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