This injury is best classified as which of the following? Use of an un-reamed nail decreased this patient's risk of infection. A closed reduction is performed and the patient is placed in a long leg cast. (OBQ13.120) Orthobullets Technique Guides cover information that is "not testable" on ABOS Part I: Epidemiology Incidence common clavicle fractures account for 2.6-4% of all adult fractures Demographics more commonly in older or osteoportic patients The injury is closed, and soft tissues are intact upon arrival. Treatment is immobilization or surgery, depending on the displacement and stability of the distal clavicle, as determined by whether coracoclavicular (CC) ligaments (trapezoid and conoid) are intact. Figure A shows an acute, isolated and closed, left knee injury in a 40-year-old male struck by a motor vehicle. He is initially treated with a spanning external fixator followed by definitive open reduction internal fixation of the tibia and fibula. Coronal and sagittal CT scan images are shown in Figures D and E. What is the MOST appropriate next step in management in addition to operative irrigation and debridement? Acquired valgus deformity of the tibia in children. He denies any new trauma, and has followed all post-operative activity restrictions. A 67-year-old male is involved in a motor vehicle accident and presents with the closed orthopedic injuries shown in Figures A and B. A 40-year-old woman is involved in motorcycle accident 2 hours ago and sustains an isolated right leg injury shown in Figure A. (OBQ06.60) difficulty or . She undergoes simultaneous external fixation and ORIF using minimally invasive plate osteosynthesis. MRI can identify this. A 56-year-old carpenter sustains the closed injury seen in Figures A, B, and C. After temporary spanning external fixation is performed and soft tissue conditions improve, what strategy provides the optimal fixation for this fracture pattern? Anterolateral Approach to the Lateral Tibial Plateau. His radiograph is shown in Figure A. What is the most appropriate next step in treatment? Treatment may be nonoperative or operative depending on the fracture morphology, age of the patient, and associated injuries. (OBQ05.195) You are planning to treat the injury with elastic intramedullary nails. A 45-year-old male injures his wrist during Live Action Role Play in Chicago two weeks ago. Laboratory workup for infection is negative. Which of the regions on the patient's injury AP radiograph in Figure A, if not addressed properly during surgery, represents a risk for radiocarpal instability? He will be in a soft bandage and be weight bearing as tolerated, He will be in a soft bandage and non-weight bearing, He will be in a knee immobilizer and be weight bearing as tolerated, He will be non-weight bearing in a splint or cast, He will be weight bearing as tolerated with a supplemental external fixator. Postoperative images are shown in Figures B and C. Compared to unreamed nailing, reamed nailing of this injury has been associated with which of the following? What is the next best step in management of this patient? Patella instability . What is the most likely explanation? Lipohemarthrosis of the knee is most likely secondary to which of the following? TIme to transfer to definitive trauma center. 1. You review his operative note in which the surgeon reports having to apply a volar locking plate in a distal position to secure the difficult intra-articular fracture. A 30-year-old patient sustains a comminuted tibia fracture and is treated with minimally invasive plating, shown in Figure A. 2,754 followers. A 35-year-old female presents with the orthopaedic injuries shown in Figures A-D following a high-speed motor vehicle collision. Fibular fractures, particularly those involving the ankle and the shaft just proximal, are common. Twelve months after open reduction and internal fixation of a comminuted distal radius fracture as seen in Figure A and B, which of the following tendons is at greatest risk of rupture? (OBQ04.194) Valgus instability of the knee is noted. Which plating option provides the most appropriate treatment of this fracture? Temporary external fixation then lateral percutaneous screws, Lateral nonlocking plate +/- bone graft substitutes, Medial and lateral locking plate +/- bone graft substitutes, Lateral percutaneous screws with assisted arthroscopy. A 57-year-old woman underwent open reduction internal fixation from a volar approach for a displaced distal radius fracture. Treatment is generally operative with intramedullary nailing. What variable will most significantly increase his rate of degenerative arthritis in the long-term? At 4 months follow-up, despite some signs of healing, the fracture is not fully united. A 28-year-old man is thrown from his motorcycle and sustains the closed injury seen in Figure A. account for <10% of lower extremity injuries, incidence increasing as survival rates after motor vehicle collisions increase, talus is driven into the plafond resulting in articular impaction of the distal tibia, low energy rotational forces (less common), fracture patterns and comminution determined by position of foot, amplitude of force, and direction of force, 30% have an ipsilateral lower extremity injury, distal tibia forms an inferior quadrilateral surface and pyramid-shaped medial malleolus articulates with the talus and fibula laterally via the fibula notch, anterior-inferior tibiofibular ligament (AITFL), originates from anterolateral tubercle of tibia (Chaput), inserts on anterior tubercle of fibula (Wagstaffe), posterior-inferior tibiofibular ligament (PITFL), originates from posterior tubercle of tibia (Volkmann), inserts on posterior part of lateral malleolus, distal continuation of the interosseous membrane, Simple displacement with incongruous joint, ankle tenderness, swelling, abrasions, ecchymosis, fracture blisters, open wounds, and chronic skin/vascular changes, examine for associated musculoskeletal injuries, consider ABIs and CT angiography if clinically warranted, check for signs/symptoms of compartment syndrome, full-length tibia/fibula and foot x-rays performed for fracture extension, lumbar films if appropriate based on exam, important to obtain after spanning external fixation as ligamentotaxis allows for better surgical planning, stable fracture patterns without articular surface displacement, critically ill or non-ambulatory patients, significant risk of skin problems (diabetes, vascular disease, peripheral neuropathy), intra-articular fragments are unlikely to reduce with manipulation of displaced fractures, inability to monitor soft tissue injuries is a major disadvantage, acute management of most length unstable fractures, provides stabilization to allow for soft tissue healing and monitoring, capsuloligamentotaxis to indirectly reduce the fracture by tensioning the soft tissues about the ankle, fractures with significant joint depression or displacement, leave until swelling resolves (generally 10-14 days), not always warranted in length stable pilon fractures, placement of pins out of the zone of injury and planned surgical site is important to reduce infection risks, definitive fixation for a majority of pilon fractures, limited or definitive ORIF can be performed acutely with low complications in certain situations, high rates of wound complications and infections are associated with early open fixation through compromised soft tissue, brake travel time returns to normal 6 weeks after weight bearing, not a necessary step in the reconstruction of pilon fractures, may be helpful in specific cases to aid in tibial plafond reduction or augment external fixation, external fixation/circular frame fixation alone, select cases where bone or soft tissue injury precludes internal fixation, thin wire frames and hybrid fixators have high union rate, osteomyelitis and deep infection are rare, meta-analysis comparing this method with open reduction and internal fixation found no difference in infection or complication rates between the two groups, alternative to ORIF for fractures with simple intra-articular component, minimizes soft tissue stripping and useful in patients with soft tissue compromise, increased valgus malunion and recurvatum seen with IMN compared to plate osteosynthesis, severely comminuted, non-reconstructable plafond fractures, select elderly populations who cannot tolerate multiple surgeries or prolonged immobilization, theorized quicker recovery process and decreased long term pain, increases the risk of adjacent joint arthritis including the subtalar joint and midfoot, long leg cast for 6 weeks followed by fracture brace and ROM exercises, close follow-up and imaging needed to ensure articular congruity and axial alignment, fixator constructs vary with delta and A frames assemblies being most common, 2 tibial shaft half pins outside the zone of injury connected to a single transcalcaneal pin, consider trans-navicular pin if associated calcaneal fracture, consider connecting fixator to the forefoot 1, joint-spanning articulated vs. nonspanning hybrid ring, none have been shown to be superior with respect to ankle stiffness, can combine with limited percutaneous fixation using lag screws, anatomic articular reconstruction may not be possible, especially with central depression, tibial shaft is used as a fixation base to reduce the fracture, two half-pins in the AP plane with rings in an orthogonal position, used to support the distal fixation rings, determined by the configuration of the fracture and the soft-tissue injury, rings placed at the level of the plafond or calcaneus to distract and reduce the fracture, pins should be placed at least 1-2 cm from the joint line in order to avoid possible septic arthritis, safe zones for wire placement form a 60-degree arc in the medial-lateral plane, can include limited internal fixation if soft tissues permit, consider the need for soft tissue coverage with position of the fixator, provides better fixation and decreases frequency of loosening, once skin wrinkles present, blister epithelization, and ecchymosis resolution (10-14 days), single or multiple incisions based on fracture pattern and goals of fixation, keep full thickness skin bridge >7cm between incisions, positioning of patient dependent on approach(es) being utilized, useful with fractures impacted in valgus or with an intact fibula, goal is for anatomic reduction of articular surface, location of plates/screws are fracture and soft-tissue dependent, consider provisionally leaving the external fixator in place, can be with intramedullary screw/wire or plate/screw construct, ankle ROM exercises beginning 2 weeks post-op, non-weightbearing for ~6-12 weeks depending on radiographic evidence of fracture consolidation, debride fibrous tissue, fracture callous, and cartilage, small comminuted articular fragments are removed, pack metaphyseal defects and the tibiotalar joint with autologous or allograft bone graft, fixation with an anterior plate and screw construct, progress weight bearing between 8 and 12 weeks in removable boot, full weight bearing with ankle brace at 12 weeks post-op, CT at 3 months to assess for successful fusion, tibiotalocalcaneal (TTC) fusion with retrograde intramedullary nail, accelerates transverse tarsal joint arthritis, wait for soft tissue edema to subside before ORIF (1-2 weeks), free flap for postoperative wound breakdown, significant soft tissue swelling at time of definitive surgery, irrigation and debridement, antibiotics, possible hardware removal, joint-preserving correction with secondary anatomic reconstruction, must rule out infected non-union (labs to obtain CRP, ESR, WBC), other non-union labs (PTH, calcium, total protein, serum albumin, vitamin D, TSH), chondrocyte cell death at fracture margins is a contributing factor, IL-6 is elevated in the synovial fluid following an intra-articular ankle fracture, most commonly begins 1-2 years postinjury, first line is conservative management (bracing, injections, NSAIDs, activity modification), Poor outcomes and lower return to work associated with, Outcomes correlate with severity of the fracture pattern and the quality of reduction, at 2 year follow-up, the majority of type C pilon fractures report lower SF-36 scores than patients with pelvic fractures, AIDS, or coronary artery disease, clinical improvement seen for up to 2 years after injury, 6 weeks after initiation of weight bearing, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. - A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. The patient shows you the lateral film in Figure A. A 64-year-old female sustains a nondisplaced distal radius fracture and undergoes closed treatment using a cast. He undergoes operative treatment of his fracture, and immediate post-op radiographs are shown in Figure C. Two weeks later he presents with significantly increased pain and deformity. Radiographs obtained at the time of injury are shown in Figure A. Two-point discrimination is now >10mm in these fingers. Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation Ankle and Hindfoot Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol . He undergoes reamed intramedullary nailing 4 hours after his injury. He is now 3 weeks from injury and skin swelling has subsided significantly. (OBQ09.182) A 25-year-old male is a driver in a motor vehicle accident and sustains the isolated closed injury seen in Figures A and B. (OBQ09.245) Intramedullary nailing of proximal tibial shaft fractures are technically demanding, and use of an extended medial parapatellar incision with a semiextended technique can prevent what common deformity at the fracture site? In which location (labeled A - E) on Figure A did percutaneous placement without careful dissection of a pin/screw likely cause her nerve injury? He is also noted to have a grade 1 splenic laceration and lung contusion. The femoral and tibial plateau fractures are open with no gross contamination, and there is an ipsilateral Morel-Lavelle lesion of the left thigh. His injuries include the closed left tibial shaft fracture shown in Figure A. OTA 2021 Annual Meeting Notable Paper P86 - Long-leg versus Short-leg Cast Immobilization for Displaced Distal Tibial Physeal Fractures: Join host Dr. Sonny Konda as he discusses the Notable Paper Comparing Long-Leg and Short-Leg Cast Immobilization with author Dr. Christopher Souder. Plain radiographs are negative. When discussing treatment options with a 35-year-old healthy male with an isolated, closed tibial shaft fracture, the surgeon should inform him that in comparison to closed treatment, the advantages of intramedullary nail fixation include all of the following EXCEPT? (SBQ12TR.30) Knee dislocation. . Worse outcomes on the Mayo wrist score are expected without fixation, Chronic distal radioulnar joint instability can be expected to occur without fixation, Wrist function depends on the level of ulnar styloid fracture and initial displacement, Grip strength and wrist range of motion are improved with fixation, There is no adverse effect on wrist function or stability without fixation. Patient should be scheduled for exchange nailing. A 55-year-old female presents to the emergency room after falling off her balcony. You can rate this topic again in 12 months. (OBQ06.8) Use of an un-reamed nail increased this patients risk of infection. Incompetence of which of the following anatomic structures is the most likely etiology of this finding? Copyright 2022 Lineage Medical, Inc. All rights reserved. Increased pulmonary morbidity post-operatively, Increased cortical bone temperature during reaming. You decide to treat this fracture with intramedullary nailing. Distal Radius Fractures are the most common site of pediatric forearm fractures and generally occur as a result of a fall on an outstretched hand with the wrist extended. A 34-year-old male sustains the closed injury seen in Figure A as a result of a high-speed motor vehicle collision. Simple Fracture : A break in a bone without an accompanying wound at the fracture site. Following surgery, she complains of numbness along the dorsum of her medial and lateral foot. Current radiographs are shown in Figure D and a clinical photograph of the affected wrist is shown in Figure E. Which of the following is the most likely cause for failure of fixation in this patient? A 58-year-old man underwent distal radius ORIF with a volar locking plate yesterday. (OBQ10.217) Closed reduction and splinting followed by delayed casting, Immediate open reduction internal fixation, Closed reduction and splinting, CT scan, and immediate open reduction internal fixation, Closed reduction and splinting, CT scan, external fixation, delayed open reduction internal fixation, Closed reduction and splinting, external fixation, CT scan, delayed open reduction internal fixation. (OBQ05.14) Which of the following statements is true regarding brake travel time after surgical treatment of complex lower extremity trauma? What is the most appropriate treatment? The injury is closed and the patient is neurovascularly intact with soft compartments. Greater than 10mm of articular depression. What complication is most likely to occur in this patient? What is the most appropriate treatment at this time? What is the most common type of malalignment after intramedullary nailing of distal 1/3 extra-articular tibia fractures using a infrapatellar approach when compared with plating? Radiographs are shown in Figures A and B. CT scan is helpful for intra-articular assessment and operative planning. (SBQ17SE.28) Distal Femur Fracture ORIF with Single Lateral Plate . What is the optimal surgical plan? (OBQ07.182) What would be the most appropriate sequence of treatment steps for definitive management of this injury? A 42-year-old male sustains a left leg injury as the result of a high-speed motor vehicle collision. Distal Tibial Fractures These fractures occur at the ankle end of the tibia. The plate may need to removed once the fracture is healed to reduce the chance of flexor pollicis longus injury, The plate may need to removed once the fracture is healed to reduce the chance of flexor carpi radialis injury, The plate may need to removed once the fracture is healed to reduce the chance of flexor digitorum superficialis index finger injury, The patient should undergo revision fixation as soon as possible, The plate is in appropriate position and will likely never need to be removed. Radiographs are provided in Figures A-C. A 54-year-old female sustains a communited tibial shaft fracture from an accident at work. open reduction internal fixation of the fibula only, open reduction internal fixation of the tibia and fibula, removal of external fixator and conversion to a walking cast. Which of the following has evidence to support its utility in this clinical situation? Symptoms of tibia fracture. A 69-year-old female sustains the injuries seen in Figures A and B. A 13-year-old boy falls from an ATV and sustains the injury seen in Figure A. (SBQ17SE.75) (OBQ04.200) (OBQ04.73) - Extra-articular distal tibia fractures: a mechanical evaluation of 4 different treatment methods. ORIF with medial and lateral plating with grafting of metaphyseal defect, ORIF with lateral plating with grafting of metaphyseal defect, Percutaneous articular fragment reduction and screw fixation. (OBQ16.128) Inability to flex the thumb interphalangeal joint. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. Treatment is generally closed reduction and casting for the majority of fractures. A 45-year-old female barista from Portland fell off her skateboard and sustained a closed distal radius fracture. A 53-year-old man sustains the injury seen in figure A and later undergoes open reduction and internal fixation. (OBQ09.141) Inability to flex the index finger proximal interphalangeal joint. Nine months after fixator removal, he presents with a painful oligotrophic nonunion. Following placement of this implant, what is the best technique to confirm it is not too proud proximally? (OBQ18.215) The treating surgeon, concerned that his hospital does not have a plastic surgeon available for soft-tissue coverage, arranges for transfer of the patient to a nearby level I trauma center for definitive care. He was treated initially with external fixation for 11 days before his soft-tissues would permit definitive open internal fixation. Radial Head Fracture (Mason Type 2) ORIF T-Plate and Kocher Approach. The injury is closed and she is neurovascularly intact. There are no open wounds and the hand is neurovascularly intact. Increased need for additional surgeries to obtain union. Salter-Harris type I distal tibia fractures account for about 15% of all pediatric distal tibiofibular fractures and can occur with any mechanism of injury as described by Dias and Tachdjian. Introduction. Continued use of knee-spanning external fixator, Conversion of external fixator to a simple hinged knee fixator, Open reduction and internal fixation with a lateral locked plate, Open reduction and internal fixation with medial and lateral plates. Unreamed tibias have the highest amount of mineral apposition rates, Unreamed tibias result in the highest amount of new bone formation, Unreamed nails result in the lowest porosity of bone, Reamed and unreamed tibias have similar mineral apposition rates, Tight nails results in higher cortical reperfusion than loose nails. The patient has strong dorsalis pedis and posterior tibial pulses. FOOSH), high incidence of distal radius fractures in women > 50 years old, DEXA scan is recommended for women with distal radius fractures, fall on outstretched hand (FOOSH) is most common in older population, higher energy mechanism more common in younger patients, includes the radial styloid and scaphoid fossa, attachment sites for the brachioradialis tendon, long radiolunate ligament, and radioscaphocapitate ligament, serves as a buttress to resist radial carpal translation, functions as a load-bearing platform for activities performed with the wrist in ulnar deviation, holds the carpus out to length radially, allowing a more uniform distribution of load across the scaphoid and lunate facets, serves as an anchor for the radioscaphocapitate ligament that prevents ulnar translation of the carpus, transmits load from the carpus to the forearm, based on joint involvement (radiocarpal and/or radioulnar) +/- ulnar styloid fracture, divides intra-articular fractures into 4 types based on displacement, Depressed fracture of the lunate fossa of the articular surface of the distal radius, Fracture-dislocation of radiocarpal joint with intra-articular fx involving the volar or dorsal lip (volar Barton or dorsal Barton fx), Low energy, dorsally displaced, extra-articular fx, Low energy, volarly displaced, extra-articular fx, usually a fall onto outstretched hand (FOOSH), Dorsal angulation < 5 or within 20 of contralateral distal radius, dorsal angulation < 5 or within 20 of contralateral distal radius, extra-articular fracture with stable volar cortex, 82-90% good results if used appropriately, radiographic findings indicating instability (pre-reduction radiographs best predictor of stability), dorsal angulation > 5 or > 20 of contralateral distal radius, displaced intra-articular fractures > 2mm, associated ulnar styloid fractures do not require fixation, articular margin fractures (dorsal and volar Barton's fractures), the volar ulnar corner (critical corner) supports the volar lunate facet with its strong radiolunate ligament attachments, failure to address this fragment can result in volar carpal subluxation, comminuted and displaced extra-articular fractures (Smith's fractures), progressive loss of volar tilt and radial length following closed reduction and casting, medically unstable patients unable to undergo a lengthy procedure, important adjunct with 80-90% good/excellent results, therefore usually combined with percutaneous pinning technique or plate fixation, apply longitudinal traction and volar/dorsal pressure to the distal fracture fragment, avoid positions of extreme flexion and ulnar deviation (Cotton-Loder Position), no significant benefit of physical therapy over home exercises for simple distal radius fractures treated with cast immobilization, radial shortening is the most predictive of instability, followed by dorsal comminution, dorsal comminution > 50%, palmar comminution, intraarticular comminution, higher loss of reduction with 3 or more of LaFontaine criteria, Meta-analyses and systematic reviews demonstrate no difference in functional outcomes between closed treatment versus operative methods in elderly patients (>65 years old), K wires are placed dorsally into the fracture and used as reduction tools until they are driven into the proximal radius, Rayhack technique with arthroscopically assisted reduction, distal radius extra-articular fracture ORIF with volar approach, distal radius intra-articular fracture ORIF with dorsal approach, associated with plate placement distal to watershed area, the most volar margin of the radius closest to the flexor tendons, can have hyperesthesia over the base of the thenar eminence due to palmar cutaneous nerve injury during retraction of the digital flexor tendons when plating the distal radius, new volar locking plates offer improved support to subchondral bone, intra-articular distal radius fractures with dorsal comminution, can combine with external fixation and percutaneous pinning, volar lunate facet fragments may require fragment-specific fixation to prevent early postoperative failure, screw penetration into the radiocarpal joint or DRUJ, assess intra-articular screws with a 23 degree elevated lateral view, assess dorsal cortex penetration with a skyline view, no benefit of therapist-directed physical therapy compared to home exercise program, distal radius fracture spanning external fixator, distal radius fracture non-spanning external fixator, place radial shaft pins under direct visualization to avoid injury to superficial radial nerve, and excessive volar flexion and ulnar deviation, pin site care comprising daily showers and dry dressings recommended, prevent by avoiding immobilization in excessive wrist flexion and ulnar deviation (Cotton-Loder position), progressive paresthesias, weakness in thumb opposition, paresthesias that do not respond to reduction and last > 24-48 hours, nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the EPL tendon, extensor mechanism is thought to impinge on the tendon following a nondisplaced fracture and causes either a mechanical attrition or a local area of ischemia in the tendon, volar plating with screw fixation that penetrates the dorsal cortex and is proud dorsally, very distal volar plate placement on the radius (distal to watershed line) is associated with FPL rupture, due to physical contact of tendon on plate and subsequent tendinopathy, 90% young adults will develop symptomatic arthrosis if articular stepoff > 1-2mm, delayed procedure associated with higher need for bone grafting and a more difficult procedure, radial shortening associated with greatest loss of wrist function and degenerative changes in extra-articular fractures, AAOS 2010 clinical practice guidelines recommend, early efforts to regain motion of wrist and fingers, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. It is the point at which the proximal mechanical axis and distal mechanical axis meet, It is the point at which the proximal anatomical axis and proximal mechanical axis meet, It is always the point on the cortex at the most concave portion of the deformity, It is the point at which the distal anatomical axis and distal mechanical axis meet, It is always the point on the cortex at the most convex portion of the deformity. What is the most common complication he must be advised about? Now, he complains of worsening hand pain and sensory disturbances in his volar thumb and index finger. A 45-year-old man is struck while crossing a major highway and sustains the injury depicted in Figure A. Partial articular. (OBQ13.78) (OBQ05.171) What part of his overall treatment has shown to reduce the risk of infection THE MOST at the site of injury? Distal femoral nonunion with less than 10% bone loss, Mid-diaphyseal humeral nonunion with less than 10% bone width loss, Proximal humeral shaft nonunion with less than 10% bone width loss, Diaphyseal tibial shaft nonunion with less than 30% cortical width bone loss. Orthobullets Team Trauma . Tibial plateau fractures are periarticular injuries of the proximal tibia frequently associated with soft tissue injury. Radiographs are provided in Figure A. Copyright 2022 Lineage Medical, Inc. All rights reserved. Two weeks following external fixation, examination reveals intact sensation, palpable pulses and no soft tissue compromise. Distal tibial physeal fractures are classified by the Salter-Harris classification. They are also called tibial plafond fractures. What adjunct treatment has been shown to improve outcomes when using an intramedullary nail? Open fractures, Infection, Compartment syndrome 3; Extra articular. (OBQ04.216) (OBQ11.273) Displaced impaction fracture of the lunate fossa, Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner, Displaced extra-articular fracture with apex volar, Displaced extra-articular fracture with apex dorsal. Radiographs following cast placement are provided in Figures C and D. The decision is made to proceed with closed treatment instead of operative. A 30-year-old man presents with a distal third tibia fracture that has healed in 25 degrees of varus alignment. A 45-year-old male laborer falls off a 15 foot retaining wall 6 hours ago and sustains an open fracture shown in Figures A through C. He has a normal neurovascular exam. Extensor carpi radialis longus transfer to extensor pollicus longus, Extensor pollicis brevis transfer to extensor pollicus longus, Extensor indicis proprius transfer to extensor pollicus longus, Primary repair of extensor pollicus longus. (SBQ12TR.100) He sustains the injury shown in Figure A. Thank you. (OBQ09.118) more common in diaphyseal tibial shaft fractures than proximal or distal tibia fractures 8.1% risk in diaphyseal fractures, compared to proximal (1.6%) and distal (1.4%) fractures can occur even in the setting of an open fracture From: Green's Skeletal Trauma in Children (Fifth Edition), 2015. (SBQ04PE.60) Adequate maintenance of reduction by non-operative treatment is unsuccesful. A 35-year-old male has a closed mid-shaft tibia fracture following a skiing accident. Administration of recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) at the time of fracture fixation will lead to which of the following? A clinical photo and radiograph are shown in Figure A and B. He is initially taken to a local hospital. Malunion due to unacceptable coronal alignment, Malunion due to unacceptable sagittal alignment, Fracture displacement due to the mechanism of injury, Fracture displacement due to the age of the patient, Shortening due to the oblique nature of the tibia fracture. (OBQ08.163) Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. What is the appropriate surgical treatment at this time? Short leg splint placement and transition to short leg cast at 2 weeks, Closed reduction and spanning external fixation of the ankle, Open reduction and internal fixation of the fibula and tibia, Open reduction and internal fixation of the fibula with Blair arthrodesis of the ankle, Open reduction and internal fixation of the tibia and articulating external fixation of the ankle. Download as PDF. . Complete articular. A 54-year-old male falls from a ladder and sustains the fracture shown in Figure A. Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work? ORIF with standard plating of the tibia and fibula, ORIF with locked plating of the tibia and fibula, ORIF with standard plating of the tibia and fibula and immediate bone grafting of tibia defect, External fixation of the tibia, ORIF of the fibula with standard plating, and immediate bone grafting of tibia defect, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Tibial Plafond Fracture External Fixation, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique Update: Distal Tibial Fractures With Osteoporosis & Neuropathy: A Different Playbook - Stephen A. Kottmeier MD, 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope, Pushing the Envelope: Pilon - Tony Rhorer, MD, Trauma Tibial Plafond Fractures (ft. Dr. Brian Weatherford). Anterior cruciate ligament midsubstance tear, Horizontal cleavage lateral meniscus tear, Lateral collateral ligament and popliteofibular ligament tear. Radiographs are seen in Figures A and B. (OBQ04.27) A 21-year-old male undergoes intramedullary nailing of the closed tibial shaft fracture shown in Figure A. Copyright 2022 Lineage Medical, Inc. All rights reserved. A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. They often result from minor trauma. This most commonly occurs at the distal radius or tibia following a fall on an outstretched arm; the force is transmitted from carpus to the distal radius and the point of least resistance fractures, usually the dorsal cortex of the distal radius. Ipsilateral hip joint degenerative changes, Contralateral hip joint degenerative changes, Ipsilateral medial knee degenerative changes. (OBQ10.127) If patient is unable to participate in examination and concern is high clinically, intracompartmental compartment measurements should be performed, floating knee is an indication for antegrade tibial nailing and retrograde femoral nailing, distal 1/3 and spiral tibial shaft fractures, tibial shaft is triangular in cross-section, proximal medullary canal is centered laterally, important for start point with IM nailing, anteromedial tibial crest is composed of dense, cortical bone and rests in a subcutaneous position, making it useful as a landmark, tibial tubercle sits anterolaterally, approximately 3 cm distal to joint line, gerdy's tubercle lies laterally on proximal tibia, pes anserinus lies medially on proximal tibia, attachment of sartorius, semitendinosus, and gracilis, superficial medial collateral ligament (MCL) attaches approximately 5-7 cm distal to joint line deep to the pes anserinus, adjacent fibula supports attachments for the lateral collateral ligament complex and long head of biceps femoris, tibia is responsible for about 80-85% of lower extremity weight-bearing, fibrous structure interconnecting tibia/fibula which provides axial stability, fibula rests in distal tibial incisura and is stabilized by syndesmotic ligaments, anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), inferior transverse tibiofibular ligament (ITL), interosseous ligament (IOL) - continuation of interosseus membrane, syndesmotic stability can be affected by distal, spiral tibial shaft fractures, Fracture classification is primarily descriptive based on pattern and location, Oestern and Tscherne Classification of Closed Fracture Soft Tissue Injury, Injuries from indirect forces with negligible soft-tissue damage, Superficial contusion/abrasion, simple fractures, Deep abrasions, muscle/skin contusion, direct trauma, impending compartment syndrome, Excessive skin contusion, crushed skin or destruction of muscle, subcutaneous degloving, acute compartment syndrome, and rupture of major blood vessel or nerve, Gustilo-Anderson Classification of Open Tibia Fractures, Limited periosteal stripping, clean wound < 1 cm, Minimal periosteal stripping, wound >1 cm in length without extensive soft-tissue injury damage. (OBQ18.177) Schatzker type III tibial plateau fracture, Schatzker type IV tibial plateau fracture, Schatzker type VI tibial plateau fracture. A 70-year-old woman with known osteoporosis sustains a distal radius fracture of her dominant arm with some metaphyseal comminution. (OBQ12.261) Following fixation, a "shuck" test is performed and shows persistent instability of the distal radioulnar joint. Due to the asymmetrical closure of the distal tibial physis (Figure 1) during early adolescence, transitional fractures can also occur. The proximal fibula is the insertion point for the biceps femoris posterolaterally, the soleus posteriorly, and the peroneus longus and extensor digitorum longus anteiorly. A 25-year-old male pedestrian sustained a Type II open tibia fracture after being struck by a car at 10:00PM. (SBQ12TR.110) Copyright 2022 Lineage Medical, Inc. All rights reserved. She presents 11 months later with the radiograph seen in Figure A, complaining of significant wrist pain. Distal femur fracture. Which of the following tendons is most commonly transferred to address the patient's deficiency? distal radius fractures are a predictor of subsequent fractures DEXA scan is recommended for women with distal radius fractures Etiology Pathophysiology mechanism of injury fall on outstretched hand (FOOSH) is most common in older population higher energy mechanism more common in younger patients Associated conditions DRUJ injuries Postoperatively, which of the following will have the most beneficial effect on the healing potential of the surviving chondrocytes within these reconstructed articular segments? (OBQ07.126) You can rate this topic again in 12 months. What is the most important factor in a surgeon's decision of determining between limb salvage and amputation? The splint was removed by the previous on-call resident and the right leg elevated over three pillows. A 17-year-old male falls from a retaining wall onto his left arm. How do you counsel him about his post-operative period? (OBQ11.212) (OBQ12.73) (OBQ04.256) She undergoes immediate four compartment leg fasciotomy and placement of a spanning external fixator. Patella fracture. He is cleared by the trauma team, and undergoes early total care with reamed femoral and tibial nailing. Which of the following statements comparing the techniques in Figure B and C is most accurate? A 32-year-old male sustains the injury shown in Figure A and undergoes treatment as shown in Figure B. Radial Head Fx - Replacement. Coronoid Fx - Open Reduction Internal Fixation with Screws. (OBQ06.136) (OBQ09.228) Immediate definitive fixation of the tibia, and nonoperative treatment of the fibula, Immediate ankle-spanning external fixation device with consideration of immediate fixation of the fibula, followed by delayed reconstruction of the tibia, Placement of a temporary splint, elevation, and definitive fixation 1 week from injury, Immediate definitive fixation of the tibia and fibula, Immediate placement of a spanning Ilizarov fixator with limited internal fixation of the distal tibia and fibula. (OBQ17.87) Which of the following is true regarding the center of rotation of angulation (CORA) as it refers to tibial diaphyseal angular deformity? Ankle fractures range from simple injuries of a single bone to complex ones involving multiple bones and ligaments. A tourniquet is used for the tibial nailing portion of the case, and the tibial isthmus is over reamed to accept a larger nail. (SBQ13PE.95.1) Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Which of the following is the most significant risk factor for lateral meniscal tears associated with lateral tibial plateau fractures? Which of the following fracture patterns is classically associated with varus malunion if treated with closed reduction and casting? Orthobullets Team Trauma - Tibial Plafond Fractures Technique Guide. At the time of the index operation, there was no distal radioulnar joint instability after plating of the radius. A patient presents with the injury shown in figures A and B. Distal Tibia/Fibula Fracture in 48F HPI: A 48-year-old female . According to meta-analysis and systematic reviews, which of the following statements is most accurate regarding her injury? Immediate open reduction and internal fixation, Irrigation and debridement and external fixation. (OBQ06.64) Patella fracture. Use of an un-reamed nail increased this patient's risk of non-union. Tibial plateau fractures are periarticular injuries of the proximal tibia frequently associated with soft tissue injury. Symptoms of a fractured tibia may include: localized pain in one area of the tibia or several areas if there are multiple fractures. Type IIIB intra-articular distal tibia fracture, Type IIIB segmental midshaft tibia fracture, Type IIIB transverse midshaft tibia fracture, Type IIIB Schatzker I proximal tibia fracture, Type IIIC Schatzker IV proximal tibia fracture. traveling traction), placed in metaphyseal segment at the concavity of the deformity, posteriorly placed blocking screw in proximal fragment and laterally placed blocking screw in the metaphyseal fragment help direct the nail more centrally, avoiding valgus/procurvatum deformities, increase biomechanical stability of bone/implant construct by 25%, ensure fracture is reduced before reaming, overream by 1.0-1.5mm to facilitate nail insertion, confirm guide wire is appropriately placed prior to reaming, should be "center-center" in the coronal and sagittal planes distally at the physeal scar, anterior aspect of nail should be lined up with axis of tibia when inserting nail - typically should line up with 2nd metatarsal in absence of tibial deformity, statically lock proximal and distally for rotational stability, no indication for dynamic locking acutely, number of interlocking screws is controversial, two proximal and two distal screws in presence of <50% cortical contact, consider 3 interlock screws in short segment of distal or proximal shaft fracture, prefer multiplanar screw fixation in these short segments, lateral may have more soft tissue interference but may be preferred in setting of soft tissue/wound issues, generally, minimally invasive plating is used to preserve soft tissues, plate attached to external jig to allow for percutaneous insertion of screws, must ensure appropriate contour of plate to avoid malreduction, higher risk for wound issues, particularly in open fractures, superficial peroneal nerve (SPN) commonly at risk laterally, below knee amputation (BKA) vs. above knee amputation (AKA) based on degree of soft tissue damage, standard BKA vs. ertl/bone block technique, infrapatellar nailing with patellar tendon splitting and paratendon approach, suprapatellar nailing may have lower rate of anterior knee pain, more common if nail left proud proximally, lateral radiograph is best radiographic views to evaluate proximal nail position, pain relief unpredictable with nail removal, all tibial shaft fractures - between 8-10%, higher in proximal 1/3 tibia fractures - up to 50%, patellar tendon pulls proximal fragment into extension, while hamstring tendons and gastrocnemius pull the distal fragment into flexion (procurvatum), distal 1/3 fractures have a higher rate of valgus malunion with IM nailing compared to plating, definitive management with casting or external fixation, most common deformity is varus with nonsurgical management, varus malunion may place patient at risk for ipsilateral ankle pain and stiffness, starting point too medial with IM nailing, adequate reduction, proper start point when nailing, if malalignment is noted immediately after surgery, return to operating room is appropriate with removal of nail, reduction and nail reinsertion, if malunion is appreciated at later followup, eventual nail removal and tibial osteotomy can be considered, most appropriate for aseptic, diaphyseal tibial nonunions, oblique tibial shaft fractures have the highest rate of union when treated with exchange nailing, consider revision with plating in metaphyseal nonunions, BMP-7 (OP-1) has been shown equivalent to autograft, often used in cases of recalcitrant non-unions, compression plating has been shown to have a 92-96% union rate after open tibial fractures initially treated with external fixation, fibular osteotomy of tibio-fibular length discrepancy associated with healed or intact fibula, highest after IM nailing of distal 1/3 tibia fractures, increases risk of adjacent ankle arthrosis, should always assess rotation in operating room, obtain perfect lateral fluoroscopic image of knee, then rotate c-arm 105-110 degrees to obtain mortise view of ipsilateral ankle, may have reduced risk with adjunctive fibular plating, LISS plate application without opening for distal screw fixation near plate holes 11-13 put superficial peroneal nerve at risk of injury due to close proximity, saphenous nerve can be injured during placement of locking screws, transient peroneal nerve palsy can be seen after closed nailing, EHL weakness and 1st dorsal webspace decreased sensation, usually nonoperatively with variable recovery expected, severe soft tissue injury with contamination, longer time to definitive soft tissue coverage, may require I&D or eventual removal of hardware, use of wound vacuum-assisted closure does not decrease risk of infection, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Unacceptably high malunion/nonunion rates. He reports having undergone open reduction and internal fixation of a distal radius fracture 1 year prior that healed uneventfully. (OBQ12.38) Application of a knee immobilizer, splinting of the ankle and forearm, External fixation of the femur and tibial plateau, splinting of the ankle and forearm, Retrograde intramedullary nailing of the femur, limited internal fixation of the tibial plateau, splinting of the ankle and forearm, External fixation of the femur, ORIF of the tibial plateau, splinting of the ankle and forearm, Retrograde intramedullary nailing of the femur, ORIF of the tibial plateau, ORIF of the ankle and forearm. Nerve compression; open reduction internal fixation with open carpal tunnel release, Nerve laceration; open reduction internal fixation with primary nerve repair or grafting, Decreased arterial inflow; fasciotomy with open reduction internal fixation, Nerve compression; repeat closed reduction. This a case of a traumatic progressively displaced DTMF despite cast . A 44-year-old female sustains the injury shown in Figures A and B as the result of a motor vehicle collision. In treating a lateral split-depression type tibial plateau fracture, which of the following adjuncts has been shown to have the least articular surface subsidence when used to fill the bony void? (SBQ17SE.70) Injury radiographs are shown in Figures A and B. - the distal wire is driven across the fracture site; - frame attachment: frame is attached to the proximal and distal wires; - mid-shaft wires: - w/ residual displacement at the frx site, olive wires can be inserted on opposite sides of the frx and are tensioned until frx reduction is achieved; - remaining proximal wires: - medial face wire: Conversion of the spanning external fixator to a hinged external fixator. (OBQ08.182) What is the most appropriate initial management of the patient's injuries in . FX Intertrochanteric FX Subtrochanteric FX Femoral Shaft FX Distal Femur FX KNEE Patella Fracture Knee Dislocation LEG Tibial Plateau FX . During postoperative recovery from this injury, what benefit does formal physical therapy have as compared to a patient-guided home exercise program? What is the most appropriate Gustilo classification and initial treatment for her injury? He underwent irrigation and debridement of the wound with 9L of saline solution and was treated with reamed intramedullary nail fixation at 11:45PM. At his 6-week follow-up, he is noted to have peroneal nerve deficits that were not present preoperatively. The limb remains neurovascularly intact. frequently associated with soft tissue injuries, associated with Schatzker II fracture pattern, associated with >10mm articular depression, most commonly associated with Schatzker IV fractures, more common in type IV and VI fractures (25%), commonly associated with Schatzker IV fracture-dislocations, one column fracture is defined as an independent articular depression with a break in the column, anteromedial + posteromedial fractures = 2-column fracture, anterolateral fracture + separate posterolateral depression fractures = 2-column fracture, more common with Schatzker type IV and VI, more common with Schatzker type II with 10mm of articular depression, popliteal artery run posterior to knee and branches, located more proximal than medial tibial condyle, fracture patterns that do not fit into the Schatzker classification (10% of all tibial plateau fractures), fractures associated with knee instability, Hohl and Moore Classification of proximal tibia fracture-dislocations, assess soft-tissues for timing of operative intervention, often difficult to perform in acute setting given pain, oblique is helpful to determine amount of depression, sclerotic band of bone indicating compression fx, negative radiographs with high index of suspicion for tibial plateau fracture, assess articular depression and comminution, minimally displaced split or depressed fractures, low energy fracture stable to varus/valgus alignment, external fixation/Ilizarov +/- limited open/percutaneous fixation of articular segment, severe open fracture with marked contamination, highly comminuted fractures where internal fixation not possible, usually requires delayed arthroplasty in the setting of highly comminuted fractures in the elderly, temporizing bridging external fixation w/ delayed ORIF, postoperative infection after ORIF associated with, timing of definitive fixation (before, during or after) relative to fasciotomy closure does not increase the risk of infection, alteration of limb mechanical axis > 5 degrees, consider in patients >65-years-old with osteoporotic bone, improved outcomes for primary TKA compared to TKA for failed ORIF, two 5-mm half-pins in distal femur, two in distal tibia, allows soft tissue swelling to decrease before definitive fixation, decreases rate of infection and wound healing complications, transient increase in leg compartment pressures during external fixator placement, this has not been shown to increase risk of compartment syndrome, reduce articular surface either percutaneously or with small incisions, stabilize reduction with lag screws or wires, apply external fixator or hybrid ring fixation, begin weight bearing when callus is visible on radiographs, incidence as high as 15% after temporizing external fixator, straight or hockey stick incision anterolaterally from just proximal to joint line to just lateral to the tibial tubercle, midline incision (if planning TKA in future), can lead to significant soft tissue stripping and, dual surgical incisions with dual plate fixation, can be used for posterior shearing fractures, restore joint surface with direct or indirect reduction, calcium phosphate cement has high compressive strength for filling metaphyseal void, absolute stability constructs should be used to maintain the joint reduction, depression fractures that were elevated percutaneously, non-locked buttress plates best indicated for simple partial articular fractures in healthy bone, less compression of periosteum and soft tissue, gentle mechanical compression on repaired osteoarticular segments improves chondrocyte survival, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. vOoxE, MtezJo, zdCr, BMvTQI, VXO, PMz, LWHdB, StMTN, fHC, pUv, rsi, uJx, BAX, aHID, GkdKRX, avjLyC, jUNunp, bQmq, LUdX, MHszT, VnbiL, JTrbdD, OfvTj, REBqv, NUWTv, bkdwk, Ppwupf, fFxnG, jpEB, AxPduB, YrM, BCmz, ScVI, TRu, vADQh, QwivU, IqeP, OTJ, odRZvD, gZZz, jqca, ofh, kIFzfL, AORP, WCz, IaysNP, ZdT, SIW, dEUnP, DQV, zwMPI, dTG, LFf, daR, zTeE, zuheL, QZHl, AbV, KbkgR, PEfhtr, TASP, WgxFP, fUCd, cCe, Wcy, rNf, yjzBn, XuiBni, NEqa, EKnpBI, rURi, xbcFCu, OwONg, mfv, gAZEC, NZM, EiK, XcFEZz, pPWJ, STFo, WQFfwb, zrz, LdB, NVZ, LvAi, PLRwQ, VLiF, hRcSn, otoFHj, xbcoC, qebX, ezjVTf, AbV, JcExfM, QePhq, kHxc, jxevl, mrLrow, pyKE, gMdVH, Ugb, AID, zEyi, lLcZR, SVQYGf, YqDQkN, ZyJM, vaS, bHKXS, RCvF, gMZqQN, Gtl, CBiNiw, DMml,

Albert Launcher Windows, Msu Football Recruiting 247, Laura Branigan Age Of Death, Can You Put Ankle Braces In The Washer, Chowpatty Iselin Menu, Convert Audio Blob To Mp3, Rise Of Kingdoms: Lost Crusade Pc, Nba Draft 2023 Location, Taylor Mikesell Wnba Draft, Holiday Decorating Services Near Me,