T: 412-692-4600. History and etymology Foothill Ranch, CA 92610. An open-mouth odontoid radiograph is useful to evaluate for disruption of the transverse ligament which leads to lateral displacement of the lateral masses relative to each other. After a long discussion of the risks and benefits the patient elects to undergo nonoperative management. A Gallie C1-2 fusion with sublaminar wiring of C1 to the spinous process of C2 is a valid treatment option for which of the following injury patterns? after 30 minutes of severe ischemia, the damage becomes irreversible. When discussing the risks and benefits of operative versus nonoperative treatment for his fracture, which of the following is true? (OBQ08.219) (SBQ08UE.37.1) The predo 26700 Towne Centre Dr. Ste 110. (OBQ07.1) A current radiograph is shown in Figure A. Posterior atlanto-dens interval (PADI) of 16mm, Combined lateral mass displacement of 8.2mm. Both Bone Forearm Fracture ORIF - Trauma - Orthobullets ORTHO BULLETS Join nowLogin Select a Community MB 1Preclinical Medical Students MB 2/3Clinical Medical Students ORTHOOrthopaedic Surgery IMInternal Medicine ENTEar, Nose and Throat GSGeneral Surgery PRSPlastic Surgery About Bullet Health Join Our Team ORTHOBULLETS It is supported by ligaments to stabilize the talus under the tibia and the tibia with the fibula. A 20-year-old woman is involved in a high-speed motor vehicle collision and sustains bilateral tibial plateau fractures as well as the clavicle fracture shown in Figure A. March fractures are a subtype of fatigue/ stress fractures. This type of fracture often affects these ligaments. Copyright 2022 Lineage Medical, Inc. All rights reserved. 2022 Lineage Medical, Inc. A 34-year-old male sustains the closed finger injury shown in Figure A one week ago. Copyright 2022 Lineage Medical, Inc. All rights reserved. The most common mechanism that cuts this ligament is foot eversion or external rotation force. (OBQ08.54) blackhead 2022 new march 90s hippie movies texas city . A nutcracker fracture of the cuboid refers to a cuboid bone fracture with associated navicular avulsion fracture due to compression between the bases of 4 th and 5 th metatarsals and calcaneus bone. Which of the following radiographic measurements would best indicate disruption of the transverse ligament? When discussing nonunion, which of the following is the best estimate for risk of nonunion with nonoperative treatment? > 50-75% destruction of metaphysis (> 2.5 cm) Permeative destruction of the subtrochanteric femoral region. Fractures that disrupt the pelvic ring predispose patients to bleeding given the large network of arterial and venous anastomoses. A radiograph taken at the time of injury is shown in Figure A, and a current radiograph is shown in Figure B. quicker recovery. Pathophysiology. displacement of femoral neck fracture will disrupt the blood supply and cause an intracapsular hematoma (effect is controversial) Classification Presentation Symptoms impacted and stress fractures slight pain in the groin or pain referred along the medial side of the thigh and knee displaced fractures pain in the entire hip region Physical exam Stability determined by the integrity of transverse ligament. However, rest alone isn't the only action you'll want to take to help put your march fracture in the past. Closed reduction and figure of 8 splinting, Sling with abduction pillow to involved side. (OBQ09.138) A 33-year-old male sustains a distal humerus fracture and is treated with open reduction and internal fixation of the distal humerus with olecranon osteotomy. Which of the following factors increase the risk of nonunion in midshaft clavicle fractures when treated nonoperatively? Type in at least one full word to see suggestions list. Ankle fractures are very common injuries to the ankle which generally occur due to a twisting mechanism. Radiographic features Please see the article on stress fractures . You can rate this topic again in 12 months. Willis AA, Kutsumi K, Zobitz ME, Cooney WP 3rd. The most common mechanismthat cuts this ligament isfoot eversion or external rotation force. Treatment can be nonoperative or operative depending on fracture displacement, ankle stability, presence of syndesmotic injury, and patient activity demands. Copyright 2022 Lineage Medical, Inc. All rights reserved. A 28-year-old male sustains the injury seen in Figure A. The latest tweets from @orthobullets.Felon finger orthobullets; avengers fanfiction bucky kidnapped; congress park saratoga springs disney; asrock b450 steel legend bios flashback; chester wales; kenmore elite dual fuel range manual; natural body lotion without chemicals; nokia 2 diag port code. Lake Forest, CA 92630. A 25-year-old patient is involved in a motor vehicle accident. Orthobullets was founded by Dr. Derek Moore, a practicing orthopedic spine surgeon. He undergoes closed reduction and pinning shown in Figure B to correct alignment. The risk of infection from these types of wounds can vary depending on the type and pattern of bullets fired as well as the distance from the firearm. shorter operative time. Department of Neurology 811 Kaufmann Medical Building 3471 Fifth Avenue Pittsburgh, PA 15213. Internal fixation of dorsally displaced fractures of the distal part of the radius. On exam, he is alert and oriented with normal motor and sensation in the upper and lower extremities. (SBQ18SP.74) Biomechanical studies have shown that an atlanto-dens interval of >7mm is likely associated with? [ Porter, 2018; Evenski, 2009] Fractures through the Distal Third and Waist of the bone are more common than the Proximal third. Copyright 2022 Lineage Medical, Inc. All rights reserved. Epidemiology Incidence (OBQ12.255) As compared to treatment with a simple sling, what is the primary advantage of treatment with a figure-of-eight brace? (949) 297-4561. To minimize risk of infection, debridement recommended to be performed within 24 hours for all type III fractures and within 12 hours for type IIIB open tibia fractures, Contamination with dirt and debris and devitalization of the soft tissues increase the risk of infection and other complications, Infection rates higher in open injuries due to blunt trauma compared to penetrating trauma, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Atlas Fractures & Transverse Ligament Injuries. 1-3 The mechanism of injury is the application of high-intensity forces to the body Dickman Transverse Ligament Injuries Classification, Bony avulsion at tubercle on C1 lateral mass, neuro deficits uncommon in isolated C1 fractures, associated C2 fractures have a higher risk of neuro deficit, decreased sensation in the occipital region, 60-degree oblique radiographs to indetify posterior arch fractures, open-mouth odontoid view important to identify atlas fractures, identify late instability following nonoperative treatment, increased widening of C1 lateral masses compared to C2 (LMD), increased distance of the atlantodental interval (ADI), fracture involving the posterior or anterior arch, occipitocervical distraction/dissociation, measured on lateral radiographs and flexion-extension views, < 3 mm = normal in adult (< 5mm normal in child), 3-5 mm = injury to transverse ligament with intact alar and apical ligaments, > 6.9 mm (rule of Spence) or 8.1mm with radiographic magnification (rule of Heller), increased thickening of retropharyngeal soft tissue (>9.5 mm) suggests an anterior arch injury, radiographs have a lower sensitivity of detecting unstable atlas fractures than CT and MRI, should be ordered for every case of suspected cervical spine injury, study of choice to delineate fracture pattern and identify associated injuries in the cervical spine, pseudospread of the atlas in pediatric patients, represents asymmetric growth of the atlas compared to the axis, greater atlantal overhang of the lateral masses, occult horizontal fractures of the anterior arch, determine total lateral mass displacement, assess the presence of a vertebral artery injury, fractures involving the anterior and posterior ring, increased radial displacement of the C1 fracture fragments (unstable), bone avulsion injuries of the tubercle (TAL insertion), sagittal split fractures of the lateral mass, lower sensitivity than MRI at detecting TAL injuries, should be ordered in any case there is a confirmed fracture of the atlas, rule out associated unstable ligamentous injuries, increased T2 signal in the TAL suggests intrasubstance injury, increased T2 signal intensity in the TAL on the sagittal and coronal views, increased T2 signal intensity in the spinal cord, increased prevertebral soft tissue T2 signal intensity at C1-2, more sensitive at detecting injury to transverse ligament, increaed T2 signal intensity in the TAL is suggestive of injury, stable Type I fx (intact transverse ligament), controversy exists around optimal form of immobilization, reduce with halo traction before immobilization, require post treatment flexion-extension radiographs to assess for late instability, most often type II odontoid and hangman's fractures, higher association with neurologic injury, some authors prefer Occ-C2 fusion as opposed to C1-2 fusion, no significant downside and lower risk of revision surgery, may consider preoperative traction to reduce displaced lateral masses, C1 lateral mass split fractures (controversial), anterior and posterior techniques described, further randomized trials needed to ascertain role of this treatment, preserves motion compared to occipitocervical fusion, C1 lateral mass - C2 pedicle screw construct (Harm's technique), may be sufficient if adequate purchase with C1 lateral mass screws, 10 medial screw trajectory protects the internal carotid artery, used when unable to obtain adequate purchase of C1 (comminuted C1 fracture), anterior and posterior approaches described, rare complication with displaced posterior ring fractures, radial displacement of fracture increased the surface area of the spinal canal', displaced unilateral sagittal split lateral mass fracture, occipital condyle settles onto the C2 superior articular facet, treat with occipitocervical fusion +/- osteotomy to correct the deformity, present in 20-80% of patients after immobilization, higher rate of complications in patients with delayed C-spine clearance so it is important to clear expeditiously, loss of ~50% of cervical rotation with C1-2 arthrodesis, loss of ~50% cervical flexion with Occ-C2 arthrodesis, higher infection rates in patients treated with posterior approaches, stability dependent on degree of injury and healing potential of transverse ligament, worse long-term patient reported outcomes in fractures with >7 mm of displacement, - Atlas Fractures & Transverse Ligament Injuries, Traumatic Spondylolisthesis of Axis (Hangman's Fracture), Cervical Lateral Mass Fracture Separation, Extension Teardrop Fracture Cervical Spine, Clay-shoveler Fracture (Cervical Spinous Process FX), Chance Fracture (flexion-distraction injury), Osteoporotic Vertebral Compression Fracture, Ossification Posterior Longitudinal Ligament, DISH (Diffuse Idiopathic Skeletal Hyperostosis), Atlantoaxial Rotatory Displacement (AARD), Pediatric Intervertebral Disc Calcification, Pediatric Spondylolysis & Spondylolisthesis. Diagnosis is made with plain radiographs of the ankle. The avulsion fracture typically involves the meniscofemoral fibres of the deep medial collateral ligament. Diagnosis can be made radiographically with AP and cephalic tilt clavicle x-rays. summary Metacarpal Fractures are the most common hand injury and are divided into fractures of the head, neck, or shaft. After discussing the risks and benefits of surgery, he elects to pursue nonoperative treatment. March fractures are treated like most types of stress fractures - with simple conservative care techniques. (SBQ12TR.3.1) He presents to the emergency room and radiographs and a CT are performed and shown in Figures A-D. 10/18/2019. Thesecrucial ligaments include thesyndesmotic ligaments that stabilize the fibula within the incisura in the tibial bone, and another critical ligament is the deltoid complex ligament, which is a broad ligament with a fan-like structure thatoriginates from the medial malleolar to insert in the talus bone; it also subdivides into two ligaments. Professionalism & Rotation Evaluations Accurate ACGME levels AND summative faculty feedback the residents want. - Moderated by Brad Parsons, MD, Displaced midshaft clavicle fracture - ORIF vs nonop - Debate, Question SessionClavicle Shaft Fractures, Peroneal Tendon Subluxation & Dislocation, Beaumont Royal Oak & Taylor Orthopaedic Residency. 1. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Bimalleolar ankle fracture is a fracture that occurs in both the lateral and medial malleoli at the distal end of the tibia and fibula bones that articulate with talus bone to form the ankle joint or tibiotalar joint. What is a reported outcome of surgery when compared to nonoperative management at 1 year postoperatively? What is the most appropriate initial management of the patient's injuries in . the tibia is the most common site of post-surgical osteomyelitis following surgical treatment of open fractures, delay in defintive soft tissue coverage greater than 7 days. They include, primary stabilizer of atlantoaxial junction, prevents posterior migration of the odontoid into the spinal canal, connects the posterior odontoid to the anterior atlas arch, inserting laterally on bony tubercles of the lateral mass, connect the odontoid to the occipital condyles, relatively strong and contributes to occipitalcervical stability, connects the posterior body of the axis to the anterior foramen magnum and is the cephalad continuation of the PLL, occipital condyles articulate with C1 superior articular processes, provides ~50% of cervical spine flexion and extension range of motion, contains anterior and posterior joint capsules, articulation between the inferior facet of C1 and superior facet of C2, aticulation between the dens (C2) and the anterior arch of the atlas. After nine months of conservative treatment, he continues to complain of pain. 2009; 67:746-751. Stability determined by the integrity of the transverse ligament. occlusion of a coronary artery disrupts the blood supply to a region in the myocardium. Atlas Fractures & Transverse Ligament Injuriesare traumatic injuries usually caused by high-energy trauma with axial loading in young patients (Jefferson Fracture) or low-energy falls in elderly. Rotational deformity. This fracture can lead to disabling long term sequelae following treatment, makingthis type of fracturehave a poor prognosis.[1][2][3][4][5][6][7][8][9]. 4% (73/1698) 3. How PASS is a win for everyone on the team Residents Chief Residents Fellows Program Coordinators Indications to treat proximal phalanx fractures operatively include all of the following EXCEPT: QID: 211138 FIGURES: A Type & Select Correct Answer. The transverse ligament is disrupted, the fracture is unstable and should be treated with either a rigid orthosis, halo immobilization, or surgical stabilization, The transverse ligament is intact, the fracture is stable and can be treated in a soft cervical collar, It is classified as Anderson and D'Alonzo Type II because the fracture extends into the C1/C2 facet, It is classified as Anderson and D'Alonzo Type III because the fracture extends into the C1/C2 facet, The imaging findings are relatively common and represent a congenital incomplete formation of the posterior arch and not a traumatic injury. timing of flap coverage for open tibial fractures remains controversial, increased risk of infection beyond 7 days, increase by 16% for each day beyond day 7, early studies demonstrated increased infection with delay beyond 72 hours, however recent studies do not support this finding (LEAP study), can proceed with bone grafting after wound is clean and closed, negative-pressure wound therapy may be utilized during debridement until definitive coverage can be achieved (increased risk of infection if open >7 days), open reduction and internal fixation or intramedullary treatment depending on fracture location and morphology, Masquelet technique ("induced-membrane" technique), 1st stage: I&D, cement spacer and temporizing fixation, 2nd stage: placement of bone graft into "induced membrane" and definitive fixation, Studies show optimal time frame for bone grafting to be, fracture related infection ranges from <1% in grade I open fractures to 30% in grade III fractures. She presents to clinic for her 6-month follow-up appointment and reports persistent pain. If disrupted, halo vest (for bony avulsion) or C1-2 fusion (for intrasubstance tear)(see Dickman classification below). Harington's criteria. Which of the following treatment options is most appropriate? Orthobullets. A 28-year-old male patient dives head first into a shallow pool. 164 plays . Which of the following statements are true regarding these radiographic findings. Indirect pull of the central slip on the distal fragment and the interossei insertions at the base of the proximal phalanx, Intrinsic muscle fibrosis and intrinsic minus contracture, PIP joint volar plate attenuation and extensor tendon disruption, Rupture of the central slip with attenuation of the triangular ligament and palmar migration of the lateral bands, Flexor tendon disruption with associated overpull of the extensor mechanism. atlas fractures make up to 25% of the injuries of the craniovertebral junction, most commonly associated with high-energy injury mechanisms, osteoporosis predisposes to low energy fractures, higher association with odontoid fractures, 30% less energy requirement to cause atlas fracture when cervical spine is in extension compared to neutral, due to large space for the spinal cord at this level, injuries tend to increase the area availabe for spinal cord at C1, atlas (C1) is a ring containing two articular lateral masses, it lacks a vertebral body or a spinous process, incomplete formation of the posterior arch is a relatively common anatomic variant and does not represent a traumatic injury, makes acute posteromedial bend around Occ-C1 joint and crosses sulcal groove, sulcal groove is a common site for posterior arch injuries/fractures, occipital-cervical junction and atlantoaxial junction are coupled, intrinsic ligaments are located within the spinal canal, provide most of the ligamentous stability. The most common ligament injury or cut is the deltoid ligament (medial ligamentous) during the medial malleolar fracture, causing joint instability. The goal of treatment is to protect the area and give the bone time to heal. An attempt at reduction and immobilization is made in the field by his unit physician assistant, and he returns to your office one week later. Open reduction and intramedullary nailing. (OBQ07.25) The Cyma line can also be disrupted 4 "Plough" fracture is an isolated anterior arch fracture caused by a force driving the odontoid through the anterior arch. Orthobullets Team Trauma - Tibial Plateau Fractures Technique Guide. A 22-year-old left hand dominant laborer sustains the injury shown in Figures A and B as the result of a fall from a ladder. Conversely, in the inversion mechanism, theprimary ligament injured is the anterior talofibular ligament, and hyper-dorsiflexion trauma might cause syndesmotic ligamenttears or sprains. (OBQ10.101) Bimalleolar ankle fracture is caused by twistingwith multiple force mechanisms, or supination injury. Safe surgical dislocation with a trochanteric flip osteotomy has been shown to be a reliable technique that provides excellent exposure for treating femoral-head fractures with minimal complications. Return multiple choice. The foot is usually dislocated medially and superiorly as it is plantarflexed and inverted, usually as a result of a high-energy impact, e.g. Traditionally, children aged 4 - 11 years are less likely than adolescents and adults to suffer a scaphoid fracture. Open Fractures Management - Trauma - Orthobullets ORTHO BULLETS Join nowLogin Select a Community MB 1Preclinical Medical Students MB 2/3Clinical Medical Students ORTHOOrthopaedic Surgery IMInternal Medicine ENTEar, Nose and Throat GSGeneral Surgery PRSPlastic Surgery About Bullet Health Join Our Team ORTHOBULLETS Events It was originally described as a four-part fracture with double fractures through the anterior and posterior arches, but three-part and two-part fractures have also been described. Current imaging is shown in Figure B. Open reduction and placement of two 0.045-inch K-wires placed longitudinally through the metacarpal head, Application of a 1.5-mm straight plate applied dorsally through and extensor tendon splitting approach, Open reduction and lag screw fixation with 1.3mm screws through a radial approach, Placement of a 1.5-mm condylar blade plate through a radial approach, Open reduction and retrograde passage of two 0.045-inch K-wires retrograde trough the PIP joint. treatment step to reduce the. OC Sports and Rehab 41 reviews. Diagnosis is often missed with plain radiographs so a CT scan may be required to make the diagnosis. What is the most appropriate treatment? Epidemiology Incidence clavicle fractures account for 2.6-4% of all adult fractures, 75-80% of all clavicle fractures will occur in the, fall onto lateral aspect of shoulder (85%), junction of the outer and middle third is the thinnest part of the bone, posterosuperiorly by sternocleidomastoid muscle, inferomedially by pectoralis major and and weight of arm, open fractures usually result from medial fragment "buttonholing" through platysma, ipsilateral scapular fracture (floating shoulder), significantly distracted/widened fracture fragments, widened interval between scapula and spine, flat laterally, tubular centrally, and prismatic medially, provide superior/inferior stability to AC joint, clavicular head originates superiorly on medial third, stabilizes distal clavicle and assists with shoulder abduction, shortening of clavicle decreases lever arm of deltoid, originates from anterior lateral third clavicle, acromion, and scapular spine, originates from occiput and C-T spine spinous process, inserts on lateral posterosuperior third of clavicle, acromion, and scapular spine, clavicular head originates from anteroinferior surface of medial half of clavicle, inserts on crest of greater tubercle of humerus, lateral to bicipital groove, protects NV structures which pass deep to muscle and displace clavicle inferiorly, originates from 1st rib and costal cartilage, cutaneous nerves that run vertically over clavicle and supply superior chest wall, passes posterior and underneath clavicle near junction of medial and middle third, subclavian vein closest to clavicle and anterior to artery and plexus, middle third is weakest portion of clavicle, transitional of the bone in both curvature and in cross-sectional anatomy, only area not supported by ligamentous or muscular attachments, popping or cracking sound near shoulder after fall, acute onset of anterior shoulder pain or directly over clavicle, tender, swelling, crepitus and deformity over clavicle, assess subclavian vessels and brachial plexus, supine may underappeciate displacement with gravity eliminated, evaluate for other injuries (ie proximal humerus, scapula), compare shortening with contralateral side, inferior displacement of lateral fragment, AP clavicle - distance between the corresponding ends of the medial and lateral fragments, AP chest - direct comparison of length of clavicle to the contralateral side, shortening >2cm associated with decrease shoulder strength and endurance, displacement relative to width of clavicle (percent), >100% displacement is a risk factor for nonunion, assess fracture pattern for preop planning, comminution, shortening, articular extension, nonunion, axial, coronal and 3D reconstruction most useful, with contrast if concern for vascular injury, may present with dysphagia, stridor, asymmetric pulses, paresthesias due to compression of surrounding structures, serendipity view or CT best demonstrate displacement, pain and prominence more lateral over AC joint, zanca or axillary views shows displaced distal clavicle relative to acromion, < 1cm displacement of the superior shoulder suspensory complex, elevate and extend shoulder to bring distal fragment to the proximal fragment, figure-of-8 associated with more pain, shortening, and lower compliance than sling, no difference in functional or cosmetic outcomes between sling and figure-of-eight braces, floating shoulder (clavicle and scapular neck fracture), brachial plexus injury (questionable because 66% have spontaneous return), open reduction internal fixation with plate and screws, operative fixation has higher union rate (>94%), similar or better functional outcomes than nonoperative, immobilize using sling or figure-of-eight brace, higher nonunion rate compared to operative management, decreased shoulder strength and endurance, displaced midshaft clavicle fractures healed with > 2cm of shortening, increased plate strength with inferior bone comminution, low rate of symptomatic hardware removal (0-3.7%), biomechanically equivalent or superior to single 3.5mm plate, limited contact, pre-controured, 3.5mm dynamic compression plate, 2.0mm, 2.4mm and 2.7mm plates can be used and combined for dual plating, improved results with ORIF for clavicle fractures with > 2cm shortening and > 100% displacement, improved functional outcomes/less pain with overhead activity, decreased symptomatic nonunion and malunion rate, increased shoulder strength and endurance, increased risk of need for future procedures, sling for 7-10 days followed by active motion, strengthening at ~6 weeks when pain-free motion and radiographic evidence of union, full activity including sports at ~3 months, goal size of intramedullary nail is 30-40% of midshaft diameter, avoids supraclavicular nerves that are commonly injured with plating, hardware migration, implant irritation, secondary procedures, typically requires hardware removal at 6 months, motion at fracture site, no callus on x-ray, DASH <40, pain and increased fatigue with overhead activities, difficulty with shoulder straps and backpacks, clavicle osteotomy with bone grafting, if symptomatic, superior plates associated with increased irritation, superior plates associated with increased risk of subclavian artery or vein penetration, 83% incidence of numbness noted at 2 weeks postop, can improve over time with ~50% having persistent numbness at 1 year, 4% in surgical group develop adhesive capsulitis requiring surgical intervention, Open treatment of clavicular fracture, includes internal fixation, when performed, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. 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