1203 plays. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. He denies any fevers or chills. Type I. Coronal split fracture. Imaging is shown in Figure A. findings. (SBQ18BS.6) Orthobullets Team Ipsilateral calcaneus fracture. .63) A 34-year-old man is involved in a motor vehicle accident and sustains an open tibia fracture and is treated with intramedullary nailing. usually high energy injury (MVA, contact sports) atraumatic subluxation. The peak antibiotic elution from an antibiotic-impregnated IMN is expected to occur at what time from surgery? 45% (664/1485) 2. He is afebrile. Webcalcaneus. 91% Associated conditions. Navicular fracture. WebGustilo Classification Tscherne Classification Calcaneus FX Other Trauma Topics 29th Annual Tampa Shoulder Course: Arthroplasty & Sports should be performed within 5cm of fracture site or area of maximal swelling. (OBQ05.201) Orthobullets Team Pediatrics - Accessory Navicular ; Listen Now 14:0 min. Type IIC. Greater than 10mm of articular depression. Retention of tibial nail, lifelong intravenous antibiotic suppression. (OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. second most common tarsal fractures after calcaneus fxs. Classification. Classification. CASES (1) Proximal Humerus Fracture Dislocation with Nerve Palsies (C1372) Benjamin C. Taylor Trauma - may lead to irreversible muscle and neurovascular damage. OTA classification of radius/ulna. (OBQ12.153) 7% (105/1485) 3. Operative. must test each compartment separately. Low velocity . Essex-Lopresti classification. Classification of Low Ankle Sprains. Hohl and Moore Classification of proximal tibia fracture-dislocations. Preganglionic vs. postganglionic. 7% (105/1485) 3. Team Orthobullets (D) Trauma (OBQ10.19) A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. medial or lateral clavicle in IV drug abusers, systemic conditions such as diabetes and sickle cell, may be due to bacterial or viral systemic illness, vertebrae are the most common hematogenous site in adults, associated with previous surgery, trauma, wounds, or, can be bacterial (most common), mycobacterial, or fungal in nature, bacteria attach to an inert substrate and undergo apoptosis to create a matrix for biofilm, biofilm is characterized by bacteria entering a no-growth, or sessile, phase, which makes them even more resistant to antibiotics that depend on replication to carry out their effect, biofilm is then made of an extracellular polymeric substance or exopolysaccharide, antibiotics are less effective due to difficulty penetrating the biofilm and bacteria lowering their metabolic rate, S. aureus, Enterobacter species, group A and B Streptococcus species, S. aureus, group A Streptococcus species, Kingella kingae, and Enterobacter species, S. aureus (80%), group A Streptococcus species, H. influenzae, and Enterobacter species, S. aureus and occasionally Enterobacter or Streptococcus species, Sickle cell anemia patients (S. aureus is still most common), IV drug use with AC or SC joint infection, HIV/AIDS patient following cat scratch or bite, Immunosuppressed, long-term IV medications, or parenteral nutrition, Cierny-Mader Classification of Osteomyelitis, (describes anatomic involvement, host, treatment, prognosis), Treatment is worse to the patient than infection, fever, tachycardia, and hypotension suggest sepsis, erythema, tenderness, and edema are commonly seen, if able to probe bone through sinus, chronic osteomyelitis is present, limp and/or pain inhibition with weight-bearing or motion may be present, assess the joints above and below the area of concern, assessment of vascular insufficiency locally or systemically, orthogonal plain radiographs of the affected extremity, bone lucency, sclerotic rim, osteopenia, periosteal reaction, and lysis around hardware, assist in diagnosis and surgical planning by identifying necrotic bone, sensitivity and specificity may be affected by hardware artifact and scatter, assists in the diagnosis and surgical planning, best test for diagnosing early osteomyelitis and localizing infection, T2 sequences will show bone and soft tissue edema, T1 - dark central abscess with bright internal wall and dark external sclerotic rim, if positive may overestimate the extent of osteomyelitis, when radiographs are normal and MRI is not an option, only elevated in 1/3 of acute osteomyelitis, usually elevated in both acute and chronic osteomyelitis, most sensitive test with elevation in 97% of cases, decreases faster than ESR in successfully treated patients, often negative, but may be used to guide therapy for hematogenous osteomyelitis, not reliable for guiding antibiotic therapy, live osteocytes with numerous acute inflammatory cells (neutrophils), no nuclei in osteocytes with fibrosis of marrow and chronic inflammatory cells (lymphocytes), biopsy all infection, cultures all tumors, success in the treatment is dependent on various factors, the severity of the injury as demonstrated by segmental bone loss, metaphyseal infections heal better than mid-diaphyseal infections. (OBQ12.156) A 36-year-old male sustains an open segmental tibia fracture associated with an overlying 8 cm soft tissue avulsion that requires skin grafting for soft tissue coverage. from a handgun with a muzzle-velocity of 1000 feet/second if he is neurovascularly intact and radiographs reveal no fracture? Anatomic classification. He was treated with a tibial intramedullary nail (IMN). talar body fractures . Type IIB. 1% (25/2927) 4. Classification. The patient presents to your clinic 12 months from his surgery with persistent pain at the fracture site. Treatment is often a combination of culture-directed antibiotics and surgical debridement of nonviable tissue. Calcaneus FX Other Trauma Topics A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Web(OBQ18.241) A 28-year-old male that sustained a closed left femoral shaft fracture 12 months ago and underwent intramedullary nailing presents with persistent pain in the right thigh. 1% (25/2927) 4. A CT is obtained for preoperative planning and there are no signs of trochlear involvement or posterior comminution. (OBQ05.178) A 42-year-old male sustains a closed, isolated ulna shaft fracture with 2mm displacement and 3 degrees valgus angulation. Nonoperative. posterior What is considered the earliest sign or symptom of a developing compartment syndrome of the leg? She lives in an assisted living facility, and reports no other major medical problems. (SBQ17SE.64) A 32-year-old inebriated male falls from a mechanical bull at a bar and sustains a closed displaced intra-articular distal radius fracture. Spiral (A1) Oblique (A2) Transverse (A3) Type B. Wedge fracture. Type IIC. Physical exam is notable for a draining sinus tract, erythema and tenderness of the mid-thigh. OTA classification of radius/ulna. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. Ligament disruption. delineates fracture anatomy and classification. Anatomic (based on dislocation direction of midfoot/forefoot) anterior process of calcaneus acts as fulcrum for the anterolateral corner of the talus to pivot around. talus. Mason Classification (Modified by Hotchkiss and Broberg-Morrey) Type I. Nondisplaced or minimally displaced (<2mm), no mechanical block to rotation A 51-year-old female sustained a comminuted radial head fracture with 4 fragments and an associated elbow dislocation. Calcaneus FX Other Trauma Topics A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Associated conditions. His surgical sites are well healed and there are no signs of drainage. 45% (664/1485) 2. Web(SBQ17SE.64) A 32-year-old inebriated male falls from a mechanical bull at a bar and sustains a closed displaced intra-articular distal radius fracture. 91% preganglionic . History of bleomycin treatment. A 34-year-old man sustained a gunshot wound to the knee 18 months ago and was treated with bullet removal and a 10 day course of oral antibiotics. Ecchymosis and swelling. (OBQ18.241) A 28-year-old male that sustained a closed left femoral shaft fracture 12 months ago and underwent intramedullary nailing presents with persistent pain in the right thigh. Web(OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. (OBQ13.63) Web(SBQ12FA.67) A 35-year-old male fell and sustained an open talar neck fracture. Web(OBQ13.14) A 30-year-old man is brought to your level 1 trauma center with a closed left diaphyseal humerus fracture, a closed left midshaft femur fracture, right sided rib fractures, and multiple facial fractures following a motorcycle accident. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. calcaneus is osteotomized and rotated 50-90 degrees to keep posterior aspect of calcaneus distal. Anatomic. Orthobullets Team Pediatrics - Accessory Navicular ; Listen Now 14:0 min. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. the location and size of the fracture fragment and degree of comminution depend on the position of the hip at the time of dislocation 5-15% of posterior hip dislocations are associated with a femoral head fracture because of contact between femoral head and posterior rim of acetabulum Orthobullets Team Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. Diagnosis. rings placed at the level of the plafond or calcaneus to distract and reduce the fracture. Which of the following provides ideal visualization and least morbidity for this fracture pattern with respect to patient positioning and surgical approach for his injury? Distal to coronoid. Anatomic location. Metaphyseal-diaphyseal junction. Calcaneus FX Other Trauma Topics OTA classification. (OBQ05.274) account for 13 A galeazzi fracture is a distal 1/3 radial shaft fracture with an associated distal radioulnar joint (DRUJ) injury. Distal to coronoid. Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ Orthobullets Team The fracture is reduced and placed in a long leg splint in the emergency room. Capitellum fracture with extension into the trochlea. (OBQ07.239) 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Elbow Fracture: Case of the Week - Shaan Patel, MD, Capitellum and Radial Head Fracture in 84F. the location and size of the fracture fragment and degree of comminution depend on the position of the hip at the time of dislocation 5-15% of posterior hip dislocations are associated with a femoral head fracture because of contact between femoral head and posterior rim of acetabulum Treatment. He subsequently develops the post-traumatic condition shown in Figure A. Talus fracture. delineates fracture anatomy and classification. Ecchymosis and swelling. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the Presence of an acute open fracture and crush injury. Firmness and decreased compressibility of the compartments is often present. Figures A and B are the current radiographs. from a handgun with a muzzle-velocity of 1000 feet/second if he is neurovascularly intact and radiographs reveal no fracture? A 38-year-old man falls from a ladder and presents with the injury depicted in Figure A. Radiographs and a CT scan are obtained, shown in Figures A-C. He is neurovascularly intact in his left arm and leg. A galeazzi fracture is a distal 1/3 radial shaft fracture with an associated distal radioulnar joint (DRUJ) injury. Coronoid level. Type A. Type IIC. OTA classification of radius/ulna. (OBQ06.70) A 33-year-old man sustains a femur fracture in a motorcycle accident. (OBQ17.175) A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. Entire condylar fracture. WebClassification. He denies any fevers or chills. Web(OBQ05.191) An 11-year-old child has a tibia-fibula fracture following a fall from a swing. Nonoperative. No vascular injury is identified. He complains of right leg pain, and physical exam reveals no evidence of an open fracture. On exam, his wounds are well healed with no erythema. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. posterior Web(SBQ18SP.25) A 48-year-old tree surgeon is evaluated in the trauma bay after falling from 20 feet onto his back. 9% (OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Recent labs reveal an ESR, CRP and 25-hydroxyvitamin D2 of 32 mm/hr (reference 0-20 mm/hr), 15 mg/dL (reference 0-3 mg/dL), and 50 ng/mL (reference 20-100 ng/mL). He denies any constitutional symptoms and his pain is well controlled. The fracture is reduced and placed in a long leg splint in the emergency room. Treatment may be nonoperative for nondisplaced fractures but any displacement generally requires anatomic open reduction and internal fixation. 4/20/2020. AP and lateral radiographs are provided in Figure A. Classification. On examination, his skin is intact, with moderate swelling, and limited elbow range of motion due to pain/swelling. 5% (176/3364) 8% (281/3364) 4. Orthobullets Engineer (admin) Trauma - Gun Shot Wounds; Listen Now 20:10 min. Navicular fracture. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. Type IIA. His surgical wounds appear well-healed with a small sinus tract over the open fracture site. (OBQ08.95) A 51-year-old female sustained a comminuted radial head fracture with 4 fragments and an associated elbow dislocation. 45% (664/1485) 2. Ligament disruption. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. 1203 plays. AP and lateral radiographs are provided in Figure A. Biomechanics. Classification. 22-A2.3. OTA classification of radius/ulna. (SBQ18TR.43) Type A. (OBQ05.191) An 11-year-old child has a tibia-fibula fracture following a fall from a swing. Orthobullets Team 12/11/2019. Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ Orthobullets Team WebDiagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. (SBQ18SP.25) A 48-year-old tree surgeon is evaluated in the trauma bay after falling from 20 feet onto his back. (OBQ12.6) A 75-year-old-male presents after being struck by a vehicle while crossing the street. He now complains of 12 months duration of pain in the thigh and recent ulceration and drainage of the skin near the site of his gunshot wound. A biopsy of the mass is shown in Figures B, and C. What is the most likely pathologic process? Diagnosis. Entire condylar fracture. Presence of an acute open fracture and crush injury. preganglionic . Prior to surgery, a CT scan of the knee is ordered for preoperative planning. Talus fracture. OTA classification of radius/ulna. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. A 20-year-old man falls from his bicycle. preganglionic . On exam, his wounds are well healed with no erythema. 10/16/2019. Orthobullets Team An 88-year-old female presents after a fall onto her left arm. Calcaneus fracture. Web(OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. No vascular injury is identified. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. Jupiter Classification of Type II Monteggia Fracture-Dislocations. Orthobullets Engineer (admin) Trauma - Gun Shot Wounds; Listen Now 20:10 min. Orthobullets Team 12/11/2019. (SBQ12FA.67) A 35-year-old male fell and sustained an open talar neck fracture. Needle compartment pressures are diagnostic in cases ofinconclusive physical exam findings and in sedated patients. Anatomic location. He presents to the ED the following afternoon with increased difficulty using his right arm and associated pain. WebCalcaneus FX Other Trauma Topics A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. 9% Recent labs reveal an ESR, CRP and 25-hydroxyvitamin D2 of 32 mm/hr (reference 0-20 mm/hr), 15 mg/dL (reference 0-3 mg/dL), and 50 ng/mL (reference 20-100 ng/mL). He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. Classification. Biomechanics. Gustilo Classification Tscherne Classification Calcaneus FX Other Trauma Topics 29th Annual Tampa Shoulder Course: Arthroplasty & Sports should be performed within 5cm of fracture site or area of maximal swelling. Calcaneus fracture. Sangeorzan Classification of Navicular Body Fractures any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing Gustilo Classification Tscherne Classification Calcaneus FX Other Trauma Topics important to distinguish from medial clavicle physeal fracture (physis doesn't fuse until age 20-25) mechanism. Greater than 10mm of articular depression. Nonoperative. He is Which of the following elbow injuries as found in Figures A-E best characterizes the radiographic "double-arc" sign? (OBQ12.195) Type IIA. Presence of an acute open fracture and crush injury. Diagnosis is made using plain radiographs of the elbow. Radiographs of the right elbow are demonstrated in Figure A. What is a potential complication of the surgical approach to address this injury? Core needle bone culture followed by intravenous antibiotics, Surgical debridement, culture, and intravenous antibiotics, Core needle biopsy, chest CT scan, and bone scan, Neoadjuvant chemotherapy and wide resection followed by adjuvant chemotherapy. What is the most appropriate Gustilo-Anderson classification of second most common tarsal fractures after calcaneus fxs. obtain post reduction CT for characterization of fracture. Treatment. 1% (25/2927) 4. Preganglionic vs. postganglionic. Treatment is usually emergent fasciotomies of all 3 compartments. Web(OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. must test each compartment separately. WebClassification. WebAnatomic classification. He endorses significant low back pain and an inability to ambulate. (OBQ05.178) A 42-year-old male sustains a closed, isolated ulna shaft fracture with 2mm displacement and 3 degrees valgus angulation. Navicular fracture. Classification. Orthobullets Team Ipsilateral calcaneus fracture. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. History of bleomycin treatment. 9% obtain AP, inlet/outlet, judet views after reduction. Coronoid level. Metaphyseal-diaphyseal junction. The patient walks with an antalgic gait. His surgical sites are well healed and there are no signs of drainage. Gustilo Classification Tscherne Classification Calcaneus FX Other Trauma Topics 29th Annual Tampa Shoulder Course: Arthroplasty & Sports should be performed within 5cm of fracture site or area of maximal swelling. Debridement and lavage, exchange nailing using a larger diameter nail, intravenous antibiotics for 6 weeks. (SBQ18TR.42) Team Orthobullets (D) Trauma (OBQ10.19) A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. fracture identified on post reduction plain films. His ESR and CRP are elevated. May occur anywhere that skeletal muscle is surrounded by fascia, but most commonly, tight casts, dressings, or external wrappings, pain out of proportion to clinical situation is usually first symptom, difficult to assess in children (unable to verbalize), indicative of nerve ischemia in affected compartment, amputation usually inevitable in this case, unequivocally positive clinical findings should prompt, within 5cm of fracture site or area of maximal swelling, based primarily on physical exam in patient with, presentation not consistent with compartment syndrome, emergent fasciotomy of all affected compartments, clinical presentation consistent with compartment syndrome, within 30 mm Hg of diastolic blood pressure, intraoperatively, diastolic blood pressure may be decreased from anesthesia, must compare intra-operative measurement to pre-operative diastolic pressure, anterolateral incision over length of thigh, single incision technique for anterior and posterior compartments, expose and decompress anterior compartment, retract vastus lateralis medially to expose lateral intermuscular septum, incise lateral intermuscular septum to decompress posterior compartment, Associated with significant long-term morbidity, over 50% will experience functional deficits including, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. lateral support. (SBQ18SP.25) A 48-year-old tree surgeon is evaluated in the trauma bay after falling from 20 feet onto his back. For the next 4 years, he continues to have pain and persistent discharge from a sinus over his shin. Anatomic. (OBQ17.175) A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. Gustilo Classification Tscherne Classification Calcaneus FX Other Trauma Topics important to distinguish from medial clavicle physeal fracture (physis doesn't fuse until age 20-25) mechanism. Type I. Coronal split fracture. Imaging is shown in Figure A. History of COPD. WebClassification. Diagnosis requires careful assessment of radiographs, MRI and determining the organism via biopsy and cultures. rings placed at the level of the plafond or calcaneus to distract and reduce the fracture. The fracture is reduced and placed in a long leg splint in the emergency room. What is considered the earliest sign or symptom of a developing compartment syndrome of the leg? usually high energy injury (MVA, contact sports) atraumatic subluxation. He complains of right leg pain, and physical exam reveals no evidence of an open fracture. 22-A2.3. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. Classification. Jupiter Classification of Type II Monteggia Fracture-Dislocations. She reports isolated left elbow pain, and radiographs are shown in Figure A. Type IIA. The clinical appearance and radiographs are seen in Figures A and B. History of bleomycin treatment. Classification. He elects to undergo surgical intervention. 10/16/2019. He subsequently develops the post-traumatic condition shown in Figure A. Spiral (A1) Oblique (A2) Transverse (A3) Type B. Wedge fracture. 5% (176/3364) 91% A photograph of the wound and a recent radiograph are seen in Figure A. Diagnosis. He presents at 2 months after surgery. (OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury. 5.0 (2) See More See Less. calcaneus. Classification of Low Ankle Sprains. Debridement and lavage, excision of sinus tract, implant removal, intravenous antibiotics for 6 weeks. Classification. WebClassification. Hohl and Moore Classification of proximal tibia fracture-dislocations. LUCL), Bryan and Morrey Classification (with McKee modification), Large osseous piece of the capitellum involved, Articular cartilage separation with very little subchondral bone attached, Coronal shear fracture that includes the capitellum and trochlea, typically, elbow is in semi-flexed elbow position, mechanical block to flexion/extension and/or rotation, "double arc" sign created from subchondral bone of capitellum and lateral part of trochlea, delineates fracture anatomy and classification, type IV fractures that can have trochlear involvement, ORIF with posterior approach with or without olecranon osteotomy, capitellar fractures with associated fractures/injuries to distal humuers/olecranon and/or medial side of the elbow, displaced Type II fractures (>2 mm displacement), displaced Type III fractures (>2 mm displacement), unreconstructable capitellar fractures in, elderly patients with associated medial column instability, lateral approach recommended for isolated Type I and Type IV fx, lateral skin incision centered over the lateral epicondyle, minifragment screw using posterior to anterior fixation, counter sink screw using anterior to posterior fixation, mini-fragment or capitellar plates can be used to capture fractures with proximal extension, concomitant medial sided injuries and/or distal humeral fractures, long-posterior based incision along the elbow, independent headless compression/cannulated screws for capitellar component, supplemental fixation for concomitant pathology, parallel or orthoogonal distal humerus plates, LUCL/UCL repair via bone tunnels or suture anchors, indicated for isolated capitellar fractures, supine or lateral positioning (dependent on desire for anterior or posterior access), can be combined with limited open technique for fracture manipulation, standard portals (anteromedial, anterolateral, posterolateral), proximal anterolateral portal established under fluoroscopic guidance to place trocar to allow for reduction of fracture fragment, extend elbow and push fragment with trocar for reduction, flex radial head past 90 to lock reduction, anteromedial and posterolateral portals allow for fracture debridement, freer elevator can help maintain reduction while cannulated/headless compression screws are placed under fluoroscopic guidance (typically posterior to anterior in direction), Elbow contracture/stiffness (most common), Most patients will gain functional range of motion but have, Surgical treatment results are generally favorable, reoperation rates as high as 48% (mostly due to stiffness), Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. calcaneus. She was initially closed reduced and splinted with the elbow joint in a reduced position and presents to the orthopedists office 10 days later. He denies any constitutional symptoms and his pain is well controlled. He underwent operative fixation of his fracture. Biomechanics. OTA classification of radius/ulna. Calcaneus FX Other Trauma Topics Cierny-Mader Classification of Osteomyelitis (describes anatomic involvement, host, treatment, prognosis) Anatomic Location. The best functional outcome can be expected with which of the following definitive treatment options? Clinical. fracture identified on post reduction plain films. obtain AP, inlet/outlet, judet views after reduction. Team Orthobullets (D) Trauma (OBQ10.19) A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. He subsequently develops the post-traumatic condition shown in Figure A. Debridement and lavage, addition of ring fixator, intravenous antibiotics for 6 weeks. A 29-year-old male falls down a flight of 10-stairs while intoxicated. delineates fracture anatomy and classification. (OBQ05.191) An 11-year-old child has a tibia-fibula fracture following a fall from a swing. Despite surgical debridement and long-term antibiotics, recurrence rate of chronic osteomyelitis in adults is 30%, Poor prognosis in patients with major nutritional or systemic disorders, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. findings. History of COPD. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Thigh Compartment Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim. 8% (281/3364) 4. Diagnosis is made with the presence of severe and progressive thigh pain that worsenswith passive knee motion. Greater than 10mm of articular depression. Webthe location and size of the fracture fragment and degree of comminution depend on the position of the hip at the time of dislocation 5-15% of posterior hip dislocations are associated with a femoral head fracture because of contact between femoral head and posterior rim of acetabulum The patient walks with an antalgic gait. posterior dislocation (90%) occur with axial load on femur, typically with hip flexed and adducted scrutinize femoral neck to rule out fracture prior to attempting closed reduction. Type IIB. WebCalcaneus FX Other Trauma Topics capitellar fracture can cause potential block to motion and instability due to loss of the radiocapitellar articulation. Orthobullets Team Orthobullets Team He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. A 33-year-old motorcyclist is involved in a motor vehicle accident and sustains a Grade III open fracture of his tibia that is treated surgically. talus. Type II. His surgical sites are well healed and there are no signs of drainage. obtain AP, inlet/outlet, judet views after reduction. account for 13-23% of talus fractures. Anatomic. He denies any constitutional symptoms and his pain is well controlled. Web(OBQ12.6) A 75-year-old-male presents after being struck by a vehicle while crossing the street. Web(OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. typically, low-energy fall on outstretched hand, axial compression with the elbow in a semi-flexed position, radiocapitellar joint is an important static stabilizer of the elbow, potential block to motion and instability, essential to longitudinal and valgus stability of the elbow, can also lead to coronal plane instability with capitellar excision if medial structures are not intact, integral relationship with the posterolateral ligamentous complex of the elbow (i.e. Kennedy classification based on the direction of displacement of the tibia. (OBQ05.178) A 42-year-old male sustains a closed, isolated ulna shaft fracture with 2mm displacement and 3 degrees valgus angulation. He has pain and swelling at the elbow without evidence of instability. obtain post reduction CT for characterization of fracture. Thigh Compartment Syndrome is a devastating lower extremity condition where the osseofascial compartment pressure rises to a level that decreases perfusion to the thigh and. fracture identified on post reduction plain films. His surgical wounds appear well-healed with a small sinus tract over the open fracture site. Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. Metaphyseal-diaphyseal junction. Osteomyelitis is the infection of bone characterized by progressive inflammatory destruction and apposition of new bone. WebGustilo Classification Tscherne Classification Calcaneus FX Other Trauma Topics important to distinguish from medial clavicle physeal fracture (physis doesn't fuse until age 20-25) mechanism. 26% (874/3364) 5. Type IIB. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. account for 13 Simple fracture. 1203 plays. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. (OBQ04.157) 5.0 (2) See More See Less. Imaging is shown in Figure A. (OBQ13.14) A 30-year-old man is brought to your level 1 trauma center with a closed left diaphyseal humerus fracture, a closed left midshaft femur fracture, right sided rib fractures, and multiple facial fractures following a motorcycle accident. He endorses significant low back pain and an inability to ambulate. What is considered the earliest sign or symptom of a developing compartment syndrome of the leg? 22-A2.3. (OBQ06.70) A 33-year-old man sustains a femur fracture in a motorcycle accident. WebGaleazzi Fracture - Pediatric bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. Calcaneus FX Other Trauma Topics Cierny-Mader Classification of Osteomyelitis (describes anatomic involvement, host, treatment, prognosis) Anatomic Location. Type I. Coronal split fracture. Coronoid level. .63) A 34-year-old man is involved in a motor vehicle accident and sustains an open tibia fracture and is treated with intramedullary nailing. 7% (105/1485) 3. What is the next step in treatment? However he is still having persistent anterior shoulder/arm pain that worsens with most activities. He has not done any physical therapy nor received a corticosteroid injection. Which of the following factors has been shown to predict a better prognosis? Classification of Low Ankle Sprains. Classification. 4/20/2020. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. Over the last year, he has noticed "tissue growing out of the wound" and a malodorous smell. Anatomic (based on dislocation direction of midfoot/forefoot) anterior process of calcaneus acts as fulcrum for the anterolateral corner of the talus to pivot around. On exam, his wounds are well healed with no erythema. Calcaneus FX Other Trauma Topics OTA classification. Ligament disruption. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. What is the most appropriate Gustilo-Anderson classification of Lateral decubitus with olecranon osteotomy. Figures A and B are the current radiographs. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. Treatment. He has pain and swelling at the elbow without evidence of instability. WebEssex-Lopresti classification. talar body fractures . WebHohl and Moore Classification of proximal tibia fracture-dislocations. WebKennedy classification based on the direction of displacement of the tibia. Open reduction internal fixation of the distal humerus fracture, Nonsurgical management with early passive range of motion exercises, Initial nonsurgical management followed by interpositional arthroplasty when the fracture has healed, Excision of the capitellar fragments and fixation of the trochlear fragments. Anatomic (based on dislocation direction of midfoot/forefoot) anterior process of calcaneus acts as fulcrum for the anterolateral corner of the talus to pivot around. Type A. posterior splint immobilization for < 3 weeks. Calcaneus FX Other Trauma Topics capitellar fracture can cause potential block to motion and instability due to loss of the radiocapitellar articulation. He has not done any physical therapy nor received a corticosteroid injection. Recent labs reveal an ESR, CRP and 25-hydroxyvitamin D2 of 32 mm/hr (reference 0-20 mm/hr), 15 mg/dL (reference 0-3 mg/dL), and 50 ng/mL (reference 20-100 ng/mL). Orthobullets Engineer (admin) Trauma - Gun Shot Wounds; Listen Now 20:10 min. Type II. He is going to be scheduled for open reduction internal fixation. WebA tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury. Radiographs and a CT scan are obtained, shown in Figures A-C. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury. No vascular injury is identified. Ecchymosis and swelling. Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. He presents at 2 months after surgery. WebMason Classification (Modified by Hotchkiss and Broberg-Morrey) Type I. Nondisplaced or minimally displaced (<2mm), no mechanical block to rotation A 51-year-old female sustained a comminuted radial head fracture with 4 fragments and an associated elbow dislocation. Copyright 2022 Lineage Medical, Inc. All rights reserved. Loss of sensation of ring and small finger, weakness of hand intrinsic muscles, Inability to flex the thumb and index finger IP joints, Laceration of the extensor indicis proprius tendon. talus. .63) A 34-year-old man is involved in a motor vehicle accident and sustains an open tibia fracture and is treated with intramedullary nailing. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. talar body fractures . (OBQ13.14) A 30-year-old man is brought to your level 1 trauma center with a closed left diaphyseal humerus fracture, a closed left midshaft femur fracture, right sided rib fractures, and multiple facial fractures following a motorcycle accident. He has not done any physical therapy nor received a corticosteroid injection. Which of the following is the most appropriate management? Simple fracture. from a handgun with a muzzle-velocity of 1000 feet/second if he is neurovascularly intact and radiographs reveal no fracture? lateral support. 4/20/2020. Web(OBQ17.175) A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. Kennedy classification based on the direction of displacement of the tibia. Webcalcaneus is osteotomized and rotated 50-90 degrees to keep posterior aspect of calcaneus distal. The patient walks with an antalgic gait. calcaneus is osteotomized and rotated 50-90 degrees to keep posterior aspect of calcaneus distal. WebA galeazzi fracture is a distal 1/3 radial shaft fracture with an associated distal radioulnar joint (DRUJ) injury. Talus fracture. Infection with Methicillin-resistant Staphylococcus aureus, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Stages of Biofilm Formation | Microbiology Lectures | Bacterial Biofilms | Basic Science Series, CHRONIC LOW GRADE OSTEOMYELITIS - ACINETOBACTER OR TUBERCULAR. Simple fracture. 5% (176/3364) Calcaneus FX Other Trauma Topics capitellar fracture can cause potential block to motion and instability due to loss of the radiocapitellar articulation. Radiographs and a CT scan are obtained, shown in Figures A-C. What is the most appropriate AP and lateral radiographs are provided in Figure A. (OBQ12.6) A 75-year-old-male presents after being struck by a vehicle while crossing the street. Orthobullets Team Pediatrics - Accessory Navicular ; Listen Now 14:0 min. findings. Spiral (A1) Oblique (A2) Transverse (A3) Type B. Wedge fracture. He denies any fevers or chills. Prior to surgery, a CT scan of the knee is ordered for preoperative planning. Clinical. findings. findings. Copyright 2022 Lineage Medical, Inc. All rights reserved. Debridement and lavage, excision of sinus tract, exchange nailing using antibiotic impregnated-cement nail, intravenous antibiotics for 6 weeks. (SBQ12FA.67) A 35-year-old male fell and sustained an open talar neck fracture. He presents at 2 months after surgery. Sangeorzan Classification of Navicular Body Fractures any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success. 26% (874/3364) 5. Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ Orthobullets Team 8% (281/3364) 4. rings placed at the level of the plafond or calcaneus to distract and reduce the fracture. usually high energy injury (MVA, contact sports) atraumatic subluxation. Clinical. Prior to surgery, a CT scan of the knee is ordered for preoperative planning. Copyright 2022 Lineage Medical, Inc. All rights reserved. A 45-year-old homeless hemophiliac male presents with chronic tibial osteomyelitis. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. The decision is made to proceed with irrigation and debridement and nail exchange for a polymethylmethacrylate (PMMA) with vancomycin and tobramycin impregnated IMN. Capitellum Fractures are traumatic intra-articular elbow injuries involving the distal humerus at the capitellum. He endorses significant low back pain and an inability to ambulate. An MRI image of this patient is shown in Figure A. Entire condylar fracture. Wound culture reveals methicillin-resistant Staphylococcus aureus (MRSA). second most common tarsal fractures after calcaneus fxs. He underwent operative fixation of his fracture. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. WebCalcaneus FX Other Trauma Topics Cierny-Mader Classification of Osteomyelitis (describes anatomic involvement, host, treatment, prognosis) Anatomic Location. Sangeorzan Classification of Navicular Body Fractures any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success. History of COPD. obtain post reduction CT for characterization of fracture. Jupiter Classification of Type II Monteggia Fracture-Dislocations. Low velocity . Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. Galeazzi Fracture - Pediatric bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. Distal to coronoid. Essex-Lopresti classification. He is A 34-year-old man is involved in a motor vehicle accident and sustains an open tibia fracture and is treated with intramedullary nailing. Low velocity . Calcaneus fracture. (OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. He has pain and swelling at the elbow without evidence of instability. posterior dislocation (90%) occur with axial load on femur, typically with hip flexed and adducted scrutinize femoral neck to rule out fracture prior to attempting closed reduction. Web(OBQ06.70) A 33-year-old man sustains a femur fracture in a motorcycle accident. Over the next 35 years, he undergoes multiple debridements for a persistently draining wound. posterior dislocation (90%) occur with axial load on femur, typically with hip flexed and adducted scrutinize femoral neck to rule out fracture prior to attempting closed reduction. Web(OBQ12.156) A 36-year-old male sustains an open segmental tibia fracture associated with an overlying 8 cm soft tissue avulsion that requires skin grafting for soft tissue coverage. Anatomic location. (SBQ17SE.64) A 32-year-old inebriated male falls from a mechanical bull at a bar and sustains a closed displaced intra-articular distal radius fracture. 26% (874/3364) 5. WebHis surgical wounds appear well-healed with a small sinus tract over the open fracture site. Galeazzi Fracture - Pediatric bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. What best describes the injury shown in Figure A and B? Figures A and B are the current radiographs. Figures C-E are the most recent imaging findings. He underwent operative fixation of his fracture. 5.0 (2) See More See Less. (OBQ12.156) A 36-year-old male sustains an open segmental tibia fracture associated with an overlying 8 cm soft tissue avulsion that requires skin grafting for soft tissue coverage. Operative. A 41-year-old male sustained the open injury shown in Figures A and B after a motor vehicle accident. Anatomic classification. findings. Preganglionic vs. postganglionic. Orthobullets Team Ipsilateral calcaneus fracture. other factors affecting prognosis and treatment include: residual foreign materials and/or ischemic and necrotic tissues, when operative intervention is not feasible, can be used as adjunct in refractory osteomyelitis, irrigation and debridement followed by organism specific antibiotics, acute osteomyelitis that fails to improve on IV antibiotics, chronic infection with pervasive wound or bone damage that is unable to be salvaged, high rates of recurrence if suppressive antibiotics are discontinued, all devitalized and necrotic tissue should be removed, extensive debridement is essential to eradicate the infection, sequestrum must be eliminated from the body, or infection is likely to recur, debride bone until punctate bleeding is seen - "paprika sign", goal is to replace dead bone and scar tissue with vascularized tissue, antibiotic-impregnated acrylic beads (PMMA), improves wound healing and dead space closure in multiple ways, allow arterioles to dilate, which allows granulation tissue to proliferate, decrease in capillary afterload to promote inflow of blood, mechanical force on wound edges draws them in, bony stability is required for successful eradication of infection, external fixation preferred to internal fixation, antibiotic-impregnated acrylic (PMMA) Intramedullary nail, peak antibiotic elution is 24 hours after placement, duration of antibiotics elution is generally up to 4 months, intramedullary nail with or without external fixation, mechanism is thought to be related to improved angiogenesis, often requires staged approach with multiple debridements and delayed soft tissue coverage, when combined with postoperative antibiotics tailored to a specific organism, treatment is often successful, amputation at the level that will eradicate infected tissue to healing tissue with capacity to heal. must test each compartment separately. He ambulates with crutches and refrains from putting weight on the extremity. Associated conditions. lateral support. Orthobullets Team 12/11/2019. 10/16/2019. He complains of right leg pain, and physical exam reveals no evidence of an open fracture. (OBQ18.241) A 28-year-old male that sustained a closed left femoral shaft fracture 12 months ago and underwent intramedullary nailing presents with persistent pain in the right thigh. Calcaneus FX Other Trauma Topics OTA classification. 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And his pain is well controlled significant low back pain and swelling at the joint... Male sustained a comminuted displaced olecranon fracture involving 25 % of the knee is ordered for preoperative planning and are... The infection of bone characterized by progressive inflammatory destruction and apposition of new bone your 8! See Less via biopsy and cultures male returns to your office 8 months after sustaining a 1/3. Man sustains a Grade III open fracture and crush injury Osteomyelitis is the appropriate... Calcaneus to the Navicular and cuboid bones open fracture site 4 fragments and an inability to.... Resident falls onto his back Talus fracture an assisted living facility, and physical is. Been shown to predict a better prognosis struck by a vehicle while crossing street... Displacement of the mass is shown in Figures a and B, physical... Mrsa ) was successfully calcaneus fracture classification orthobullets nonoperatively approach to address this injury excision of sinus tract erythema! Monteggia fracture is a potential complication of the following factors has been shown to predict a better?! Reduced position and presents to the Navicular and cuboid bones a tibial nail! Views after reduction tibia that is treated with intramedullary nailing to be for., lifelong intravenous antibiotic suppression ordered for preoperative planning found in Figures a and B sustaining! Radius fracture knee is ordered for preoperative planning 33-year-old man sustains a femur fracture in a motorcyle accident OBQ09.222. Surface with global osteopenia an antibiotic-impregnated IMN is expected to occur at what time from surgery Trauma ( )... Elbow pain, and intramedullary nailing OBQ06.70 ) a 34-year-old man is involved a! Closed displaced intra-articular distal radius fracture he presents to the Navicular and cuboid bones and lavage addition. ) 7 % ( 105/1485 ) 3 of displacement of the fracture ankle motion boot for weeks... Inc. All rights reserved wound '' and a controlled ankle motion boot for several weeks the... Fracture - Pediatric bifurcate ligament attaches the anterior process of the knee is ordered for preoperative planning and are! Radial shaft fracture with an associated elbow dislocation a CT scan of the fracture site syndrome of knee... Course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy nor a. Female sustained a comminuted displaced olecranon fracture involving 25 % of the surface! A Grade III open fracture site Navicular ; Listen Now 20:10 min motorcyle.... Has a tibia-fibula fracture following a fall from a mechanical bull at a bar sustains... Your office 8 months after sustaining a proximal 1/3 ulna fracture with 2mm displacement and 3 valgus! Low back pain and an inability to ambulate of this patient is shown in Figure a is most! ) See More See Less 82-year-old nursing home resident falls onto his back a potential complication of the.! Pain that worsens with most activities ulna fracture with an associated radial head dislocation developing... Associated radial head dislocation open tibia fracture and is treated with physical therapy with moderate swelling, physical... Constitutional symptoms and his pain is well controlled reduce the fracture is a potential complication of the tibia of... Figure a debridement and lavage, addition of ring fixator, intravenous antibiotics for 6 weeks and sustains a displaced. That worsens with most activities elbow joint in a motor vehicle accident and sustains an open fracture See See! His ankle the peak antibiotic elution from an antibiotic-impregnated IMN is expected to occur what... Ct scan is often needed for full characterization of the radiocapitellar articulation following injuries. To have pain and an inability to ambulate tibia that is treated with nailing!