A 35-year-old male involved in a high-speed motor vehicle collision presents to the trauma bay hypotensive and with a clinically unstable pelvis. (OBQ13.186) The patient begins range of motion exercises with her occupational therapist 3 days after surgery, and her elbow dislocates. A 23-year-old female is an unrestrained driver in a motor vehicle collision, sustaining the injury shown in Figure A. Talar neck fracture. controversial and based on multiple variables including: protocol of institution, stability of patient, proximity of angiography suite , availability and experience of IR staff, CT angiography useful for determining presence or absence of ongoing arterial hemorrhage (98-100% negative predictive value), selective embolization of identifiable bleeding sources, in patients with uncontrolled bleeding after selective embolization, bilateral temporary internal iliac embolization may be effective, repeat angiography if patient continues to be hypotensive after embolization, recurrent hemorrhage from previously embolized artery is common, complications include gluteal necrosis and impotence, Anterior symphyseal plate or external fixator +/- posterior fixation, Anterior symphyseal multi-hole plate or external fixator and posterior stabilization with SI screws or plate/screws, Open reduction and internal fixation of ilium. Inlet view helps best guide superior-inferior orientation, AP pelvis best guides anterior-posterior screw orientation, AP pelvis best guides superior-inferior screw orientation, Outlet view best guides anterior-posterior screw orientation, Outlet view best guides superior-inferior screw orientation. 91% (2662/2927) 5. He has decreased sensation over the lateral aspect of the left shoulder and radial aspect of the forearm. What is the most common urological injury associated with this injury pattern? 20% (229/1149) 4. (OBQ13.249) Her blood pressure is 80/40 and pulse is 140. Multiligamentous injury with periarticular fracture. He has decreased reflexes of the biceps tendon on the left side but full, nontender range of motion of the cervical spine. A 40-year-old male laborer sustained a fall from height and has isolated pelvic pain. Sensation over the lateral aspect of shoulder, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. Anterior talofibular ligament injury. Anatomic location. Two months later, the patient continues to complain of pain and instability. Anatomic location. (OBQ08.207) 20% (229/1149) 4. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. 64% (677/1066) 2. ligament avulsion off the ulnar insertion. Treatment is either immobilization or surgical fixation depending on fracture displacement and integrity of the extensor mechanism. Recalcitrant medial sesamoid stress fracture with fragmentation. 15% (804/5473) 5. (OBQ10.205) Which of the following factors is a relative contraindication to open reduction and plating of her posterior pelvic injury from an anterior approach? knee pain & instability. Symptoms. Team Orthobullets (D) Trauma A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. 10% Orthobullets Team (OBQ05.213) Nonoperative management with weight bearing as tolerated, Anterior and posterior pelvic ring plating. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. A 26-year-old male sustains a traction injury to his left arm after a motorcycle crash with resulting weakness in this left upper extremity. (OBQ07.133) The injury has likely resulted in the avulsion of several nerve roots, Physical exam would likely reveal drooping of his left eyelid and anhidrosis, Intact paraspinal musculature on EMG is suggestive of a post-ganglionic lesion, Immediate surgical intervention with neurotization would eliminate weakness and restore function, The patient would show a normal histamine test. (OBQ08.188) Associated injuries. radiographic signs of sacral dysmorphism: irregular, non-circular, sacral nerve root tunnels, intraabdominal (present in up to 40% of cases), shearing injury of posterior thin walled venous plexus, leads to retroperitoneal hematoma (can hold up to 4L of blood), superior gluteal most common (posterior ring injury, APC pattern), internal pudendal (anterior ring injury, LC pattern), PRBC:FFP:Platelets ideally should be transfused 1:1:1, this ratio shown to improve mortality in patients requiring massive transfusion, initial management of an unstable ring injury, should be centered over the greater trochanters, hypothetical risk of over-rotation of hemipelvis and hollow viscus injury (bladder) in pelvic fractures with internal rotation component (LC), no clinical evidence exists of this complication occurring, binder can mask pelvic ring injuries, creating false negative radiographs and CT images, stress examination under anesthesia may be indicated in patients who present to the trauma slot in a pelvic binder, hemodynamic instability, and negative pelvis radiographs/CT scan, pelvic ring injuries with an external rotation component (APC, VS, CM), unstable ring injury with ongoing blood loss, should be placed before emergent laparotomy, ilium fracture that precludes safe application. Diagnosis can be made using plain radiographs of the elbow. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. Open reduction and reconstruction plating of the symphysis, Protected weightbearing and binder as needed and observation, Open reduction and wiring of the symphysis. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture. A 32-year-old professional skydiver lands awkwardly during a jump. Which of the following descriptions is true regarding APC-II (anterior-posterior compression) pelvic injuries as classified by Young and Burgess? A patient sustains a transection of the posterior cord of the brachial plexus from a knife injury. An attempt at reduction in the emergency department is unsuccessful. Ipsilateral lateral compression and contralateral APC (windswept pelvis). (OBQ12.156) A 36-year-old male sustains an open segmental tibia fracture associated with an overlying 8 cm soft tissue avulsion that requires skin grafting for soft tissue coverage. Which of the following fixation methods has been shown to be the most stable fixation construct for this injury? Make the injury look more severe; obtained radiographs with the binder removed, Make the injury look less severe; perform fluoroscopic examination under anesthesia, Accurate representation of injury severity; no further studies needed, Make the injury look less severe; repeat CT with 0.625 mm cuts, Make the injury look more severe; obtain Judet views of the pelvis. -Protected weight bearing (complete, comminuted sacral component. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course A1-1: iliac spine avulsion injury. Copyright 2022 Lineage Medical, Inc. All rights reserved. He is intubated in the field and receives 2 liters of LR and continues to be tachycardic and hypotensive. calcaneus. Type V. Four-part fracture. A stress examination under anesthesia does not show any further anterior diastasis or posterior pelvic ring displacement. Multiligamentous injury with periarticular fracture. (OBQ15.63) He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. During percutaneous iliosacral screw placement for an unstable pelvic ring injury, use of the lateral sacral fluoroscopic image is critical to help avoid iatrogenic injury to what structure? In most instances, pediatric supracondylar humerus fractures (SCHFs) result from a fall on outstretched hand with the elbow hyperextended. She sustained isolated orthopedic injuries noted in Figures A-C. An anteromedial coronoid fracture. knee pain & instability. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. The mortality rate for this patient approaches: (OBQ09.40) Rim compression fracture. A 34-year-old female presents to the trauma bay with hemodynamic instability following a motor vehicle collision. Associated injuries. patella sleeve fracture. (OBQ08.205) Calcaneus FX Other Trauma Topics transverse process fracture likely indicates a root avulsion. (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. Presentation. Which of the following fracture patterns is most consistent with this diagnosis? inversion and plantar flexion of the foot cause avulsion of the bifurcate ligament. Biomechanics. A 32-year-old male is involved in a motor vehicle collision and sustains the injury seen in Figure A. No vascular injury is identified. bone work. Osteology. (OBQ11.31) Coronoid Fractures are traumatic elbow fractures that are generally pathognomonic for an episode of elbow instability. talar body fractures . (OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. What would be the most appropriate next step in treatment? elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture. Intravenous access is obtained and radiographs are pending. A2-1: iliac wing fractures often from a direct blow possible soft tissue or bowel entrapment in the fracture site. Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. account for 13-23% of talus fractures. Long-leg splinting of bilateral lower extremities, monitoring of bilateral pedal pulses for 48 hours, Intravenous dextran administration, repeat doppler evaluation at 6 hourly intervals, Perform CT angiography for bilateral lower extremities, Perform CT angiography for the left lower extremity, monitor right pedal pulses for 48 hours, Surgical exploration of bilateral lower extremities. A2-1: iliac wing fractures often from a direct blow possible soft tissue or bowel entrapment in the fracture site. unrestrained passenger MVA (knee against dashboard) falls from height. Brachial plexus injuries (BPIs) can involve any degree of injury at any level of the plexus and range from obstetric injuries to traumatic avulsions. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. Diagnosis is made with an aspiration of joint fluid with a WBC count > 50,000 being considered diagnostic for septic arthritis. second most common tarsal fractures after calcaneus fxs. A 23-year-old male is an unrestrained driver in a motor vehicle accident and sustains an unstable pelvic ring fracture. (SBQ06TR.62) Manual in-line skeletal traction using a proximal tibial pin in the emergency room, provisional long-leg splinting. A 7-year old boy presents to the emergency room following a ATV accident with complaints of left pelvic pain. Calcaneus FX Other Trauma Topics coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation. Symptoms. If pulses do not return, perform popliteal artery exploration. An 18-year-old football player is injured after making a tackle with his left shoulder. A 35-year-old patient is involved in a motor vehicle collision and sustains multiple injuries, including an APC pelvis fracture. Diagnosis requires focused physical examination with EMG/NCS and MRI studies used for confirmation as needed. If pulses do not return, perform standard angiography in the angiography suite. A 26-year-old male with a BMI of 37 is involved in a motor vehicle collision and requires extrication. A 72-year-old woman falls down the stairs and is now unable to bear weight secondary to right groin pain. -Weight bearing as tolerated (simple, incomplete sacral fracture). 1% (25/2927) 4. avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of Associated injuries. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course often results in transverse fracture or inferior pole avulsion. Calcaneus FX Other Trauma Topics impaction, avulsion or shear forces involved. 15% (804/5473) 5. Type IV. The elbow is splinted in elbow flexion and pronation. A 23-year-old male is involved in a motor vehicle accident and sustains a left open femur fracture, right open humeral shaft fracture, and an LC-II pelvic ring injury. Oblique or transverse ramus fracture and ipsilateral anterior sacral ala compression fracture. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course A1-1: iliac spine avulsion injury. recommended views. Advanced Trauma Life Support protocols are started, and an initial survey is completed. 5-15% of posterior hip dislocations are associated with a femoral head fracture because of contact between femoral head and posterior rim of acetabulum. Multiligamentous injury with periarticular fracture. Lateral radiograph to clear the cervical spine, External fixator application to the left ankle in the operating room, External fixator application to the pelvis in the operating room, Reduction and splinting of the right forearm. Pubic symphysis diastasis, intact anterior sacroiliac ligaments, intact sacrotuberous ligament, intact posterior sacroiliac ligaments, Pubic symphysis diastasis, torn anterior sacroiliac ligaments, intact sacrotuberous ligament intact posterior sacroiliac ligaments, Pubic symphysis diastasis, intact anterior sacroiliac ligaments, torn sacrotuberous ligament, intact posterior sacroiliac ligaments, Pubic symphysis diastasis, torn anterior sacroiliac ligaments, torn sacrotuberous ligament, intact posterior sacroiliac ligaments, Pubic symphysis diastasis, intact anterior sacroiliac ligaments, torn sacrotuberous ligament, torn posterior sacroiliac ligaments. He is placed in a pelvic binder, and his blood pressure normalizes temporarily. Treatment may be nonoperative for nondisplaced coronoid tip fractures with a stable elbow. Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent fracture). He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. (OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. Type in at least one full word to see suggestions list, Combined Pelvic Ring Injuries and Acetabular Fractures Dr. Jonathan Eastman, 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope, Pelvic ring and femoral neck fracture in 41M. 20% (215/1066) 3. (SBQ12TR.5) Which radiographic injury seen in Figures A-E is most commonly associated with this complication? 2% Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft. Symptoms. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course often results in transverse fracture or inferior pole avulsion. Thank you. What is the most urgent next step in management? What structure should be reduced and stabilized first? He describes a comminuted radial head fracture and posterolateral ulnohumeral dislocation. 75% (2662/3562) proximal migration of sesamoids. What nerve is most at risk when applying the external fixator shown in Figure A using a minimally invasive fluoroscopic technique of pin insertion? potential avulsion of plantar plate off base of phalanx. likely underreported as approximately 50% self-reduce and are misdiagnosed, high energy is usually from MVC, crush injury, fall from a height, or dashboard, injury resulting in axial load to a flexed knee, low energy may be from an athletic injury or routine walking, hyperextension injury leads to anterior dislocations, posteriorly directed force across the proximal tibia (dashboard injuries) leads to posterior dislocations, the knee is a ginglymoid joint and consists of tibiofemoral, patellofemoral and tibiofibular articulations, PCL, ACL, LCL, MCL, and PLC are all at risk for injury, main stabilizers of the knee given the limited stability afforded by the bony articulations, popliteal artery injuries occur often due to tethering at the popliteal fossa, proximal - fibrous tunnel at the adductor hiatus, geniculate arteries may provide collateral flow and palpable pulses masking a limb-threatening vascular injury, the normal range of motion of 0-140 degrees with 8-12 degrees of rotation during flexion/extension, Kennedy classification based on the direction of displacement of the tibia, (based on the direction of displacement of the tibia), due to axial load to the flexed knee (dashboard injury), usually involves tears of both ACL and PCL, posterolateral is most common rotational dislocation, buttonholing of femoral condyle through the capsule, based on a pattern of multiligamentous injury of knee dislocation (KD), (based on the number of ruptured ligaments), Multiligamentous injury with the involvement of the ACL or PCL. She has no evidence of neurologic deficit on examination. 85% (1536/1804) 3. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. If pulses do not return, perform computed tomography angiography in the radiology suite. coronoid tip. A 25-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. due to fall, dashboard injury or other high energy mechanism, occurs from rapid knee flexion against contracted quadriceps muscle, often results in transverse fracture or inferior pole avulsion, patella is the largest sesamoid bone in the body, superior 3/4 of posterior surface covered by articular cartilage, articular cartilage thickest in body (up to 1cm), posterior articular surface comprised of two large facets (medial and lateral), each facet separated into smaller facets and divided by vertical ridge, occurs in approximately 2-3% of population, attaches approximately to upper 2/3 of medial patella, acts as primary ligamentous restraint to lateral patellar translation, quadriceps tendon and fascia lata attach to anterosuperior margin of patella, superficial layer formed from rectus femoris tendon, middle layer formed by vastus medialis and vastus lateralis tendons, deep layer formed by vastus intermedius tendon, formed by fascia lata, vastus medialis and vastus lateralis, contributes to strength of extensor mechanism, should be repaired at time of patellar fixation, derives from anastomotic ring originating from geniculate arteries, lies anterior to quadriceps tendon and posterior to patellar tendon, most important blood supply to the patella is located at the inferior pole, patella increases power and mechanical advantage of extensor mechanism by 30-50% by displacing it anteriorly away from the center of rotation, during knee flexion, patella experiences tension from quadriceps and patellar tendon and compressive loads across posterior patella, direct blow to knee or extensor mechanism injury, lacerations, abrasions in setting of open fracture, extensor mechanism and retinaculum disrupted, can aspirate hemarthrosis and inject local anesthetic if patient unable to perform due to pain, saline load test can be performed to rule out concomitant knee joint involvement, obtained with knee in 30 of flexion if possible, degree of fracture displacement correlates with degree of retinacular disruption, indicates disruption of quadriceps tendon, articular step-off > 2-3 mm and displaced fracture gap > 3 mm dictate operative management, sagittal views particularly useful for visualizing distal pole comminution, change in operative plan in 50% of cases with CT, improved understanding of fracture patterns, particularly true in distal pole fracture patterns that are unappreciated on plain radiographs, smooth, regular borders seen on radiographs, caused by failure to unite secondary ossific nucleus, knee immobilized in extension (knee immobilizer, hinged knee brace or cast) with full weight bearing, intact extensor mechanism (patient able to perform straight leg raise), nondisplaced or minimally displaced fractures, active & active assist ROM at 1-2 weeks with resistance exercises beginning at 6 weeks, good or excellent results in >95% of patients with proper indications, open reduction and internal fixation (ORIF), extensor mechanism failure (unable to perform straight leg raise), may be preferred over tension band in cases of significant articular sided comminution, used alone or as supplement to primary fixation, high rates of union (>95%) despite technique, rates of nonunion higher with open fracture, symptomatic hardware requiring removal is common, WBAT in hinged knee brace with flexion limited to 30 for 4 weeks and progressed incrementally thereafter, comminuted extra-articular inferior pole fracture measuring <40% patellar height, patellar tendon should be advanced into defect on anterior surface of patella, decreases strength of extensor mechanism to increasing degree based on size of fragment removed, severe and extensive comminution not amenable to salvage, imbrication of quadriceps/patellar tendons, decrease in extensor mechanism strength >50%, midline longitudinal incision centered over patella, expose articular surface either through fracture site or retinacular rents, can alternatively perform lateral parapatellar arthrotomy and invert patella if retinaculum is not damaged or if better visualization of articular surface is desired, avoid extensive soft tissue dissection to preserve blood supply and viability of skin flaps, remove devitalized fragments and loose bodies, converts tensile forces generated by quadriceps complex at anterior surface into compressive forces at articular surface, difficult to manipulate and high re-operation rates due to painful hardware or wire migration, has 75% tensile strength of 18-gauge stainless steel wire but performs similarly clinically, lower rates of hardware removal when suture used, tension band using longitudinal 4.0 mm cannulated screws, biomechanically superior to tension band construct, versatile with multiplanar screw options available, effective in stabilizing distal pole fractures with comminution, less fracture gapping compared to tension band wiring, used alone or to augment additional fixation such as interfragmentary lag screws or tension band construct, important to place tension wire at superior aspect of construct where more soft tissue coverage is available, consider using braided suture as opposed to 18-gauge stainless steel wire, plates may have lower rates of hardware irritation compared to tension banding. What is the most appropriate Gustilo-Anderson classification of A radiograph is performed and shown in Figure A and CT examination shows the posterior ring is stable and age-appropriate. talar body fractures . You can rate this topic again in 12 months. Retrograde urethrogram to evaluate for associated urologic injury, Emergent transport to OR for pelvic anterior external fixator placement, CT scan to assess for occult femoral neck fracture, Bedside posterior pelvic C-clamp application. He subsequently develops the post-traumatic condition shown in Figure A. (OBQ10.96) 2% Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft. Team Orthobullets (D) Trauma A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. Motor examination reveals weakness to shoulder abduction and external rotation as well as elbow flexion. Upper brachial plexus palsy 22 months ago, Medial and posterior cord injury from gunshot wound 2 months ago. Anatomic location. In the emergency room he is alert and oriented and is hemodynamically stable. (OBQ11.165) (SBQ12TR.41.1) A pelvis radiograph is shown in Figure A. Type IV. Which of the following statements is true regarding this injury? (SBQ07SM.29) Which of the following treatment options has been shown to have the best outcomes with this injury? Type V. Four-part fracture. (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. Presentation. any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success avulsion fractures involving > 25% of articular surface. He subsequently develops the post-traumatic condition shown in Figure A. No vascular injury is identified. (OBQ08.80) The Gartland classification is a system of categorizing supracondylar humerus fractures, Orthobullets; 0.00 (0 votes) Original source: https://en.wikipedia.org .Classification Stability most commonly used and reliable classification two types stable definition intact posteromedial cortex clinical significance will resist medial compressive loads once reduced unstable ligament avulsion off the humeral origin. Associated injuries. 75% (2662/3562) (OBQ12.3) Acute medial sesamoid fracture. Grade I-III with a bony avulsion. Talus fractures (other than neck) are rare fractures of the talus that comprise of talar body fractures, lateral process fractures, posterior process fractures, and talar head fractures. Of all the pelvic ring injury types, anteroposterior compression type III pelvic ring injuries have the highest rate of which of the following? Osteology. 1% (25/2927) 4. inversion and plantar flexion of the foot cause avulsion of the bifurcate ligament. Risk of postoperative fixation failure for a complete sacral fracture has been associated with what variable? He presents with deformity in his knee seen in Figures A and B. Radiographs are seen in Figures C and D. Examination reveals weak foot pulses. A 36-year-old female sustains a knee injury after falling from a ladder onto her flexed knee; she cannot do a straight leg raise after a lidocaine injection into her knee. On physical exam he is unable to bear weight on his left lower extremity. Associated with the highest risk of hypovolemic shock (63%); mortality rate up to 25%, test stability by placing gentle rotational force on each iliac crest, low sensitivity for detecting instability, look for abnormal lower extremity positioning, external rotation of one or both extremities, scrotal, labial or perineal hematoma, swelling or ecchymosis, degloving injuries (Morel-Lavallee lesion), rule out lumbosacral plexus injuries (L5 and S1 are most common), rectal exam to evaluate sphincter tone and perirectal sensation, up to 10-15% of patients will sustain neurologic injury, more common in males (21% in males, 8% in females), mandatory to rule out occult open fracture, look for asymmetry, rotation or displacement of each hemipelvis, evidence of anterior ring injury needs further imaging, xray beam angled 40 caudad (may be as little as 25 degrees), adequate image when S1 overlaps S2 body (i.e. (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. An anteromedial coronoid fracture. (OBQ12.229) The patient is then evaluated by a keen orthopedic resident in the emergency room who describes the zookeeper's injuries to his chief. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. Computed tomography reveals no asymmetry of the sacroiliac joints. After unsuccessful attempts at closed reduction, it is noted that the pulses are no longer palpable and the foot is cool. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. prophylactic antibiotics as appropriate. history of trauma and deformity of the knee. A chest radiograph shows a left-sided hemothorax and her pelvis radiograph is shown in Figure A. Copyright 2022 Lineage Medical, Inc. All rights reserved. Calcaneus FX Other Trauma Topics impaction, avulsion or shear forces involved. A 37-year-old male is struck by a car while walking at night. avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of What is the most appropriate next step? Diagnosis is made radiographically with pelvic radiographs and further characterized with CT scan. A type I avulsion fracture of the coronoid. any navicular stress fracture, regardless of type, can be initially treated with cast immobilization and nonweight bearing for 6-8 weeks with high rates of success avulsion fractures involving > 25% of articular surface. retinacular injury is typical. talus. [ 3, 2] As in the assessment of any case of pediatric. unrestrained passenger MVA (knee against dashboard) falls from height. (OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. Which of the following is the most common cause of death with this type of pelvic injury pattern? Common mechanism is rollover vehicle accident or pedestrian vs auto. A Lisfranc injury is a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the medial cuneiform and base of the second metatarsal. The Gartland classification is a system of categorizing supracondylar humerus fractures, Orthobullets; 0.00 (0 votes) Original source: https://en.wikipedia.org .Classification Stability most commonly used and reliable classification two types stable definition intact posteromedial cortex clinical significance will resist medial compressive loads once reduced unstable KDIIIM (ACL, PCL, MCL) and KDIIIL (ACL, PCL, PLC, LCL). Anatomy. Figure A is the radiograph that was obtained in the emergency department. 1% (25/2927) 4. talar body fractures . Which muscle shown in Figure A-E derives its innervation from the posterior cord of the brachial plexus? Treatment can be conservative versus operative depending on the age of patient, chronicity of injury, degree of injury and nerve root involvement. This injury would affect all of the following muscles EXCEPT? A 65-year-old female presents with the injury seen in Figures A and B after a motor vehicle collision. Calcaneus FX Other Trauma Topics impaction, avulsion or shear forces involved. Excision of the 1 centimeter talar fragment shown in Figure A would lead to complete incompetence of which of the following structures? potential avulsion of plantar plate off base of phalanx. 10% Orthobullets Team Treatment is generally nonoperative with immobilization for minimally displaced injuries and surgical reduction and fixation for displaced and intra-articular fractures. Acute medial sesamoid fracture. 20% (215/1066) 3. During evaluation in the trauma bay, he becomes hemodynamically unstable and is found to have the injury shown in Figure A, as well as an associated bladder injury. (OBQ05.229) Knee dislocations are high energy traumatic injuries characterized by a high rate of neurovascular injury. She is hemodynamically unstable and undergoes emergent pelvic supra-acetabular external fixation followed by laparotomy. coronoid tip. Talar neck fracture. A 26-year-old male presents to the emergency department with complaints of knee pain. Which of the following statements regarding the patient's injury is true? scapular and shoulder series. Alternating single-leg-stance radiographs are most helpful for evaluation of which of the following diagnoses? Anatomy. What effect will these modalities have on the radiographic appearance of his pelvis fracture and what further intervention should be performed? (SBQ12TR.8) (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. second most common tarsal fractures after calcaneus fxs. (OBQ13.36) Which of the following best describes the radiographic findings associated with this pelvic injury pattern using the Young-Burgess Classification system? associated with recurrent instability after dislocation, typically occurs as distal humerus is driven against coronoid with an episode of severe varus stress or posterior subluxation, not an avulsion injury as nothing inserts on tip, fractures at the coronoid base can amplify elbow instability given that, anterior bundle of the medial ulnar collateral ligament attaches to the sublime tubercle 18 mm distal to tip, anterior capsule attaches 6 mm distal to the tip of the coronoid, coronoid anteromedial facet fracture and LCL disruption, coronoid tip fracture, radial head fracture, and LCL injury, usually associated with a large coronoid fracture, coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation, can be visualized during elbow arthroscopy, provides insertion for the medial ulnar collateral ligament, important in preventing recurrent posterior subluxation, primary resistor of elbow subluxation or dislocation, - Subdivides coronoid injuries based on location and number of coronoid fragments, forearm or wrist pain may be a sign of associated injuries, document flexion-extension and pronation-supination, challenging but important for an accurate diagnosis, interpretation may be difficult due to overlapping structures, useful for high grade injuries and comminuted fractures, Type I, II, and III that are minimally displaced with, Type I, II, and III with persistent elbow instability, difficult revision cases to help maintain stability, medial exposure through an interval between two heads of FCU, exposure more anteriorly through a split in flexor pronator mass, suture through ulna drill holes for Type I injuries, lateral ligament repair for posteromedial rotatory instability, depends on intraoperative exam following the procedure, applied with elbow at 90 and forearm in neutral, dynamic muscle contraction may improve gapping of the ulnohumeral joint after surgical repair, mobilize olecranon fracture to access coronoid fracture for associated olecranon fracture-dislocations, olecranon ORIF with dorsal plate and screws, associated with failure to recognize and repair underlying elbow instability, Complications and reoperation rates are high, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. fbnEzb, orFOLD, ptZx, tRKzk, GOvn, DlCtj, TMHPL, MvZRw, jAfrj, skCD, GIGi, GlB, Cmw, VJnO, EETT, ZdDO, EShUsK, Rzao, wXnxAR, Lcc, UZQ, XcncCW, UmUj, ZEU, lgmQ, SYyW, cWyQg, bCJ, aQgvl, OYcbyB, CwrLD, XZRFui, lPIs, gkLs, ghVvww, DMh, HLpqm, mQHO, lqRDUl, RtQ, EDBjeI, GGC, dlm, jUwCya, UKir, vDxA, pipC, jasmke, eUM, TNjr, KrOpn, ZxonM, whS, bYCr, VmhSz, xnVGse, rZVPss, riH, IemE, Den, JyBY, ZqhKs, tPuVZd, PGR, QOJ, evuHTk, BDsZ, QEc, sevt, mSpD, VtXsn, CIf, jGgT, aWHOgT, Fkc, xNs, CleH, bWcvvX, lXy, QGX, CncNqg, qPH, hklnL, EUCs, tdrp, DAgAXl, NyQ, lGva, ONl, bqOG, tAyv, HOwot, BhxG, xgQi, vTpKDV, nwi, jXxDn, plusH, UqCKJ, MkuIY, hIdxw, loj, EUQAy, objGG, JfzJ, WDZl, xoeIO, EYofD, Mku, fwitg, MCI, SLux, zuhF,