Type IIB. He presents at 2 months after surgery. Type A. Prior to surgery, a CT scan of the knee is ordered for preoperative planning. The patient walks with an antalgic gait. He subsequently develops the post-traumatic condition shown in Figure A. Recent labs reveal an ESR, CRP and 25-hydroxyvitamin D2 of 32 mm/hr (reference 0-20 mm/hr), 15 mg/dL (reference 0-3 mg/dL), and 50 ng/mL (reference 20-100 ng/mL). He has not done any physical therapy nor received a corticosteroid injection. Capitellum fracture with extension into the trochlea. Spiral (A1) Oblique (A2) Transverse (A3) Type B. Wedge fracture. He presents at 2 months after surgery. 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. History of COPD. 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. Anatomic. Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ Orthobullets Team Wound culture reveals methicillin-resistant Staphylococcus aureus (MRSA). 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. What is a potential complication of the surgical approach to address this injury? He is going to be scheduled for open reduction internal fixation. Classification. He has pain and swelling at the elbow without evidence of instability. The clinical appearance and radiographs are seen in Figures A and B. 5% (176/3364) delineates fracture anatomy and classification. (OBQ05.191) An 11-year-old child has a tibia-fibula fracture following a fall from a swing. (OBQ06.70) A 33-year-old man sustains a femur fracture in a motorcycle accident. Classification. Anatomic location. (SBQ18BS.6) Radiographs and a CT scan are obtained, shown in Figures A-C. Greater than 10mm of articular depression. A 29-year-old male falls down a flight of 10-stairs while intoxicated. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. Distal to coronoid. 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. Calcaneus fracture. (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. On exam, his wounds are well healed with no erythema. account for 13-23% of talus fractures. Low velocity . delineates fracture anatomy and classification. (OBQ05.178) A 42-year-old male sustains a closed, isolated ulna shaft fracture with 2mm displacement and 3 degrees valgus angulation. 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. No vascular injury is identified. History of COPD. Presence of an acute open fracture and crush injury. 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. Classification. obtain post reduction CT for characterization of fracture. CASES (1) Proximal Humerus Fracture Dislocation with Nerve Palsies (C1372) Benjamin C. Taylor Trauma - 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. Presence of an acute open fracture and crush injury. Copyright 2022 Lineage Medical, Inc. All rights reserved. 10/16/2019. Classification. findings. talus. (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 recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. Web(OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. No vascular injury is identified. (OBQ18.241) A 28-year-old male that sustained a closed left femoral shaft fracture 12 months ago and underwent intramedullary nailing presents with persistent pain in the right thigh. calcaneus. Type IIA. OTA classification of radius/ulna. Type I. Coronal split fracture. Treatment is often a combination of culture-directed antibiotics and surgical debridement of nonviable tissue. 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. On exam, his wounds are well healed with no erythema. An MRI image of this patient is shown in Figure A. talar body fractures . Orthobullets Team 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. Talus fracture. He is afebrile. Classification. Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. 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. She reports isolated left elbow pain, and radiographs are shown in Figure A. Associated conditions. 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. Type IIC. (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. (SBQ18TR.42) Essex-Lopresti classification. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. (SBQ18SP.25) A 48-year-old tree surgeon is evaluated in the trauma bay after falling from 20 feet onto his back. Diagnosis is made with the presence of severe and progressive thigh pain that worsenswith passive knee motion. WebKennedy classification based on the direction of displacement of the tibia. Ecchymosis and swelling. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. He is 7% (105/1485) 3. Entire condylar fracture. (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. 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. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. The peak antibiotic elution from an antibiotic-impregnated IMN is expected to occur at what time from surgery? Copyright 2022 Lineage Medical, Inc. All rights reserved. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. 1% (25/2927) 4. Anatomic. Orthobullets Team 12/11/2019. Web(OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. 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. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. Associated conditions. He has pain and swelling at the elbow without evidence of instability. No vascular injury is identified. Kennedy classification based on the direction of displacement of the tibia. He has not done any physical therapy nor received a corticosteroid injection. 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. Orthobullets Team Pediatrics - Accessory Navicular ; Listen Now 14:0 min. Prior to surgery, a CT scan of the knee is ordered for preoperative planning. Web(OBQ06.70) A 33-year-old man sustains a femur fracture in a motorcycle accident. Debridement and lavage, addition of ring fixator, intravenous antibiotics for 6 weeks. Capitellum Fractures are traumatic intra-articular elbow injuries involving the distal humerus at the capitellum. 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. posterior splint immobilization for < 3 weeks. Metaphyseal-diaphyseal junction. (OBQ13.63) Simple fracture. 22-A2.3. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. Orthobullets Team Ipsilateral calcaneus fracture. WebCalcaneus FX Other Trauma Topics capitellar fracture can cause potential block to motion and instability due to loss of the radiocapitellar articulation. 91% OTA classification of radius/ulna. Orthobullets Team 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. Diagnosis. 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. Figures A and B are the current radiographs. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. Biomechanics. Type I. Coronal split fracture. Calcaneus FX Other Trauma Topics Cierny-Mader Classification of Osteomyelitis (describes anatomic involvement, host, treatment, prognosis) Anatomic Location. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. His surgical sites are well healed and there are no signs of drainage. His surgical sites are well healed and there are no signs of drainage. (OBQ05.178) A 42-year-old male sustains a closed, isolated ulna shaft fracture with 2mm displacement and 3 degrees valgus angulation. AP and lateral radiographs are provided in Figure A. Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ Orthobullets Team 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. Galeazzi Fracture - Pediatric bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. Preganglionic vs. postganglionic. Webcalcaneus is osteotomized and rotated 50-90 degrees to keep posterior aspect of calcaneus distal. Web(SBQ18SP.25) A 48-year-old tree surgeon is evaluated in the trauma bay after falling from 20 feet onto his back. (OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. 4/20/2020. The best functional outcome can be expected with which of the following definitive treatment options? OTA classification of radius/ulna. .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. Osteomyelitis is the infection of bone characterized by progressive inflammatory destruction and apposition of new bone. She lives in an assisted living facility, and reports no other major medical problems. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. (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. posterior Navicular fracture. Radiographs and a CT scan are obtained, shown in Figures A-C. Preganglionic vs. postganglionic. posterior A 38-year-old man falls from a ladder and presents with the injury depicted in Figure A. lateral support. usually high energy injury (MVA, contact sports) atraumatic subluxation. .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. Calcaneus FX Other Trauma Topics Cierny-Mader Classification of Osteomyelitis (describes anatomic involvement, host, treatment, prognosis) Anatomic Location. preganglionic . Type I. Coronal split fracture. Preganglionic vs. postganglionic. Hohl and Moore Classification of proximal tibia fracture-dislocations. History of bleomycin treatment. Imaging is shown in Figure A. Type IIB. He underwent operative fixation of his fracture. 9% Treatment. Classification of Low Ankle Sprains. 22-A2.3. 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. Prior to surgery, a CT scan of the knee is ordered for preoperative planning. usually high energy injury (MVA, contact sports) atraumatic subluxation. obtain post reduction CT for characterization of fracture. (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. Distal to coronoid. 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. lateral support. rings placed at the level of the plafond or calcaneus to distract and reduce the fracture. Talus 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. 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. 26% (874/3364) 5. Ecchymosis and swelling. He denies any constitutional symptoms and his pain is well controlled. rings placed at the level of the plafond or calcaneus to distract and reduce the fracture. A galeazzi fracture is a distal 1/3 radial shaft fracture with an associated distal radioulnar joint (DRUJ) injury. WebClassification. OTA classification of radius/ulna. The patient walks with an antalgic gait. Coronoid level. Ligament disruption. His surgical wounds appear well-healed with a small sinus tract over the open fracture site. He endorses significant low back pain and an inability to ambulate. Operative. History of bleomycin treatment. lateral support. 5.0 (2) See More See Less. WebDiagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. He complains of right leg pain, and physical exam reveals no evidence of an open fracture. AP and lateral radiographs are provided in Figure A. Orthobullets Engineer (admin) Trauma - Gun Shot Wounds; Listen Now 20:10 min. 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. He denies any constitutional symptoms and his pain is well controlled. (OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Metaphyseal-diaphyseal junction. Low velocity . Sangeorzan Classification of Navicular Body Fractures any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing Galeazzi Fracture - Pediatric bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. Classification. Biomechanics. Type A. 22-A2.3. obtain AP, inlet/outlet, judet views after reduction. Calcaneus FX Other Trauma Topics capitellar fracture can cause potential block to motion and instability due to loss of the radiocapitellar articulation. Team Orthobullets (D) Trauma (OBQ10.19) A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. 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. Orthobullets Team 12/11/2019. Debridement and lavage, exchange nailing using a larger diameter nail, intravenous antibiotics for 6 weeks. Retention of tibial nail, lifelong intravenous antibiotic suppression. 4/20/2020. The patient walks with an antalgic gait. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. from a handgun with a muzzle-velocity of 1000 feet/second if he is neurovascularly intact and radiographs reveal no fracture? (OBQ12.153) Anatomic location. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. Treatment is usually emergent fasciotomies of all 3 compartments. 91% 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). Hohl and Moore Classification of proximal tibia fracture-dislocations. (OBQ06.70) A 33-year-old man sustains a femur fracture in a motorcycle accident. 5% (176/3364) Spiral (A1) Oblique (A2) Transverse (A3) Type B. Wedge fracture. Team Orthobullets (D) Trauma (OBQ10.19) A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. 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. usually high energy injury (MVA, contact sports) atraumatic subluxation. 5.0 (2) See More See Less. Orthobullets Engineer (admin) Trauma - Gun Shot Wounds; Listen Now 20:10 min. 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. 5.0 (2) See More See Less. Simple fracture. other factors affecting prognosis and treatment include: residual foreign materials and/or ischemic and necrotic tissues, when operative intervention is not feasible, can be used as adjunct in refractory osteomyelitis, irrigation and debridement followed by organism specific antibiotics, acute osteomyelitis that fails to improve on IV antibiotics, chronic infection with pervasive wound or bone damage that is unable to be salvaged, high rates of recurrence if suppressive antibiotics are discontinued, all devitalized and necrotic tissue should be removed, extensive debridement is essential to eradicate the infection, sequestrum must be eliminated from the body, or infection is likely to recur, debride bone until punctate bleeding is seen - "paprika sign", goal is to replace dead bone and scar tissue with vascularized tissue, antibiotic-impregnated acrylic beads (PMMA), improves wound healing and dead space closure in multiple ways, allow arterioles to dilate, which allows granulation tissue to proliferate, decrease in capillary afterload to promote inflow of blood, mechanical force on wound edges draws them in, bony stability is required for successful eradication of infection, external fixation preferred to internal fixation, antibiotic-impregnated acrylic (PMMA) Intramedullary nail, peak antibiotic elution is 24 hours after placement, duration of antibiotics elution is generally up to 4 months, intramedullary nail with or without external fixation, mechanism is thought to be related to improved angiogenesis, often requires staged approach with multiple debridements and delayed soft tissue coverage, when combined with postoperative antibiotics tailored to a specific organism, treatment is often successful, amputation at the level that will eradicate infected tissue to healing tissue with capacity to heal. fracture identified on post reduction plain films. He complains of right leg pain, and physical exam reveals no evidence of an open fracture. Web(OBQ05.191) An 11-year-old child has a tibia-fibula fracture following a fall from a swing. Calcaneus fracture. talar body fractures . 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 Greater than 10mm of articular depression. 45% (664/1485) 2. Orthobullets Team 12/11/2019. delineates fracture anatomy and classification. WebA galeazzi fracture is a distal 1/3 radial shaft fracture with an associated distal radioulnar joint (DRUJ) injury. 1203 plays. (SBQ18SP.25) A 48-year-old tree surgeon is evaluated in the trauma bay after falling from 20 feet onto his back. (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. 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. Calcaneus FX Other Trauma Topics OTA classification. 1203 plays. The fracture is reduced and placed in a long leg splint in the emergency room. He endorses significant low back pain and an inability to ambulate. Calcaneus FX Other Trauma Topics A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. He endorses significant low back pain and an inability to ambulate. A galeazzi fracture is a distal 1/3 radial shaft fracture with an associated distal radioulnar joint (DRUJ) injury. Classification. (OBQ04.157) WebHohl and Moore Classification of proximal tibia fracture-dislocations. (OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. 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. Diagnosis is made using plain radiographs of the elbow. Diagnosis. WebAnatomic classification. .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. (SBQ18TR.43) Clinical. Firmness and decreased compressibility of the compartments is often present. Low velocity . 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. Lateral decubitus with olecranon osteotomy. WebCalcaneus FX Other Trauma Topics Cierny-Mader Classification of Osteomyelitis (describes anatomic involvement, host, treatment, prognosis) Anatomic Location. (OBQ12.6) A 75-year-old-male presents after being struck by a vehicle while crossing the street. Type IIA. Calcaneus FX Other Trauma Topics capitellar fracture can cause potential block to motion and instability due to loss of the radiocapitellar articulation. He subsequently develops the post-traumatic condition shown in Figure A. Calcaneus fracture. He was treated with a tibial intramedullary nail (IMN). Metaphyseal-diaphyseal junction. 26% (874/3364) 5. Jupiter Classification of Type II Monteggia Fracture-Dislocations. calcaneus is osteotomized and rotated 50-90 degrees to keep posterior aspect of calcaneus distal. 1% (25/2927) 4. He denies any fevers or chills. Orthobullets Team Over the last year, he has noticed "tissue growing out of the wound" and a malodorous smell. obtain AP, inlet/outlet, judet views after reduction. Ecchymosis and swelling. A photograph of the wound and a recent radiograph are seen in Figure A. (OBQ08.95) A 51-year-old female sustained a comminuted radial head fracture with 4 fragments and an associated elbow dislocation. Spiral (A1) Oblique (A2) Transverse (A3) Type B. Wedge fracture. Classification. WebClassification. Navicular fracture. 26% (874/3364) 5. 7% (105/1485) 3. Nonoperative. second most common tarsal fractures after calcaneus fxs. may lead to irreversible muscle and neurovascular damage. Greater than 10mm of articular depression. talar body fractures . Debridement and lavage, excision of sinus tract, implant removal, intravenous antibiotics for 6 weeks. 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. WebClassification. Ligament disruption. 8% (281/3364) 4. WebGaleazzi Fracture - Pediatric bifurcate ligament attaches the anterior process of the calcaneus to the navicular and cuboid bones. His surgical sites are well healed and there are no signs of drainage. Classification of Low Ankle Sprains. Type IIA. Associated conditions. Imaging is shown in Figure A. second most common tarsal fractures after calcaneus fxs. Anatomic classification. Orthobullets Engineer (admin) Trauma - Gun Shot Wounds; Listen Now 20:10 min. (OBQ12.195) Anatomic. Type II. fracture identified on post reduction plain films. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. 10/16/2019. findings. Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. What is considered the earliest sign or symptom of a developing compartment syndrome of the leg? On examination, his skin is intact, with moderate swelling, and limited elbow range of motion due to pain/swelling. Coronoid level. Radiographs and a CT scan are obtained, shown in Figures A-C. What is the most appropriate Gustilo-Anderson classification of (SBQ12FA.67) A 35-year-old male fell and sustained an open talar neck fracture. Figures C-E are the most recent imaging findings. findings. Orthobullets Team Pediatrics - Accessory Navicular ; Listen Now 14:0 min. 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. Webcalcaneus. rings placed at the level of the plafond or calcaneus to distract and reduce the fracture. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. Orthobullets Team Pediatrics - Accessory Navicular ; Listen Now 14:0 min. A 45-year-old homeless hemophiliac male presents with chronic tibial osteomyelitis. An 88-year-old female presents after a fall onto her left arm. The fracture is reduced and placed in a long leg splint in the emergency room. findings. What is considered the earliest sign or symptom of a developing compartment syndrome of the leg? 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). 8% (281/3364) 4. Presence of an acute open fracture and crush injury. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Thigh Compartment Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim. Type A. Classification. Biomechanics. He has pain and swelling at the elbow without evidence of 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. Classification of Low Ankle Sprains. Simple fracture. His ESR and CRP are elevated. WebEssex-Lopresti 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. Coronoid level. Type IIC. (OBQ05.274) AP and lateral radiographs are provided in Figure A. 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. He is Type IIC. account for 13 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. WebCalcaneus FX Other Trauma Topics A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. The decision is made to proceed with irrigation and debridement and nail exchange for a polymethylmethacrylate (PMMA) with vancomycin and tobramycin impregnated IMN. Which of the following is the most appropriate management? Type II. Figures A and B are the current radiographs. The patient presents to your clinic 12 months from his surgery with persistent pain at the fracture site. 9% Ligament disruption. Treatment may be nonoperative for nondisplaced fractures but any displacement generally requires anatomic open reduction and internal fixation. A CT is obtained for preoperative planning and there are no signs of trochlear involvement or posterior comminution. obtain post reduction CT for characterization of fracture. Over the next 35 years, he undergoes multiple debridements for a persistently draining wound. Type II. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. (SBQ12FA.67) A 35-year-old male fell and sustained an open talar neck fracture. Anatomic location. from a handgun with a muzzle-velocity of 1000 feet/second if he is neurovascularly intact and radiographs reveal no fracture? calcaneus is osteotomized and rotated 50-90 degrees to keep posterior aspect of calcaneus distal. He denies any fevers or chills. He elects to undergo surgical intervention. (OBQ07.239) He denies any fevers or chills. 9% 10/16/2019. (OBQ05.178) A 42-year-old male sustains a closed, isolated ulna shaft fracture with 2mm displacement and 3 degrees valgus angulation. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the obtain AP, inlet/outlet, judet views after reduction. (OBQ05.191) An 11-year-old child has a tibia-fibula fracture following a fall from a swing. Navicular fracture. Essex-Lopresti classification. (OBQ12.6) A 75-year-old-male presents after being struck by a vehicle while crossing the street. from a handgun with a muzzle-velocity of 1000 feet/second if he is neurovascularly intact and radiographs reveal no fracture? talus. posterior dislocation (90%) occur with axial load on femur, typically with hip flexed and adducted scrutinize femoral neck to rule out fracture prior to attempting closed reduction. Web(SBQ12FA.67) A 35-year-old male fell and sustained an open talar neck fracture. Kennedy classification based on the direction of displacement of the tibia. 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. 45% (664/1485) 2. What is the next step in treatment? A 34-year-old man is involved in a motor vehicle accident and sustains an open tibia fracture and is treated with intramedullary nailing. 1203 plays. Nonoperative. Diagnosis requires careful assessment of radiographs, MRI and determining the organism via biopsy and cultures. History of COPD. Diagnosis. Which of the following factors has been shown to predict a better prognosis? He presents to the ED the following afternoon with increased difficulty using his right arm and associated pain. Entire condylar fracture. Figures A and B are the current radiographs. Nonoperative. 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 Jupiter Classification of Type II Monteggia Fracture-Dislocations. OTA classification of radius/ulna. Classification. second most common tarsal fractures after calcaneus fxs. 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. 7% (105/1485) 3. He presents at 2 months after surgery. (OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. 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 The fracture is reduced and placed in a long leg splint in the emergency room. For the next 4 years, he continues to have pain and persistent discharge from a sinus over his shin. Radiographs of the right elbow are demonstrated in Figure A. Web(OBQ12.6) A 75-year-old-male presents after being struck by a vehicle while crossing the street. On exam, his wounds are well healed with no erythema. talus. He subsequently develops the post-traumatic condition shown in Figure A. preganglionic . Calcaneus FX Other Trauma Topics OTA classification. Type IIB. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. History of bleomycin treatment. Jupiter Classification of Type II Monteggia Fracture-Dislocations. Entire condylar fracture. Calcaneus FX Other Trauma Topics A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. What best describes the injury shown in Figure A and B? 91% He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. What is considered the earliest sign or symptom of a developing compartment syndrome of the leg? 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. A 41-year-old male sustained the open injury shown in Figures A and B after a motor vehicle accident. Which of the following elbow injuries as found in Figures A-E best characterizes the radiographic "double-arc" sign? Treatment. Anatomic classification. Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. 5% (176/3364) findings. 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. 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. Orthobullets Team Ipsilateral calcaneus fracture. What is the most appropriate Treatment. 8% (281/3364) 4. 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. preganglionic . He has not done any physical therapy nor received a corticosteroid injection. Operative. Clinical. must test each compartment separately. Distal to coronoid. He is neurovascularly intact in his left arm and leg. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. Calcaneus FX Other Trauma Topics OTA classification. Orthobullets Team Imaging is shown in Figure A. Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ Orthobullets Team He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. 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? Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. He denies any constitutional symptoms and his pain is well controlled. A 20-year-old man falls from his bicycle. Needle compartment pressures are diagnostic in cases ofinconclusive physical exam findings and in sedated patients. Clinical. account for 13 WebClassification. Orthobullets Team Ipsilateral calcaneus 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. A biopsy of the mass is shown in Figures B, and C. What is the most likely pathologic process? (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. He underwent operative fixation of his fracture. 1% (25/2927) 4. He underwent operative fixation of his fracture. (OBQ13.14) A 30-year-old man is brought to your level 1 trauma center with a closed left diaphyseal humerus fracture, a closed left midshaft femur fracture, right sided rib fractures, and multiple facial fractures following a motorcycle accident. He ambulates with crutches and refrains from putting weight on the extremity. 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. 45% (664/1485) 2. Talus fracture. Debridement and lavage, excision of sinus tract, exchange nailing using antibiotic impregnated-cement nail, intravenous antibiotics for 6 weeks. WebHis surgical wounds appear well-healed with a small sinus tract over the open fracture site. His surgical wounds appear well-healed with a small sinus tract over the open fracture site. She was initially closed reduced and splinted with the elbow joint in a reduced position and presents to the orthopedists office 10 days later. must test each compartment separately. (OBQ05.201) must test each compartment separately. findings. Physical exam is notable for a draining sinus tract, erythema and tenderness of the mid-thigh. fracture identified on post reduction plain films. OTA classification of radius/ulna. Copyright 2022 Lineage Medical, Inc. All rights reserved. 4/20/2020. 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The presence of an open tibia fracture and is treated with intramedullary nailing range of motion due to loss the. Nailing using a larger diameter nail, lifelong intravenous antibiotic suppression evaluated in Trauma... Fracture in a motor vehicle accident and sustains an open talar neck.! Persistent anterior shoulder/arm pain that worsens with most activities most likely pathologic process with a dorsiflexion inversion!