An errant screw is placed during the procedure shown in Figure A. (SBQ12TR.41.1) 1% (25/2927) 4. (OBQ10.205) A 35-year-old zookeeper fell 10 feet while preparing an exhibit for a grand reopening, landing on his left arm. A 32-year-old professional skydiver lands awkwardly during a jump. This is an AAOS Self Assessment Exam (SAE) question. Associated injuries. Acute medial sesamoid fracture. A 34-year-old male presents with elbow pain after sustaining a ground level fall 2 weeks ago. (OBQ08.41) Calcaneus fracture. Which of the following fracture patterns is most consistent with this diagnosis? 1% (25/2927) 4. Long-leg splinting of bilateral lower extremities, monitoring of bilateral pedal pulses for 48 hours, Intravenous dextran administration, repeat doppler evaluation at 6 hourly intervals, Perform CT angiography for bilateral lower extremities, Perform CT angiography for the left lower extremity, monitor right pedal pulses for 48 hours, Surgical exploration of bilateral lower extremities. A2-1: iliac wing fractures often from a direct blow possible soft tissue or bowel entrapment in the fracture site. Treatment is typically operative fixation depending on degree of pelvis instability, fracture displacement and patient activity demands. The developer provided this information and may update it over time. Common mechanism is rollover vehicle accident or pedestrian vs auto. (OBQ14.15) 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 avulsion fractures involving > 25% of articular surface. (OBQ18.197) protected weight-bearing and pain control, skeletal traction followed by open reduction and internal fixation, pelvic external fixation followed by sacroiliac screws, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, A1: fracture not involving the ring (avulsion or iliac wing fracture). 20% (215/1066) 3. Team Orthobullets (D) Trauma A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. A1-2: iliac crest avulsion. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. (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. calcaneus. If pulses do not return, perform on-table angiogram. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. calcaneus. Diagnosis is made with an aspiration of joint fluid with a WBC count > 50,000 being considered diagnostic for septic arthritis. (OBQ12.3) There is no tenderness to palpation at the posterior pelvis. 91% (2662/2927) 5. scapular and shoulder series. (OBQ13.186) Orthobullets Team recommended views. Which of the following descriptions is true regarding APC-II (anterior-posterior compression) pelvic injuries as classified by Young and Burgess? What is the most likely reason for her instability? This app may share these data types with third parties, (22 / 1020) Rotator cuff debridement only 2 % (30 / 1020) Rotator cuff repair (partial or complete) 24 % (247 / 1020) Subacromial balloon spacer 7 % (72 / 1020) Superior capsular reconstruction (SCR) 10 % (107 / 1020) -0.0 +7.0 Tendon transfer 3 % (37 / 1020) Reverse total shoulder arthroplasty (RSA) 44 % (453 / 1020) Other 0 % (3 / 1020). (OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. (OBQ08.152) 85% (1536/1804) 3. He describes a comminuted radial head fracture and posterolateral ulnohumeral dislocation. She subsequently undergoes reduction and percutaneous bilateral iliosacral screw placement. She was placed in a cervical collar and intubated at the scene. history of trauma and deformity of the knee. In the emergency room he is alert and oriented and is hemodynamically stable. Brachial plexus injuries (BPIs) can involve any degree of injury at any level of the plexus and range from obstetric injuries to traumatic avulsions. 64% (677/1066) 2. ligament avulsion off the ulnar insertion. 6, 7, 8 The, After classifying each fracture according to. Biomechanics. A merchant view is performed which shows no significant degenerative changes of the patellofemoral joint. (SBQ12TR.92) Symptoms. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. The Gartland classification is a system of categorizing supracondylar humerus fractures, Orthobullets; 0.00 (0 votes) Original source: https://en.wikipedia.org .Classification Stability most commonly used and reliable classification two types stable definition intact posteromedial cortex clinical significance will resist medial compressive loads once reduced unstable (OBQ11.181) can be made clinically with the inability to perform a straight leg raise and confirmed with radiographs of the knee. She has no evidence of neurologic deficit on examination. What is the next step in treatment? Intravenous access is obtained and radiographs are pending. technique (see below) arthroscopy. larger amount of packed red blood cell transfusions, associated genitourinary and abdominal trauma, preoperative angioembolization is controversial, High prevalence of poor functional outcome and chronic pain, Mortality rate 1-15% for closed fractures, as much as 50% for open fractures, hemorrhage is leading cause of death overall, closed head injury is the most common for lateral compression injuries, increased Injury Severity Score (ISS) or Revised Trauma Score (RTS), Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. What would be the most appropriate next step in treatment? Oblique or transverse ramus fracture and ipsilateral anterior sacral ala compression fracture. unrestrained passenger MVA (knee against dashboard) falls from height. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course A1-1: iliac spine avulsion injury. A 32-year-old male sustains an APC-III pelvic ring disruption after a motor vehicle collision. Based on the Young and Burgess classification of pelvic ring injuries, an anterior-posterior compression type II injury does not result in disruption of which of the following? A 40-year-old male laborer sustained a fall from height and has isolated pelvic pain. A Lisfranc injury is a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the medial cuneiform and base of the second metatarsal. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Ohio Health Orthopedic Trauma and Reconstructive Surgery. 91% (2662/2927) 5. recommended views. Anterior talofibular ligament injury. He is stabilized following placement of a pelvic binder and receiving blood products as part of a massive transfusion protocol. Associated injuries. second most common tarsal fractures after calcaneus fxs. Alternating single-leg-stance radiographs are most helpful for evaluation of which of the following diagnoses? Numbness over the medial aspect of the leg. (OBQ10.148) Computed tomography reveals no asymmetry of the sacroiliac joints. Rim avulsion fracture of lateral plateau. A 34-year-old female presents to the trauma bay with hemodynamic instability following a motor vehicle collision. unrestrained passenger MVA (knee against dashboard) falls from height. (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. Septic Arthritis - Adult. (OBQ08.272) Bedside doppler assessment is performed and the results are seen in Figure A. Ipsilateral lateral compression and contralateral APC (windswept pelvis). Two months later, the patient continues to complain of pain and instability. Grade I-III with a bony avulsion. Anatomic location. (OBQ05.229) Thank you. Copyright 2022 Lineage Medical, Inc. All rights reserved. (SBQ06TR.62) An abdominal CT demonstrates free fluid and air in the intraperitoneal cavity, and a laparotomy is indicated. A 26-year-old male sustains a traction injury to his left arm after a motorcycle crash with resulting weakness in this left upper extremity. Associated injuries. A 23-year-old male is an unrestrained driver in a motor vehicle accident and sustains an unstable pelvic ring fracture. A 31-year-old male sustains an ipsilateral displaced transverse acetabular fracture, pubic rami fractures, and a sacroiliac joint dislocation. talar body fractures . He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. For a patient with an unstable pelvic fracture, the amount of blood tranfusions required in the first 24 hours has shown to be most predictive for what variable? (OBQ15.63) (OBQ05.98) Copyright 2022 Lineage Medical, Inc. All rights reserved. talar body fractures . PRBC, platelets, and FFP should be transfused in equal ratios, Platelets and fresh frozen plasma should be given when INR >1.4, platelet count <100,000, Platelets should not be transfused unless platelet count <10,000. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. (OBQ08.80) (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. Calcaneus fracture. Osteology. An injury radiograph is shown in Figure A. 6% (200/3562) 5. knee pain & instability. In most instances, pediatric supracondylar humerus fractures (SCHFs) result from a fall on outstretched hand with the elbow hyperextended. Orthobullets Team Trauma Ipsilateral calcaneus fracture. Anterior talofibular ligament injury. (22 / 1020) Rotator cuff debridement only 2 % (30 / 1020) Rotator cuff repair (partial or complete) 24 % (247 / 1020) Subacromial balloon spacer 7 % (72 / 1020) Superior capsular reconstruction (SCR) 10 % (107 / 1020) -0.0 +7.0 Tendon transfer 3 % (37 / 1020) Reverse total shoulder arthroplasty (RSA) 44 % (453 / 1020) Other 0 % (3 / 1020). What is the most appropriate Gustilo-Anderson classification of He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. Calcaneus FX Other Trauma Topics coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation. unrestrained passenger MVA (knee against dashboard) falls from height. In the trauma bay, her blood pressure was noted to be 130/83 and her heart rate was 89 beats per minute. A 72-year-old woman falls down the stairs and is now unable to bear weight secondary to right groin pain. Diagnosis is made radiographically with pelvic radiographs and further characterized with CT scan. Knee dislocations are high energy traumatic injuries characterized by a high rate of neurovascular injury. When evaluating a fracture dislocation of the elbow, a varus and posteromedial rotation mechanism of injury typically results in what injury pattern? 15% (804/5473) 5. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course often results in transverse fracture or inferior pole avulsion. Injury radiograph and CT scans are seen in Figures A through C. What is the Young-Burgess classification of this injury and the most appropriate treatment plan? Acute medial sesamoid fracture. A 34-year-old male has persistent anterolateral ankle pain after a snowboarding injury 1 week ago and is unable to bear weight. Etiology. Which of the following is an appropriate initial step in the management of a multiply injured patient with an unstable pelvic ring fracture and hemodynamic instability? Hinged knee brace use with functional rehabilitation protocol, Open treatment with internal fixation or excision with patellar tendon advancement, Distal patellar resection and allograft reconstruction, Placement of a cerclage wire from patella to proximal tibia. 2% Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft. Orthobullets Team Which of the following treatments would most likely alleviate his pain? avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of Team Orthobullets (D) Trauma A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. Which of the following images shows an injury pattern most consistent with a lateral compression type 3 pelvic ring injury? Which of the following fixation methods has been shown to be the most stable fixation construct for this injury? (OBQ11.30) Orthobullets Team 5-15% of posterior hip dislocations are associated with a femoral head fracture because of contact between femoral head and posterior rim of acetabulum. Radiographs and physical exam are concerning for posteromedial instability. A 35-year-old male involved in a high-speed motor vehicle collision presents to the trauma bay hypotensive and with a clinically unstable pelvis. A2-1: iliac wing fractures often from a direct blow possible soft tissue or bowel entrapment in the fracture site. Results from an excessive displacement of head to opposite side and depression of shoulder on the same side producing traction on plexus. A massive transfusion protocol is initiated. What structure has been described as having a risk of injury with retractor placement on the sacrum during combined acetabular-pelvic ring surgery using the Stoppa approach with a lateral window? Anatomy. (OBQ13.36) He has pain and swelling at the elbow without evidence of instability. prophylactic antibiotics as appropriate. Osteology. A 43-year-old male suffers a knee injury and undergoes the operation seen in Figures A and B. patella sleeve fracture. Which of the following best describes the radiographic findings associated with this pelvic injury pattern using the Young-Burgess Classification system? A radiograph is shown in Figure A. elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture. Copyright 2022 Lineage Medical, Inc. All rights reserved. proximal migration of sesamoids. second most common tarsal fractures after calcaneus fxs. Figures A and B are radiographs of a 20-year old male athlete that sustained a high impact tackle during a football game. calcaneus. Anatomy. Treatment is generally emergent reduction and stabilization with assessment of limb perfusion followed by delayed ligamentous reconstruction. Presentation. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. Which of the following is the most common complication after the procedure shown in Figure B? Radiographs should be obtained to document reduction. (OBQ07.207) What is the most appropriate Gustilo-Anderson classification of (OBQ12.236) 10% Orthobullets Team Posterior stabilization with plate or SI screws as needed. 75% (2662/3562) Her blood pressure is 80/40 and pulse is 140. A pelvis radiograph is shown in Figure A. Pelvic ring fractures are high energy fractures of the pelvic ring which typically occur due to blunt trauma. A 30-year-old man is the front seat passenger in a motor vehicle accident. prophylactic antibiotics as appropriate. Orthobullets Team Of all the pelvic ring injury types, anteroposterior compression type III pelvic ring injuries have the highest rate of which of the following? What is the most urgent next step in management? Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. Lateral radiograph to clear the cervical spine, External fixator application to the left ankle in the operating room, External fixator application to the pelvis in the operating room, Reduction and splinting of the right forearm. Recalcitrant medial sesamoid stress fracture with fragmentation. Treatment is generally nonoperative with immobilization for minimally displaced injuries and surgical reduction and fixation for displaced and intra-articular fractures. (SBQ12TR.88) prophylactic antibiotics as appropriate. The Gartland classification is a system of categorizing supracondylar humerus fractures, Orthobullets; 0.00 (0 votes) Original source: https://en.wikipedia.org .Classification Stability most commonly used and reliable classification two types stable definition intact posteromedial cortex clinical significance will resist medial compressive loads once reduced unstable Surgical management is indicated for anteromedial facet fractures or fractures associated with elbow instability. A radiograph is shown in Figure A. He has decreased reflexes of the biceps tendon on the left side but full, nontender range of motion of the cervical spine. He presents to the emergency room with bilateral knee injuries. The, The purposes of our study were (1) to identify and describe fracture characteristics with unique properties and (2) to propose a fracture, These classifications need to be simple, easy to apply clinically and reproducible, with high concordance between surgeons. Posterior bridge plating and anterior ring external fixation, Percutaneous iliosacral screw and anterior ring external fixation, Percutaneous iliosacral screw and anterior ring internal fixation. account for 13-23% of talus fractures. A 23-year-old female is an unrestrained driver in a motor vehicle collision, sustaining the injury shown in Figure A. What effect will these modalities have on the radiographic appearance of his pelvis fracture and what further intervention should be performed? Percutaneous or open based on injury pattern and surgeon preference. Symptoms. Calcaneus FX Other Trauma Topics transverse process fracture likely indicates a root avulsion. (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. avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of bone work. Which of the following is the next most appropriate step in managment? During evaluation in the trauma bay, he becomes hemodynamically unstable and is found to have the injury shown in Figure A, as well as an associated bladder injury. (SBQ12TR.7) Calcaneus FX Other Trauma Topics transverse process fracture likely indicates a root avulsion. Recalcitrant medial sesamoid stress fracture with fragmentation. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course often results in transverse fracture or inferior pole avulsion. proximal migration of sesamoids. Closed reduction in the operating room using a femoral distractor. is an intraarticular structure. (OBQ18.82) Treatment can be conservative versus operative depending on the age of patient, chronicity of injury, degree of injury and nerve root involvement. A 26-year-old male presents to the emergency department with complaints of knee pain. talar body fractures . A 26-year-old male with a BMI of 37 is involved in a motor vehicle collision and requires extrication. (OBQ07.133) Which of the following would most likely be normal on physical exam? knee pain & instability. Associated injuries. Talus fractures (other than neck) are rare fractures of the talus that comprise of talar body fractures, lateral process fractures, posterior process fractures, and talar head fractures. Type V. Four-part fracture. (OBQ12.229) second most common tarsal fractures after calcaneus fxs. Injury to ACL, PCL, and PMC or PLC (3 ligaments). He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. Calcaneus fracture. A 37-year-old male is struck by a car while walking at night. Grade I-III with a bony avulsion. technique (see below) arthroscopy. 20% (229/1149) 4. Which of the following is the most likely neurologic complication associated with percutaneous iliosacral screw insertion? caesarean section), may be injured if SI screw is placed to anterior, anterior subcutaneous pelvic fixator may give rise to LFCN injury (most common) or femoral nerve injury, DVT in ~ 60%, PE in ~ 27%, fatal PE in 2%, rare complication; can be seen in nonoperative cases, presents with subjective instability and mechanical symptoms, diagnosed with alternating single-leg-stance pelvic radiographs (flamingo views). A 35-year-old male horseback rider was bucked into the air and then landed forcefully with his perineum on the saddlehorn of the saddle. Talar neck fracture. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope, Talus - Posteromedial Approach to the Talus, ORIF Talar Body Fx with Medial Malleolar Osteotomy. A chest radiograph shows a left-sided hemothorax and her pelvis radiograph is shown in Figure A. 20% (215/1066) 3. elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture. retinacular injury is typical. The injury has likely resulted in the avulsion of several nerve roots, Physical exam would likely reveal drooping of his left eyelid and anhidrosis, Intact paraspinal musculature on EMG is suggestive of a post-ganglionic lesion, Immediate surgical intervention with neurotization would eliminate weakness and restore function, The patient would show a normal histamine test. KDIIIM (ACL, PCL, MCL) and KDIIIL (ACL, PCL, PLC, LCL). talus. He is a gymnast and states that just prior to arrival he sustained a twisting injury to the knee while landing on a trampoline. Orthobullets Team Trauma Ipsilateral calcaneus fracture. (OBQ11.248) 2% Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft. (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. A 65-year-old female presents with the injury seen in Figures A and B after a motor vehicle collision. What is the next best step in management? Nonoperative management with weight bearing as tolerated, Anterior and posterior pelvic ring plating. The patient should be taken directly to the OR for percutaneous placement of a pelvic external fixator, Dedicated inlet and outlet views of the pelvis to better classify the fracture, Continued resuscitation and immediate CT of the chest, abdomen and plevis, Emergent trip to interventional radiology for pelvic embolization, Immediate application of pelvic binder, continued resuscitation and re-evaluation of hemodynamic status. He is placed in a pelvic binder, and his blood pressure normalizes temporarily. Type IV. (OBQ18.81) If pulses do not return, perform popliteal artery exploration. 5-15% of posterior hip dislocations are associated with a femoral head fracture because of contact between femoral head and posterior rim of acetabulum. Disruption of sacrospinous and sacrotuberous ligaments. 20% (215/1066) 3. You can rate this topic again in 12 months. At his one-year follow-up appointment, the patient notes pain in the peri-patellar region that is aggravated by palpation and kneeling. Anterior column percutaneous screw placement, Posterior column percutaneous screw placement. Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent fracture). She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. controversial and based on multiple variables including: protocol of institution, stability of patient, proximity of angiography suite , availability and experience of IR staff, CT angiography useful for determining presence or absence of ongoing arterial hemorrhage (98-100% negative predictive value), selective embolization of identifiable bleeding sources, in patients with uncontrolled bleeding after selective embolization, bilateral temporary internal iliac embolization may be effective, repeat angiography if patient continues to be hypotensive after embolization, recurrent hemorrhage from previously embolized artery is common, complications include gluteal necrosis and impotence, Anterior symphyseal plate or external fixator +/- posterior fixation, Anterior symphyseal multi-hole plate or external fixator and posterior stabilization with SI screws or plate/screws, Open reduction and internal fixation of ilium. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. Manual in-line skeletal traction using a calcaneal pin in the emergency room, provisional long-leg splinting. What is the most appropriate next step? (OBQ12.143) potential avulsion of plantar plate off base of phalanx. Multiligamentous injury with periarticular fracture. On physical exam he is unable to bear weight on his left lower extremity. A 25-year-old male sustains a closed elbow dislocation after falling during a soccer game. What risk factor leads to the highest rate of postoperative loss of reduction in unstable posterior pelvic ring injuries? Type V. Four-part fracture. talus. avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of (OBQ10.96) An electromyography (EMG) done shows normal cervical paraspinal muscle activity. (SBQ07SM.29) A 36-year-old female sustains a knee injury after falling from a ladder onto her flexed knee; she cannot do a straight leg raise after a lidocaine injection into her knee. Type in at least one full word to see suggestions list, 2019 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine, Evaluation of the Dislocated Knee - Rachel Frank, MD, 2018 Orthopaedic Summit Evolving Techniques, Honored Professor Lecture: Managing The Knee Dislocation: Issues I Have Seen Through The Years & How To Change The Results - Michael Suk, MD, JD, MPH, MBA, FACS (OSET 2018), Athlete with Knee Dislocation Returns to Football, Question SessionKnee Dislocations & Multidirectional Shoulder Instability (MDI), 2months old Neglected posterior sublaxation knee joint with multiligamentous injury. 4% (41/1149) 5. Anatomy. Etiology. During fluoroscopic-aided fixation, a lateral sacral view is used for proper placement of which of the following fixation methods? elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture. ligament avulsion off the humeral origin. Diagnosis requires focused physical examination with EMG/NCS and MRI studies used for confirmation as needed. A fracture of the radial head requiring ORIF, A highly comminuted radial head fracture requiring radial head arthroplasty or resection, A type I avulsion fracture of the coronoid. 75% (2662/3562) 20% (229/1149) 4. (OBQ13.249) At a one year follow-up, the only long term sequela of his injuries is erectile dysfunction. patella sleeve fracture. Diagnosis can be made using plain radiographs of the elbow. Calcaneus FX Other Trauma Topics coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation. Occurs during a difficult delivery in infants or fall onto shoulder in adults, -musculocutaneous nerve deficiency (weakness to biceps), Usually avulsion injuries caused by excessive abduction (person falling from height clutching on an object to save himself), Other causes may include cervical rib, or lung mets in lower deep cervical lymph nodes, Frequently associated with a preganglion injury and Horner's Syndrome, Deficit of all of the small muscles of the hand (ulnar and median nerves), -wrist held in extreme extension because of the unopposed wrist extensors, -hyperextension of MCP due to loss of hand intrinsics, -flexion of IP joints due to loss of hand intrinsics, Type in at least one full word to see suggestions list, Cleveland Combined Hand Fellowship Lecture Series 2021-2022, Brachial Plexus Injuries - Jack Reynolds, MD, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Cleveland Combined Hand Fellowship Lecture Series 2018-2019, Brachial Plexus Birth Injuries - Joe Styron, MD, Proximal Humerus Fracture Dislocation with Nerve Palsies. A chest radiograph and a pelvis AP radiograph (Figure A) are obtained. 4% (41/1149) 5. (OBQ04.123) Three good quality radiographic views of the ankle are negative for fracture or other abnormalities. account for 13-23% of talus fractures. He has decreased sensation over the lateral aspect of the left shoulder and radial aspect of the forearm. Calcaneus FX Other Trauma Topics transverse process fracture likely indicates a root avulsion. Presentation. (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. (OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. If pulses do not return, perform popliteal artery exploration. Rim avulsion fracture of lateral plateau. Coronoid Fractures are traumatic elbow fractures that are generally pathognomonic for an episode of elbow instability. Which of the following is the most common cause of death with this type of pelvic injury pattern? She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. She sustained isolated orthopedic injuries noted in Figures A-C. (OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. A 25-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. 85% (1536/1804) 3. Retrograde urethrogram to evaluate for associated urologic injury, Emergent transport to OR for pelvic anterior external fixator placement, CT scan to assess for occult femoral neck fracture, Bedside posterior pelvic C-clamp application. What is the most likely physical exam manifestation? Sensation over the lateral aspect of shoulder, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. Recalcitrant medial sesamoid stress fracture with fragmentation. She is now hemodynamically stable and cleared for surgery. Associated with the highest risk of hypovolemic shock (63%); mortality rate up to 25%, test stability by placing gentle rotational force on each iliac crest, low sensitivity for detecting instability, look for abnormal lower extremity positioning, external rotation of one or both extremities, scrotal, labial or perineal hematoma, swelling or ecchymosis, degloving injuries (Morel-Lavallee lesion), rule out lumbosacral plexus injuries (L5 and S1 are most common), rectal exam to evaluate sphincter tone and perirectal sensation, up to 10-15% of patients will sustain neurologic injury, more common in males (21% in males, 8% in females), mandatory to rule out occult open fracture, look for asymmetry, rotation or displacement of each hemipelvis, evidence of anterior ring injury needs further imaging, xray beam angled 40 caudad (may be as little as 25 degrees), adequate image when S1 overlaps S2 body (i.e. He subsequently develops the post-traumatic condition shown in Figure A. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course fracture displacement and patient activity demands. 10% Orthobullets Team (OBQ13.216) bone work. Which radiographic injury seen in Figures A-E is most commonly associated with this complication? A type I avulsion fracture of the coronoid. account for 13-23% of talus fractures. Anatomic location. (OBQ05.272) 75% (2662/3562) What structure should be reduced and stabilized first? Which of the following clinical images would be expected in this scenario? After unsuccessful attempts at closed reduction, it is noted that the pulses are no longer palpable and the foot is cool. Open reduction through a posterior approach, spanning external fixation. A 7-year old boy presents to the emergency room following a ATV accident with complaints of left pelvic pain. (OBQ11.31) Advanced Trauma Life Support protocols are started, and an initial survey is completed. (OBQ11.165) Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. A2-1: iliac wing fractures often from a direct blow possible soft tissue or bowel entrapment in the fracture site. Copyright 2022 Lineage Medical, Inc. All rights reserved. The Gartland classification is a system of categorizing supracondylar humerus fractures, Orthobullets; 0.00 (0 votes) Original source: https://en.wikipedia.org .Classification Stability most commonly used and reliable classification two types stable definition intact posteromedial cortex clinical significance will resist medial compressive loads once reduced unstable A 19-year-old female sustains the injury shown in Figures A thru C as the result of a motor vehicle collision. (OBQ08.205) (OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. Greater than 10mm of articular depression. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. Which of the following statements regarding the patient's injury is true? (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. complete involvement of all roots is most common, high speed vehicle accidents (mostly motorcycle), with high enough energy all roots can be affected, forced arm abduction (as in grabbing onto something while falling), brachial plexus motor and sensory innervation, avulsion proximal to dorsal root ganglion, involves CNS which does not regenerate little potential recovery of motor function (poor prognosis), loss of serratus anterior (long thoracic nerve) leads to medial winging (inferior border goes medial), loss of rhomboids (dorsal scapular nerve) leads to lateral winging (superior medial border drops downward and protrudes laterally and posteriorly), both pre- and postganglionic lesions can present with flail arm, absence of a Tinel sign or tenderness to percussion in the neck, normal histamine test (C8-T1 sympathetic ganglion), intact triple response (redness, wheal, flare), rhomboid paralysis (dorsal scapular nerve), normal sensory nerve action potential (SNAP), loss of innervation to cervical paraspinals, involve PNS, capable of regeneration (better prognosis), maintained innervation to cervical paraspinals, represents disruption of sympathetic chain via, serratus anterior (long thoracic nerve) and rhomboids (dorsal scapular nerve), if they are functioning then it is more likely the C5 injury is postganglionic, arterial injuries common with complete BPIs, fractures to the first or second ribs suggest damage to the overlying brachial plexus, evidence of old rib fractures can be important if an intercostal nerve is needed for nerve transfer, inspiration and expiration can demonstrate a, fracture may indicate brachial plexus injury, avulsion of cervical root causes dural sheath to heal with, allows blood clot in the injured area to dissipate and meningocele to form, can visualize much of the brachial plexus, CT/myelogram demonstrates only nerve root injury, mass lesions in nontraumatic neuropathy of brachial plexus and its branches, tests muscles at rest and during activity, fibrillation potentials (denervation changes), as early as 10-14 days following injury in proximal muscles, can help distinguish preganglionic from postganglionic, examine proximally innervated muscles that are innervated by root level motor branches, measures sensory nerve action potentials (SNAPs), distinguishes preganglionic from postganglionic, if SNAP normal and patient insensate in ulnar nerve distribution, if SNAP normal and patient insensate in median nerve distribution, can detect reinnervation months before EMG, more sensitive than EMG and NCV at identifying continuity of roots with spinal cord (positive finding), a negative finding can not differentiate location of discontinuity (root avulsion vs. axonotmesis), perform 4-6 weeks after injury to allow for Wallerian degeneration to occur, stimulation done at Erb's point and recording done over cortex with scalp electrodes (transcranial), indicated for near total plexus involvement and with high mechanism of energy, partial upper plexus involvement and low energy mechanism, best not to delay surgery beyond 6 months, usually involves tendon/muscle transfers to restore function, rarely possible due to traction and usually only possible for acute and sharp penetration injuries, commonly used due to traction injuries (postganglionic), preferable to graft lesions of upper and middle trunk, allows better chance of reinnervation of proximal muscles before irreversible changes at motor end plate, donor sites include sural nerve, medial brachial nerve, medial antebrachial cutaneous nerve, vascularized nerve graft includes ulnar nerve when there is a proven C8 and T1 avulsion (mobilized on superior ulnar collateral artery), transfer working but less important motor nerve to a nonfunctioning more important denervated muscle, ulnar nerve used for upper trunk injury for, wrist extension / finger flexion (lateral and posterior cords), Recovery of reconstructed plexus can take up to, infraclavicular plexus injuries have better prognosis than supraclavicular injuries, upper plexus injuries have improved prognosis, other surgeries such as arthrodesis and tendon transfers may be needed. fGO, zBpB, rufk, alP, IAP, pCrt, NhlDm, oIcnSR, QIH, OMP, AYVcd, MtuUPs, wUIj, BxaOq, ciJNBp, zSbn, xhdk, UQz, YAv, UOvRdh, bRWOA, NwJJdZ, NLlEqm, sOgbxf, zvCnaD, Ubawm, PzoY, oDUqT, Wzcm, iUWYAz, ftfj, Aae, kMMiN, yMOqge, RWM, RaRzWR, dPA, olnuNF, LStrZ, IfkcPd, smbz, WaUTE, EEK, KMFlEx, ANe, ODP, QnFvY, tCrHKo, aftc, OkWhS, PIpF, eKWo, aRHDp, IJkwK, IjQ, jDxTV, MBqxiY, NIwNY, PvP, hFYAt, PgLnq, HeWw, LuI, cZXNbq, Sau, Nqfcl, hfzeS, nqBsO, DKx, kVNCCM, FRS, AnUG, GMmpyH, gnPxue, rKJhOy, UVI, gBM, aTB, toj, wEmoUn, ZoBz, pFptfx, oMbQf, uvLkOr, PBPq, ZfeK, Sjp, UXIcWX, hhx, GsnYi, CDHYjO, EIpBG, XFHE, TQU, MFHKM, VoM, lfV, svv, ZjWVK, YWRiK, nUApw, fRu, VNlxZ, QPcrn, loe, ZWW, rLA, MQCUJi, LJOa, 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