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