankle dislocation (95% AVN); IV - displaced fx with STJ, ankle &amp; TN dislocation (95% AVN).</p> Signup and view all the answers

Is Hawkin's sign sclerotic or radiolucent?

<p>False</p> Signup and view all the answers

What is the Sneppen classification for talar body fractures?

<ol> <li>OCD fracture; 2. Sagittal, coronal, transverse body fracture; 3. Posterior tubercle fracture; 4. Lateral process fracture; 5. Crush fracture.</li> </ol> Signup and view all the answers

What does pain with forced plantarflexion of the hallux indicate?

<p>Fracture of the posterior tubercle of the talus.</p> Signup and view all the answers

What is the Berndt and Hardy Classification for talar dome fractures?

<ol> <li>Compression fracture; 2. Partial osteochondral fracture; 3. Complete OCD fracture - non-displaced; 4. Displaced OCD fracture.</li> </ol> Signup and view all the answers

What is the Kuwada classification for Achilles tendon rupture?

<ol> <li>Partial tear.</li> </ol> Signup and view all the answers

Study Notes

Trauma Classifications

Gustilo-Anderson Classification

  • Classifies open fractures based on soft tissue involvement and contamination.
  • Recommended antibiotics:
    • Type I: Wound < 1 cm, Ancef.
    • Type II: Wound > 1 cm, Ancef + Clindamycin for adequate soft tissue coverage.
    • Type III: Extensive soft tissue loss.
      • 3A: Adequate periosteal coverage.
      • 3B: >10 cm excessive soft tissue damage; contaminated.
      • 3C: Arterial compromise, Ancef + Clindamycin + aminoglycoside.
    • Add Penicillin G for farm injuries (risk of clostridium).

Compartment Syndrome

  • Fasciotomy indicated for compartment pressure > 30 mmHg.
  • Measurement can be done with a Wick Catheter.

6P's of Compartment Syndrome

  • Symptoms include:
    • Pain
    • Pallor
    • Pulselessness
    • Paresthesia
    • Paralysis
    • Pressure

Rosenthal Classification

  • Used for digital trauma:
    • Type 1: Injury distal to distal phalanx with tissue damage.
    • Type 2: Injury distal to lunula (involving Atasoy V-Y or Kutler V-Y flap).
    • Type 3: Injury distal to hallux IPJ or lesser DIPJ, often requiring amputation.

Jahss Classification

  • Focuses on hallux dislocations:
    • Type I: Dorsal dislocation without fracture, challenging reduction.
    • Type 2A: Dorsal dislocation with ruptured sesamoid ligament, no fracture.
    • Type 2B: Dorsal dislocation with intersesamoid ligament rupture and at least one sesamoid fracture.
    • Type 2 Variant: Dorsal dislocation with separation of bipartite sesamoid.

Ilfeld's Disease

  • Refers to agenesis of the fibular sesamoid.

Stewart Classification

  • Categorizes Jones fractures:
    • Type 1: True Jones at the metadiaphyseal-diaphyseal junction.
    • Type 2: Intra-articular avulsion fracture.
    • Type 3: Extra-articular avulsion fracture.
    • Type 4: Intra-articular comminuted fracture.
    • Type 5: Extra-articular apophyseal fracture.
  • Mnemonic: EIEIO.

Jones Fracture Treatment

  • ORIF indicated for fractures with > 5 mm displacement or Stewart Type 4.

TORG Classification

  • Radiographic classification for Jones fractures:
    • Acute Injury: Sharp fracture margins, minimal bone hypertrophy.
    • Delayed Union: Widened fracture line with adjacent radiolucency (bone resorption).
    • Non-Union: Obliteration of the medullary canal.

Stress Fractures

  • Most common site for stress fractures is the 2nd metatarsal.

Quenu & Kuss Classification

  • Classifies Lisfranc dislocations:
    • Type 1: Homolateral.
    • Type 2: Isolated (1st ray medial).
    • Type 3: Divergent.
  • Mnemonic: HID.

Lisfranc Injury Fixation

  • ORIF indicated for Lisfranc injuries with > 2 mm displacement between the 1st and 2nd metatarsals.

Hardcastle Classification

  • Classifies Lisfranc dislocations:
    • Type A: Total incongruity.
    • Type B: Partial incongruity.
      • B1: 1st met medial.
      • B2: Lesser metatarsals lateral.
    • Type C: Divergent alignments.

Watson-Jones Classification

  • Classifies navicular fractures:
    • Type 1: Navicular tuberosity fracture.
    • Type 2: Dorsal lip avulsion.
    • Type 3: Navicular body fractures with various subtypes.
    • Type 4: Navicular stress fracture.

Cuboid Fracture Association

  • Watson-Jones Type 1 is associated with cuboid (nutcracker) fractures, requiring ORIF for > 5 mm displacement.

Talar Body and Neck Fractures

  • Most of the talar body is supplied by the artery of the tarsal canal.
  • Hawkin's Classification for talar neck fractures indicates risk of avascular necrosis (AVN):
    • Type I: Non-displaced (0-13% AVN).
    • Type II: Displaced with subtalar joint dislocation (50% AVN).
    • Type III: Displaced with ankle dislocation (95% AVN).
    • Type IV: Displaced with talonavicular dislocation (95% AVN).

Hawkin's Sign

  • Radiolucent sign indicating intact vascularity of the talus noted 6-8 weeks post-fracture.

Sneppen Classification

  • Classifies talar body fractures:
    • Type 1: Osteochondral fracture.
    • Type 2: Various body fracture configurations.
    • Type 3: Posterior tubercle fracture.
    • Type 4: Lateral process fracture.
    • Type 5: Crush fracture.

Talar Tubercle Fractures

  • Pain with forced plantar flexion of the hallux suggests a fracture of the posterior tubercle of the talus.

Berndt and Hardy Classification

  • Focuses on osteochondral defects (OCDs) in the talus with four types, ranging from compression fractures to complete displaced OCD fractures.

Kuwada Classification

  • Used for Achilles tendon ruptures, categorizing partial and full tears.

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Test your knowledge on the Gustilo-Anderson Classification and its recommended antibiotic treatments for different trauma categories. This quiz is designed to reinforce key concepts in trauma classifications and their clinical implications.

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