What is the most likely reason for her instability? Associated injuries. knee pain & instability. Symptoms. What is the next best step in management? Symptoms. Pelvic ring fractures are high energy fractures of the pelvic ring which typically occur due to blunt trauma. potential avulsion of plantar plate off base of phalanx. Now the Best Buy app is more than just great hand-held shopping. recommended views. A chest radiograph and a pelvis AP radiograph (Figure A) are obtained. (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. Copyright 2022 Lineage Medical, Inc. All rights reserved. What is the next step in management? At a one year follow-up, the only long term sequela of his injuries is erectile dysfunction. 4% (41/1149) 5. elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture. Talar neck fracture. (OBQ10.96) 20% (229/1149) 4. Coronoid Fractures are traumatic elbow fractures that are generally pathognomonic for an episode of elbow instability. (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. Which muscle shown in Figure A-E derives its innervation from the posterior cord of the brachial plexus? prophylactic antibiotics as appropriate. Radiographs should be obtained to document reduction. 75% (2662/3562) 64% (677/1066) 2. ligament avulsion off the ulnar insertion. What structure should be reduced and stabilized first? Anatomy. (OBQ19.114) Sensation over the lateral aspect of shoulder, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. Multiligamentous injury with periarticular fracture. unrestrained passenger MVA (knee against dashboard) falls from height. avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of talus. He describes a comminuted radial head fracture and posterolateral ulnohumeral dislocation. A 31-year-old male sustains an ipsilateral displaced transverse acetabular fracture, pubic rami fractures, and a sacroiliac joint dislocation. 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). (OBQ08.41) (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. second most common tarsal fractures after calcaneus fxs. Bilateral weight bearing as tolerated for Anterior Posterior Compression Type I injury, Touchdown weight bearing on the right for Lateral Compression Type I injury, Bilateral weight bearing as tolerated for Lateral Compression Type I injury, Posterior sacroiliac screw, followed by non-weight bearing for Lateral Compression Type II injury, Posterior sacral plate, followed by non-weight bearing for Lateral Compression Type III injury. 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. [ 3, 2] As in the assessment of any case of pediatric. What would be the most appropriate next step in treatment? He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. (OBQ04.60) (OBQ07.133) Which of the following is true regarding the transfusion of packed red blood cells, platelets, and fresh frozen plasma? He is otherwise hemodynamically stable. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. 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. In most instances, pediatric supracondylar humerus fractures (SCHFs) result from a fall on outstretched hand with the elbow hyperextended. account for 13-23% of talus fractures. -Protected weight bearing (complete, comminuted sacral component. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. Associated injuries. Biomechanics. 15% (804/5473) 5. He subsequently develops the post-traumatic condition shown in Figure A. Which of the following is the next most appropriate step in managment? patella sleeve fracture. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. 91% (2662/2927) 5. He has pain and swelling at the elbow without evidence of instability. Manual in-line skeletal traction using a proximal tibial pin in the emergency room, provisional long-leg splinting. coronoid tip. A 36-year-old woman was injured in a train derailment. Orthobullets Team Team Orthobullets (D) Trauma A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. During surgery, the trauma surgeon replaces the radial head and repairs the lateral collateral ligament complex. Calcaneus fracture. talus. Grade I-III with a bony avulsion. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. (SBQ12TR.92) What risk factor leads to the highest rate of postoperative loss of reduction in unstable posterior pelvic ring injuries? 4% (41/1149) 5. A 25-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. Anatomic location. Presentation. 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. A 32-year-old professional skydiver lands awkwardly during a jump. Anatomic location. second most common tarsal fractures after calcaneus fxs, injuries often result from high energy trauma, with the hindfoot either in supination or pronation, injuries result from forced dorsiflexion, axial loading, and inversion with external rotation, Talus has no muscular or tendinous attachments, seventy percent of the talus is covered by cartilage, this forms the lateral margin of the talofibular joint, because of limited soft tissue attachments, the talus has a direct extra-osseous blood supply, may be only remaining blood supply with a talar neck fracture, Fractures do not involved the articular surface, Fractures involve the subtalar and talofibular joint, Avulsion of the posterior talotibial ligament or posterior deltoid ligament, Avulsion of the posterior talofibular ligament, lateral process fractures often misdiagnosed as ankle sprains, pain aggravated by FHL flexion or extension may be found with a posterolateral tubercle fractures, lateral process fractures may be viewed on AP radiographs, may be falsely negative in talar lateral process fx, indicated when suspicion is high and radiographs are negative, best study for posterior process fx, lateral process fx, and posteromedial process fx, helpful to determine degree of displacement, comminution, and articular congruity, can be used to confirm diagnosis when radiographs are negative, nondisplaced (< 2mm) lateral process fractures, nondisplaced (< 2mm) posterior process fractures, nondisplaced (< 2mm) talar head fractures, nondisplaced (< 2mm) talar body fractures, displaced (> 2mm) lateral process fractures, medial, lateral or posterior malleolar osteotomies may be necessary, displaced (> 2mm) posteromedial process fractures, may require osteotomies of posterior or medial malleoli to adequately reduce the fragments, incision over tarsal sinus, reflect EDB distally, for medial tubercle of posterior process fracture or for entire posterior process fracture that has displaced medially, for lateral tubercle of posterior process fractures, between peroneal tendons and Achilles tendon (protect sural nerve), beware when dissecting medial to FHL tendon (neurovascular bundle lies there), required for talar body fractures with more than 2 mm of displacement, incompetence of the lateral talocalcaneal ligament is expected with excision of a 1 cm fragment, this is biomechanically tolerated and does not lead to ankle or subtalar joint instability, lack of Hawkins sign with sclerosis is indicative of AVN, posttraumatic arthritis is common in all of these fractures, this can be treated with an arthrodesis of the talonavicular joint, may have pain up to 2 years after treatment, found in 45% of patients with lateral process fractures, treated either non-operatively or operatively, Lateral process injuries have a favorable outcomes with prompt diagnosis and immediate treatment, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Which of the following statements is true regarding this injury? The elbow is splinted in elbow flexion and pronation. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Which of the following is the most common complication after the procedure shown in Figure B? A patient sustains a transection of the posterior cord of the brachial plexus from a knife injury. A 34-year-old male has persistent anterolateral ankle pain after a snowboarding injury 1 week ago and is unable to bear weight. You can rate this topic again in 12 months. He has pain and swelling at the elbow without evidence of instability. What is the most appropriate next step in orthopaedic management? A2-1: iliac wing fractures often from a direct blow possible soft tissue or bowel entrapment in the fracture site. 4% (41/1149) 5. What is the most appropriate management of this injury? He is intubated in the field and receives 2 liters of LR and continues to be tachycardic and hypotensive. potential avulsion of plantar plate off base of phalanx. (OBQ12.43) talar body fractures . Intravenous access is obtained and radiographs are pending. A2-1: iliac wing fractures often from a direct blow possible soft tissue or bowel entrapment in the fracture site. Rim avulsion fracture of lateral plateau. This injury would affect all of the following muscles EXCEPT? Calcaneus FX Other Trauma Topics coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation. A 40-year-old male laborer sustained a fall from height and has isolated pelvic pain. Closed reduction in the operating room using a femoral distractor. Orthobullets Team An injury radiograph is shown in Figure A. Septic Arthritis is the inflammation of the joints secondary to an infectious etiology, most commonly affecting the knee, hip, and shoulder. If pulses do not return, perform popliteal artery exploration. 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. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. (OBQ12.143) 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. There is no tenderness to palpation at the posterior pelvis. Lack of coronoid fixation with medial buttress plate, Lack of coronoid fixation from lateral approach, Lack of medial collateral ligament repair, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Orthopedic Building at Rush University Medical Center, Coronoid Fx - Open Reduction Internal Fixation with Screws, Type in at least one full word to see suggestions list. If pulses do not return, perform computed tomography angiography in the radiology suite. Calcaneus FX Other Trauma Topics impaction, avulsion or shear forces involved. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course fracture displacement and patient activity demands. Etiology. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. This is an AAOS Self Assessment Exam (SAE) question. Which of the following factors is a relative contraindication to open reduction and plating of her posterior pelvic injury from an anterior approach? retinacular injury is typical. Range-of-motion is from -5 degrees to 130 degrees. likely underreported as approximately 50% self-reduce and are misdiagnosed, high energy is usually from MVC, crush injury, fall from a height, or dashboard, injury resulting in axial load to a flexed knee, low energy may be from an athletic injury or routine walking, hyperextension injury leads to anterior dislocations, posteriorly directed force across the proximal tibia (dashboard injuries) leads to posterior dislocations, the knee is a ginglymoid joint and consists of tibiofemoral, patellofemoral and tibiofibular articulations, PCL, ACL, LCL, MCL, and PLC are all at risk for injury, main stabilizers of the knee given the limited stability afforded by the bony articulations, popliteal artery injuries occur often due to tethering at the popliteal fossa, proximal - fibrous tunnel at the adductor hiatus, geniculate arteries may provide collateral flow and palpable pulses masking a limb-threatening vascular injury, the normal range of motion of 0-140 degrees with 8-12 degrees of rotation during flexion/extension, Kennedy classification based on the direction of displacement of the tibia, (based on the direction of displacement of the tibia), due to axial load to the flexed knee (dashboard injury), usually involves tears of both ACL and PCL, posterolateral is most common rotational dislocation, buttonholing of femoral condyle through the capsule, based on a pattern of multiligamentous injury of knee dislocation (KD), (based on the number of ruptured ligaments), Multiligamentous injury with the involvement of the ACL or PCL. 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. Which of the following best describes the radiographic findings associated with this pelvic injury pattern using the Young-Burgess Classification system? -Weight bearing as tolerated (simple, incomplete sacral fracture). A 32-year-old male is involved in a motor vehicle collision and sustains the injury seen in Figure A. Type V. Four-part fracture. Orthobullets Team Trauma Ipsilateral calcaneus fracture. coronoid tip. Figure A is the radiograph that was obtained in the emergency department. (SBQ09TR.31.1) Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course often results in transverse fracture or inferior pole avulsion. retinacular injury is typical. A 34-year-old male presents with elbow pain after sustaining a ground level fall 2 weeks ago. Which of the following fixation methods has been shown to be the most stable fixation construct for this injury? He is subsequently taken to radiology for radiographs and a chest, abdomen, and pelvis CT with 4mm cuts. 6% (200/3562) 5. If pulses do not return, perform on-table angiogram. Partial patellectomy is the recommended treatment for which of the following injuries? 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. Which of the following treatment options has been shown to have the best outcomes with this injury? (OBQ15.63) What percentage of these injuries will present with an associated vascular injury? A 23-year-old male is an unrestrained driver in a motor vehicle accident and sustains an unstable pelvic ring fracture. Grade I-III with a bony avulsion. Common mechanism is rollover vehicle accident or pedestrian vs auto. 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. Which of the following provocative maneuvers will most likely be positive? Copyright 2022 Lineage Medical, Inc. All rights reserved. A radiograph is shown in Figure A. Which radiographic injury seen in Figures A-E is most commonly associated with this complication? What is the most likely physical exam manifestation? A 30-year-old man is the front seat passenger in a motor vehicle accident. (OBQ08.205) Calcaneus FX Other Trauma Topics coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation. The patient is then evaluated by a keen orthopedic resident in the emergency room who describes the zookeeper's injuries to his chief. A 34-year-old female presents to the trauma bay with hemodynamic instability following a motor vehicle collision. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. An 18-year-old football player is injured after making a tackle with his left shoulder. 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. He is hemodynamically unstable at initial evaluation in the trauma bay. What effect will these modalities have on the radiographic appearance of his pelvis fracture and what further intervention should be performed? Diagnosis can be made using plain radiographs of the elbow. What is the most common urological injury associated with this injury pattern? Copyright 2022 Lineage Medical, Inc. All rights reserved. A 65-year-old female presents with the injury seen in Figures A and B after a motor vehicle collision. The chief resident orders a CT scan which demonstrates a coronoid fracture involving 50% the height with no involvement of the anteromedial facet. Greater than 10mm of articular depression. (OBQ12.229) A 72-year-old woman falls down the stairs and is now unable to bear weight secondary to right groin pain. 6% (200/3562) 5. An anteromedial coronoid fracture. scapular and shoulder series. (OBQ18.197) Following successful closed reduction of both extremities, both feet are warm and pulses are present. scapular and shoulder series. Biomechanics. These classifications need to be simple, easy to apply clinically and reproducible, with high concordance between surgeons.6, 7, 8 The. Anterior talofibular ligament injury. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. bone work. (OBQ18.81) (OBQ11.30) Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course A1-1: iliac spine avulsion injury. (OBQ14.15) 91% (2662/2927) 5. Open reduction and reconstruction plating of the symphysis, Protected weightbearing and binder as needed and observation, Open reduction and wiring of the symphysis. Symptoms. Safety starts with understanding how developers collect and share your data. Which of the following imaging techniques best describes the correct utilization of intraoperative flouroscopy for percutaneous iliosacral screw placement across S1? A 43-year-old male suffers a knee injury and undergoes the operation seen in Figures A and B. Talar neck fracture. Thank you. Recalcitrant medial sesamoid stress fracture with fragmentation. A 23-year-old male is involved in a motor vehicle accident and sustains a left open femur fracture, right open humeral shaft fracture, and an LC-II pelvic ring injury. 2% Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft. 10% Orthobullets Team second most common tarsal fractures after calcaneus fxs. recommended views. (SAE07SM.29) 10% Orthobullets Team A type I avulsion fracture of the coronoid. He subsequently develops the post-traumatic condition shown in Figure A. A merchant view is performed which shows no significant degenerative changes of the patellofemoral joint. Anterior talofibular ligament injury. (OBQ13.249) A 37-year-old male is struck by a car while walking at night. Multiligamentous injury with periarticular fracture. Pubic symphysis diastasis, intact anterior sacroiliac ligaments, intact sacrotuberous ligament, intact posterior sacroiliac ligaments, Pubic symphysis diastasis, torn anterior sacroiliac ligaments, intact sacrotuberous ligament intact posterior sacroiliac ligaments, Pubic symphysis diastasis, intact anterior sacroiliac ligaments, torn sacrotuberous ligament, intact posterior sacroiliac ligaments, Pubic symphysis diastasis, torn anterior sacroiliac ligaments, torn sacrotuberous ligament, intact posterior sacroiliac ligaments, Pubic symphysis diastasis, intact anterior sacroiliac ligaments, torn sacrotuberous ligament, torn posterior sacroiliac ligaments. proximal migration of sesamoids. A 35-year-old zookeeper fell 10 feet while preparing an exhibit for a grand reopening, landing on his left arm. Which of the following treatments would most likely alleviate his pain? 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. (OBQ12.236) (OBQ04.123) Treatment may be nonoperative for nondisplaced coronoid tip fractures with a stable elbow. 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. Biomechanics. Results from an excessive displacement of head to opposite side and depression of shoulder on the same side producing traction on plexus. An abdominal CT demonstrates free fluid and air in the intraperitoneal cavity, and a laparotomy is indicated. 75% (2662/3562) 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. She sustained isolated orthopedic injuries noted in Figures A-C. Bedside doppler assessment is performed and the results are seen in Figure A. 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. 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). If pulses do not return, perform standard angiography in the angiography suite. 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. Recalcitrant medial sesamoid stress fracture with fragmentation. KDIIIM (ACL, PCL, MCL) and KDIIIL (ACL, PCL, PLC, LCL). No vascular injury is identified. A 42-year-old female sustains the injury shown in Figure A as the result of a fall from a ladder. Copyright 2022 Lineage Medical, Inc. All rights reserved. account for 13-23% of talus fractures. Diagnosis is made with an aspiration of joint fluid with a WBC count > 50,000 being considered diagnostic for septic arthritis. (OBQ13.216) Type V. Four-part fracture. Presentation. Anatomic location. Acute medial sesamoid fracture. 6, 7, 8 The, After classifying each fracture according to. bone work. Osteology. Diagnosis requires focused physical examination with EMG/NCS and MRI studies used for confirmation as needed. Which of the following is the most common cause of death with this type of pelvic injury pattern? He is stabilized following placement of a pelvic binder and receiving blood products as part of a massive transfusion protocol. What would be the most appropriate surgical indication for transferring fascicles of the ulnar nerve to the motor nerve of the biceps and fascicles of the median nerve to the motor nerve of the brachialis? What is the most urgent next step in management? Severely comminuted inferior pole fracture, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Patella Fracture ORIF with Tension Band and K Wires, Type in at least one full word to see suggestions list, Patella Fracture - Tension Band Wiring (A Touch Surgery Video TM), Patella (Kneecap) Fracture treated with a plate and screws, Patellar Fracture Fixation With Cannulated Compression Screws and FiberTape Cerclage, Question SessionPatella Fractures & Scaphoid Fractures. Two months later, the patient continues to complain of pain and instability. technique (see below) arthroscopy. 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. (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. (OBQ08.207) Alternating single-leg-stance radiographs are most helpful for evaluation of which of the following diagnoses? 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. A pelvis radiograph is shown in Figure A. 85% (1536/1804) 3. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. (OBQ08.188) 6% (200/3562) 5. A stress examination under anesthesia does not show any further anterior diastasis or posterior pelvic ring displacement. (OBQ10.144) (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. During percutaneous iliosacral screw placement for an unstable pelvic ring injury, use of the lateral sacral fluoroscopic image is critical to help avoid iatrogenic injury to what structure? 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? Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course often results in transverse fracture or inferior pole avulsion. talar body fractures . 1% (25/2927) 4. What is the next step in treatment? An anteromedial coronoid fracture. Septic Arthritis - Adult. (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. (SBQ07SM.29) 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? She is hemodynamically unstable and undergoes emergent pelvic supra-acetabular external fixation followed by laparotomy. Copyright 2022 Lineage Medical, Inc. All rights reserved. He has decreased sensation over the lateral aspect of the left shoulder and radial aspect of the forearm. (OBQ05.229) Anatomy. 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. What anatomic site has been injured? Which of the following descriptions is true regarding APC-II (anterior-posterior compression) pelvic injuries as classified by Young and Burgess? Anterior talofibular ligament injury. patella sleeve fracture. Injury to ACL, PCL, PMC, and PLC (4 ligaments), Multiligamentous injury with periarticular fracture, history of trauma and deformity of the knee, may present with subtle signs of trauma (swelling, effusion, abrasions, ecchymosis), reduce immediately, especially if absent pulses, indicative of an irreducible posterolateral dislocation, a contraindication to closed reduction due to risks of skin necrosis, priority is to rule out vascular injury on exam both before and after reduction, palpate the dorsalis pedis and posterior tibial pulses on injured and contralateral side, does not indicate the absence of arterial injury, collateral circulation can mask a complete popliteal artery occlusion, measure Ankle-Brachial Index (ABI) on all patients with suspected KD, then monitor with serial examination (100% Negative Predictive Value), perform an arterial duplex ultrasound or CT angiography, if arterial injury confirmed then consult vascular surgery, confirm that the knee joint is reduced or perform immediate reduction and reassessment, >8 hours has amputation rates as high as 86%, imaging contraindicated if it will delay surgical revascularization, if pulses present after reduction then measure ABI then consider observation vs. angiography, assess sensory and motor function of peroneal and tibial nerve as nerve deficits often occur concomitantly with vascular injuries, may see recurvatum when held in extension, avulsion fxs (Segond sign - lateral tibial condyle avulsion fx), post reduction AP and lateral of the knee, fracture identified on post reduction plain films, obtain post reduction CT for characterization of fracture, tibial eminence, tibial tubercle, and tibial plateau fractures may be seen, after acute reduction but prior to hardware placement, required to evaluate soft tissue injury (ligaments, meniscus) and for surgical planning, emergent closed reduction followed by vascular assessment/consult, pulses are absent or diminished following reduction, if arterial injury confirmed by arterial duplex ultrasound or CT angiography, successful closed reduction without vacular compromise, most cases require some form of surgical stabilization following reduction, worse outcomes are seen with nonoperative management, prolonged immobilization will lead to loss of ROM with persistent instability, obesity (may be difficult to obtain closed), obese (if difficult to maintain reduction), instability will require some kind of ligamentous repair or fixation, patients can be placed in a knee immobilizer until treated operatively, anterior dislocation - traction and anterior translation of the femur, posterior dislocation - traction, extension, and anterior translation of the tibia, medial/lateral - traction and medial or lateral translation, rotatory - axial limb traction and rotation in the opposite direction of deformity, midline incision with a medial parapatellar arthrotomy, the medial capsule may need to be pulled over medial condyle if buttonholed, acute associated soft tissue injuries (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair, periarticular fractures may be fixed acutely or spanned with external fixator depending on surgeon preference, place knee-spanning external fixator in 20-30 degrees of flexion with knee reduced in AP and sagittal planes, arthroscopic may not be possible if large capsular injury and creates a risk of fluid extravasation and compartment syndrome, PLC and PMC require open reconstruction given subcutaneous nature and proximity to neurovascular structures, arthroscopic reconstruction of ACL and/or PCL, address intraarticular pathology (menisci, cartilage defects, capsular injury), open repair versus reconstruction of collateral ligaments, acute (< 3 weeks) and staged reconstruction have equivalent outcomes, KD IV injuries have the highest rate of vascular injuries, emergent vascular repair and prophylactic fasciotomies, 25% occurrence of a peroneal nerve injury, neurolysis or exploration at the time of reconstruction, nerve repair or reconstruction or tendon transfers if chronic nerve palsy persists, dynamic tendon transfer involves transferring the posterior tibial tendon (PTT) to the foot, Complications frequent and rarely does knee return to a pre-injury state, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries.