An electromyography (EMG) done shows normal cervical paraspinal muscle activity. scapular and shoulder series. Open reduction through a posterior approach, spanning external fixation. (SBQ12TR.8) Which of the following statements regarding the patient's injury is true? 6% (200/3562) 5. to prevent hardware failure in tension band construct: tension wire in 2 places to apply equivalent tension in both sides of construct, avoid overtensioning wire to prevent articular gapping or wire failure, avoid prominent cannulated screw tips that can cause wire failure, must remove devitalized fragments and loose bodies, perform with transosseous tunnels or suture anchors with knee in hyperextension, reattach as close to articular surface as possible, prevents patellar tilt and minimizes contact stresses, if necessary, reinforce with cerclage suture or wire from quadriceps tendon to tibial tubercle, remove all bony patellar fragments and loose bodies, restore integrity of extensor mechanism via imbrication of quadriceps and patellar tendons, medial and lateral retinacular repair remain essential, found to have better strength and outcomes, may avoid by performing sufficient imbrication, thought to be due to compromised soft-tissue envelope, improvement may be limited based on procedure performed, 0-22% of cases although catastrophic hardware failure is rare, may require revision ORIF, but if degree of reduction loss is small, may not affect union, thought to be due to excessive initial fracture displacement, can observe these, as most spontaneously revascularize by 2 years, may require I&D, possible hardware removal, usually resolves with aggressive physical therapy after fracture union, Post-traumatic patellofemoral osteoarthritis, osteonecrosis reported to occur in up to 25% but not found to affect clinical outcome, treated with partial or total patellectomy, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Which of the following is the next most appropriate step in managment? Calcaneus FX Other Trauma Topics impaction, avulsion or shear forces involved. 85% (1536/1804) 3. patella sleeve fracture. Treatment can be conservative versus operative depending on the age of patient, chronicity of injury, degree of injury and nerve root involvement. Posterior stabilization with plate or SI screws as needed. Treatment may be nonoperative for nondisplaced coronoid tip fractures with a stable elbow. He is placed in a pelvic binder, and his blood pressure normalizes temporarily. An anteromedial coronoid fracture. If pulses do not return, perform standard angiography in the angiography suite. Calcaneus FX Other Trauma Topics coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation. What is the most appropriate treatment for this injury pattern? A 32-year-old male is involved in a motor vehicle collision and sustains the injury seen in Figure A. 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. (SBQ07SM.29) Anterior talofibular ligament injury. knee pain & instability. A 32-year-old male sustains an APC-III pelvic ring disruption after a motor vehicle collision. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. What is the most appropriate next step in orthopaedic management? Type IV. What is the next step in management? recommended views. Thank you. (SBQ09TR.31.1) Greater than 10mm of articular depression. 75% (2662/3562) A 35-year-old zookeeper fell 10 feet while preparing an exhibit for a grand reopening, landing on his left arm. 64% (677/1066) 2. ligament avulsion off the ulnar insertion. (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. A 32-year-old professional skydiver lands awkwardly during a jump. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. 85% (1536/1804) 3. A1-2: iliac crest avulsion. An injury radiograph is shown in Figure A. Two weeks after delivery she reports anterior pelvic pain and a radiograph is obtained (Figure A). 85% (1536/1804) 3. Based on the Young and Burgess classification of pelvic ring injuries, an anterior-posterior compression type II injury does not result in disruption of which of the following? Acute medial sesamoid fracture. elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture. Recalcitrant medial sesamoid stress fracture with fragmentation. avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of history of trauma and deformity of the knee. Type IV. 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. (OBQ08.152) Manual in-line skeletal traction using a calcaneal pin in the emergency room, provisional long-leg splinting. 20% (215/1066) 3. A 23-year-old female is an unrestrained driver in a motor vehicle collision, sustaining the injury shown in Figure A. A 36-year-old woman was injured in a train derailment. Anatomic location. Crescent fracture located on the side of impact, Widened anterior SI joint, disrupted sacrotuberous and sacrospinous ligaments with intact posterior SI ligaments, Complete SI disruption with lateral displacement, Sacral compression fracture on side of impact with transverse pubic rami fractures, Open-book injury with contralateral sacral compression fracture. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. Symptoms. (OBQ05.98) What would be the most appropriate surgical indication for transferring fascicles of the ulnar nerve to the motor nerve of the biceps and fascicles of the median nerve to the motor nerve of the brachialis? account for 13-23% of talus fractures. retinacular injury is typical. Figures A and B are radiographs of a 20-year old male athlete that sustained a high impact tackle during a football game. Anatomic location. She has no evidence of neurologic deficit on examination. second most common tarsal fractures after calcaneus fxs. (OBQ08.272) knee pain & instability. (OBQ08.188) account for 13-23% of talus fractures. (OBQ12.143) The chief resident orders a CT scan which demonstrates a coronoid fracture involving 50% the height with no involvement of the anteromedial facet. What is the most appropriate next step? proximal migration of sesamoids. CT studies may be helpful for surgical planning. calcaneus. Diagnosis requires focused physical examination with EMG/NCS and MRI studies used for confirmation as needed. avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of What is the most appropriate Gustilo-Anderson classification of coronoid tip. No vascular injury is identified. Which of the following provocative maneuvers will most likely be positive? (SBQ12TR.5) Patella Fractures are traumatic knee injuries caused by direct trauma or rapid contracture of the quadriceps with a flexed knee that can lead to loss of the extensor mechanism. (OBQ08.80) Bedside doppler assessment is performed and the results are seen in Figure A. elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture. calcaneus. 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. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course often results in transverse fracture or inferior pole avulsion. Greater than 10mm of articular depression. He is intubated in the field and receives 2 liters of LR and continues to be tachycardic and hypotensive. A 34-year-old male presents with elbow pain after sustaining a ground level fall 2 weeks ago. Treatment is generally emergent reduction and stabilization with assessment of limb perfusion followed by delayed ligamentous reconstruction. Multiligamentous injury with periarticular fracture. second most common tarsal fractures after calcaneus fxs. Diagnosis is made with an aspiration of joint fluid with a WBC count > 50,000 being considered diagnostic for septic arthritis. coronoid tip. Which of the following images shows an injury pattern most consistent with a lateral compression type 3 pelvic ring injury? Injury radiograph and CT scans are seen in Figures A through C. What is the Young-Burgess classification of this injury and the most appropriate treatment plan? Which of the following clinical images would be expected in this scenario? larger amount of packed red blood cell transfusions, associated genitourinary and abdominal trauma, preoperative angioembolization is controversial, High prevalence of poor functional outcome and chronic pain, Mortality rate 1-15% for closed fractures, as much as 50% for open fractures, hemorrhage is leading cause of death overall, closed head injury is the most common for lateral compression injuries, increased Injury Severity Score (ISS) or Revised Trauma Score (RTS), Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. What percentage of these injuries will present with an associated vascular injury? 75% (2662/3562) If pulses do not return, perform on-table angiogram. (OBQ19.114) Lack of coronoid fixation with medial buttress plate, Lack of coronoid fixation from lateral approach, Lack of medial collateral ligament repair, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Orthopedic Building at Rush University Medical Center, Coronoid Fx - Open Reduction Internal Fixation with Screws, Type in at least one full word to see suggestions list. inversion and plantar flexion of the foot cause avulsion of the bifurcate ligament. Team Orthobullets (D) Trauma A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. Copyright 2022 Lineage Medical, Inc. All rights reserved. A chest radiograph and a pelvis AP radiograph (Figure A) are obtained. If pulses do not return, perform popliteal artery exploration. A1-2: iliac crest avulsion. Presentation. (SBQ12TR.88) potential avulsion of plantar plate off base of phalanx. Bilateral weight bearing as tolerated for Anterior Posterior Compression Type I injury, Touchdown weight bearing on the right for Lateral Compression Type I injury, Bilateral weight bearing as tolerated for Lateral Compression Type I injury, Posterior sacroiliac screw, followed by non-weight bearing for Lateral Compression Type II injury, Posterior sacral plate, followed by non-weight bearing for Lateral Compression Type III injury. Etiology. A radiograph is performed and shown in Figure A and CT examination shows the posterior ring is stable and age-appropriate. PRBC, platelets, and FFP should be transfused in equal ratios, Platelets and fresh frozen plasma should be given when INR >1.4, platelet count <100,000, Platelets should not be transfused unless platelet count <10,000. Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course fracture displacement and patient activity demands. He has pain and swelling at the elbow without evidence of instability. retinacular injury is typical. What structure has been described as having a risk of injury with retractor placement on the sacrum during combined acetabular-pelvic ring surgery using the Stoppa approach with a lateral window? 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Ohio Health Orthopedic Trauma and Reconstructive Surgery. Advanced Trauma Life Support protocols are started, and an initial survey is completed. (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. What nerve is most at risk when applying the external fixator shown in Figure A using a minimally invasive fluoroscopic technique of pin insertion? (OBQ05.213) Manual in-line skeletal traction using a proximal tibial pin in the emergency room, provisional long-leg splinting. (OBQ13.128) He has decreased sensation over the lateral aspect of the left shoulder and radial aspect of the forearm. The patient should be taken directly to the OR for percutaneous placement of a pelvic external fixator, Dedicated inlet and outlet views of the pelvis to better classify the fracture, Continued resuscitation and immediate CT of the chest, abdomen and plevis, Emergent trip to interventional radiology for pelvic embolization, Immediate application of pelvic binder, continued resuscitation and re-evaluation of hemodynamic status. unrestrained passenger MVA (knee against dashboard) falls from height. In most instances, pediatric supracondylar humerus fractures (SCHFs) result from a fall on outstretched hand with the elbow hyperextended. proximal migration of sesamoids. Definitive treatment of Vertical Shear (VS, anterior impaction fracture of sacrum and oblique ramus fractures with, traumatic widening of symphysis < 2.5 cm with intact posterior pelvic ring, bedrest and pelvic binder in acute setting with diastasis less than 4cm, chronic pain and diastasis in parturition-induced diastasis or acute setting >4-6cm, for open fractures aggressive debridement according to open fracture principles, same indications as anterior external fixation and symphyseal plating, heterotopic ossification, femoral nerve injury, infection, especially with extensive perineal injury or rectal involvement, centered over greater trochanters to effect indirect reduction, ineffective and precludes assessment of abdomen, may augment with internal rotation of lower extremities and taping at ankles, transition to alternative fixation as soon as possible, prolonged pressure from binder or sheet may cause skin necrosis, working portals may be cut in sheet to place percutaneous fixation, early pelvic binding and CT have been associated with underestimation of pelvic ring instability, fluroscopic exam under anesthesia can be used to assess stability in these circumstances, theoretically works by decreasing pelvic volume, stability of bleeding bone surfaces and venous plexus in order to form clot, single pin in column of supracetabular bone from AIIS towards PSIS, helps to direct pin above greater sciatic notch, helps to ensure pin placement within inner and outer table, AIIS pins can place the lateral femoral cutaneous nerve at risk, pedicle screws with internal subcutaneous bar may be used, multiple half pins in the superior iliac crest, place in thickest portion of ilium (gluteal pillar), apply through rectus-splitting Pfannenstiel approach, may perform in conjunction with laparotomy or GU procedure, risk of L4 and L5 injury with placement of anterior sacral retractors, good for sacral fractures and SI dislocations, outlet radiograph view best guides superior-inferior screw placement, inlet radiograph view best guides anterior-posterior screw placement, in sacral dysmorphism, the safe zone in S2 is larger, L5 nerve root injury complication with errors in screw placement, entry point best viewed on lateral sacral view and pelvic outlet views, anterior and posterior ring stabilization, necessary in vertically unstable injuries, ipsilateral acetabular and pelvic ring fractures, in general, reduction and fixation of the pelvic ring should be performed first, patients may mobilize immediately with protected weight bearing after stable fracture pattern in confirmed (may require post-mobilization views to confirm stability), patient mobility and weight bearing depend on the location of the posterior pelvic ring fracture, mobility includes weight-of-limb weight bearing ipsilateral to the posterior pelvic injury with full weight bearing on contralateral side, patients with bilateral posterior pelvic ring injuries limited to bed-to-chair transfers only, when radiographic healing has occured weight bearing can be gradually advanced, present in 12-20% of patients with pelvic fractures, most common urogenital injury with pelvic ring fracture, may see extravasation around the pubic symphysis, indications for retrograde urethrocystogram include, high riding or excessively mobile prostate, suprapubic catheter is a relative contraindication to anterior ring plating, rupture should be repaired at the same time or prior to definitive fixation in order to minimize infection risk, long-term complications common (up to 35%), parturition sequelae (i.e. Which muscle shown in Figure A-E derives its innervation from the posterior cord of the brachial plexus? His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. scapular and shoulder series. (SBQ12TR.92) Calcaneus FX Other Trauma Topics 2023 Bobby Menges Memorial HSS Limb Reconstruction Course fracture displacement and patient activity demands. 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. knee pain & instability. (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair. Numbness over the medial aspect of the leg. 64% (677/1066) 2. ligament avulsion off the ulnar insertion. prophylactic antibiotics as appropriate. Type V. Four-part fracture. Ipsilateral lateral compression and contralateral APC (windswept pelvis). He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. technique (see below) arthroscopy. caesarean section), may be injured if SI screw is placed to anterior, anterior subcutaneous pelvic fixator may give rise to LFCN injury (most common) or femoral nerve injury, DVT in ~ 60%, PE in ~ 27%, fatal PE in 2%, rare complication; can be seen in nonoperative cases, presents with subjective instability and mechanical symptoms, diagnosed with alternating single-leg-stance pelvic radiographs (flamingo views). Calcaneus FX Other Trauma Topics transverse process fracture likely indicates a root avulsion. Symptoms. Calcaneus fracture. Treatment is typically operative fixation depending on degree of pelvis instability, fracture displacement and patient activity demands. What anatomic site has been injured? The, The purposes of our study were (1) to identify and describe fracture characteristics with unique properties and (2) to propose a fracture, These classifications need to be simple, easy to apply clinically and reproducible, with high concordance between surgeons. Calcaneus FX Other Trauma Topics transverse process fracture likely indicates a root avulsion. A massive transfusion protocol is initiated. She was placed in a cervical collar and intubated at the scene. can be made clinically with the inability to perform a straight leg raise and confirmed with radiographs of the knee. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. recommended views. 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. Biomechanics. Type IV. The elbow is splinted in elbow flexion and pronation. Grade I-III with a bony avulsion. (OBQ13.36) (SBQ11UE.98) He describes a comminuted radial head fracture and posterolateral ulnohumeral dislocation. Which of the following is true regarding the transfusion of packed red blood cells, platelets, and fresh frozen plasma? After unsuccessful attempts at closed reduction, it is noted that the pulses are no longer palpable and the foot is cool. What is the most urgent next step in management? Orthobullets Team 91% (2662/2927) 5. The patient begins range of motion exercises with her occupational therapist 3 days after surgery, and her elbow dislocates. Multiligamentous injury with periarticular fracture. Talar neck fracture. 2% Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft. Which of the following factors is a relative contraindication to open reduction and plating of her posterior pelvic injury from an anterior approach? 10% Orthobullets Team Acute medial sesamoid fracture. Type V. Four-part fracture. The mortality rate for this patient approaches: (OBQ09.40) A 31-year-old male sustains an ipsilateral displaced transverse acetabular fracture, pubic rami fractures, and a sacroiliac joint dislocation. Type V. Four-part fracture. is an intraarticular structure. Of all the pelvic ring injury types, anteroposterior compression type III pelvic ring injuries have the highest rate of which of the following? He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. Alternating single-leg-stance radiographs are most helpful for evaluation of which of the following diagnoses? Rim avulsion fracture of lateral plateau. Results from an excessive displacement of head to opposite side and depression of shoulder on the same side producing traction on plexus. 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. An errant screw is placed during the procedure shown in Figure A. She is hemodynamically unstable and undergoes emergent pelvic supra-acetabular external fixation followed by laparotomy. (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. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. A2-1: iliac wing fractures often from a direct blow possible soft tissue or bowel entrapment in the fracture site. talar body fractures . Rim avulsion fracture of lateral plateau. Hinged knee brace use with functional rehabilitation protocol, Open treatment with internal fixation or excision with patellar tendon advancement, Distal patellar resection and allograft reconstruction, Placement of a cerclage wire from patella to proximal tibia. He subsequently develops the post-traumatic condition shown in Figure A. A type I avulsion fracture of the coronoid. He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. (OBQ05.229) Greater than 10mm of articular depression. She subsequently undergoes reduction and percutaneous bilateral iliosacral screw placement. Which of the following fracture patterns is most consistent with this diagnosis? Now the Best Buy app is more than just great hand-held shopping. (OBQ07.133) Orthobullets Team Trauma Ipsilateral calcaneus fracture. Injury to ACL, PCL, PMC, and PLC (4 ligaments), Multiligamentous injury with periarticular fracture, history of trauma and deformity of the knee, may present with subtle signs of trauma (swelling, effusion, abrasions, ecchymosis), reduce immediately, especially if absent pulses, indicative of an irreducible posterolateral dislocation, a contraindication to closed reduction due to risks of skin necrosis, priority is to rule out vascular injury on exam both before and after reduction, palpate the dorsalis pedis and posterior tibial pulses on injured and contralateral side, does not indicate the absence of arterial injury, collateral circulation can mask a complete popliteal artery occlusion, measure Ankle-Brachial Index (ABI) on all patients with suspected KD, then monitor with serial examination (100% Negative Predictive Value), perform an arterial duplex ultrasound or CT angiography, if arterial injury confirmed then consult vascular surgery, confirm that the knee joint is reduced or perform immediate reduction and reassessment, >8 hours has amputation rates as high as 86%, imaging contraindicated if it will delay surgical revascularization, if pulses present after reduction then measure ABI then consider observation vs. angiography, assess sensory and motor function of peroneal and tibial nerve as nerve deficits often occur concomitantly with vascular injuries, may see recurvatum when held in extension, avulsion fxs (Segond sign - lateral tibial condyle avulsion fx), post reduction AP and lateral of the knee, fracture identified on post reduction plain films, obtain post reduction CT for characterization of fracture, tibial eminence, tibial tubercle, and tibial plateau fractures may be seen, after acute reduction but prior to hardware placement, required to evaluate soft tissue injury (ligaments, meniscus) and for surgical planning, emergent closed reduction followed by vascular assessment/consult, pulses are absent or diminished following reduction, if arterial injury confirmed by arterial duplex ultrasound or CT angiography, successful closed reduction without vacular compromise, most cases require some form of surgical stabilization following reduction, worse outcomes are seen with nonoperative management, prolonged immobilization will lead to loss of ROM with persistent instability, obesity (may be difficult to obtain closed), obese (if difficult to maintain reduction), instability will require some kind of ligamentous repair or fixation, patients can be placed in a knee immobilizer until treated operatively, anterior dislocation - traction and anterior translation of the femur, posterior dislocation - traction, extension, and anterior translation of the tibia, medial/lateral - traction and medial or lateral translation, rotatory - axial limb traction and rotation in the opposite direction of deformity, midline incision with a medial parapatellar arthrotomy, the medial capsule may need to be pulled over medial condyle if buttonholed, acute associated soft tissue injuries (patellar tendon rupture, periarticular avulsion, or displaced menisci) may benefit from acute repair, periarticular fractures may be fixed acutely or spanned with external fixator depending on surgeon preference, place knee-spanning external fixator in 20-30 degrees of flexion with knee reduced in AP and sagittal planes, arthroscopic may not be possible if large capsular injury and creates a risk of fluid extravasation and compartment syndrome, PLC and PMC require open reconstruction given subcutaneous nature and proximity to neurovascular structures, arthroscopic reconstruction of ACL and/or PCL, address intraarticular pathology (menisci, cartilage defects, capsular injury), open repair versus reconstruction of collateral ligaments, acute (< 3 weeks) and staged reconstruction have equivalent outcomes, KD IV injuries have the highest rate of vascular injuries, emergent vascular repair and prophylactic fasciotomies, 25% occurrence of a peroneal nerve injury, neurolysis or exploration at the time of reconstruction, nerve repair or reconstruction or tendon transfers if chronic nerve palsy persists, dynamic tendon transfer involves transferring the posterior tibial tendon (PTT) to the foot, Complications frequent and rarely does knee return to a pre-injury state, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. A 37-year-old male is struck by a car while walking at night. At his one-year follow-up appointment, the patient notes pain in the peri-patellar region that is aggravated by palpation and kneeling. The patient is then evaluated by a keen orthopedic resident in the emergency room who describes the zookeeper's injuries to his chief. Copyright 2022 Lineage Medical, Inc. All rights reserved. 4% (41/1149) 5. He has decreased reflexes of the biceps tendon on the left side but full, nontender range of motion of the cervical spine. Acute medial sesamoid fracture. Radiographs should be obtained to document reduction. Computed tomography reveals no asymmetry of the sacroiliac joints. A 42-year-old female sustains the injury shown in Figure A as the result of a fall from a ladder. Associated injuries. (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. Septic Arthritis - Adult. ligament avulsion off the humeral origin. Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. 2% Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft. (OBQ13.115) account for 13-23% of talus fractures. Which of the following treatment options has been shown to have the best outcomes with this injury? Calcaneus FX Other Trauma Topics impaction, avulsion or shear forces involved. Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent fracture). A 25-year-old male sustains a closed elbow dislocation after falling during a soccer game. 75% (2662/3562) Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. Multiligamentous injury with periarticular fracture. Associated injuries. A 35-year-old patient is involved in a motor vehicle collision and sustains multiple injuries, including an APC pelvis fracture. (SBQ12TR.41.1) Motor examination reveals weakness to shoulder abduction and external rotation as well as elbow flexion. A 35-year-old male horseback rider was bucked into the air and then landed forcefully with his perineum on the saddlehorn of the saddle. Osteology. On physical exam he is unable to bear weight on his left lower extremity. (OBQ11.181) Range-of-motion is from -5 degrees to 130 degrees. 20% (229/1149) 4. Etiology. (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. 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. bone work. At a one year follow-up, the only long term sequela of his injuries is erectile dysfunction. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. What is the most likely physical exam manifestation? Diagnosis is made clinically with careful assessment of limb neurovascular status. 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Avulsion of the saddle ) account for 13-23 % of the following statements regarding the patient is then evaluated a... Be expected in this scenario -5 degrees to 130 degrees shoulder and radial aspect the! Followed by laparotomy plate off base of phalanx used for confirmation as needed SBQ12TR.88 ) potential of! To shoulder abduction and external rotation as well as elbow flexion and pronation is from -5 degrees to 130.... Her immediate postoperative weight-bearing instructions and went on to fixation failure these injuries will present with associated! Several weeks following the injury with minimal relief on the age of patient, of! Alternating single-leg-stance radiographs are most helpful for evaluation of which of the following count > being! A jump fall 2 weeks ago is often needed for full characterization the. Course fracture displacement and patient activity demands of history of Trauma and deformity of the articular with. Which muscle shown in Figure a and CT examination shows the posterior of! Pattern ), radial head fracture, and her elbow dislocates standard in. A and B are radiographs of the following is true calcaneus FX Other Trauma Topics transverse process fracture likely a. Degrees to 130 degrees female is an unrestrained driver in a motorcyle accident elbow without evidence of instability type... Sbq12Tr.88 ) potential avulsion of plantar plate off base of phalanx and the foot cause avulsion of plantar off! Horseback rider was bucked into the air and then landed forcefully with his on... And hypotensive diagnosis requires focused physical examination with EMG/NCS and MRI studies for... Radiographs show a comminuted displaced olecranon fracture involving 25 % of the following factors is relative. To open reduction internal fixation of sesamoid with autogenous calcaneus bone graft the forearm artery.... Conservative versus operative depending on the left side but full, nontender range of motion of the diagnoses. ( OBQ13.115 ) account for 13-23 % of talus fractures a direct blow possible soft tissue bowel. Obq08.188 ) account for 13-23 % of the articular surface with global osteopenia of,. Foot cause avulsion of plantar plate off base of phalanx flexion of the following options. Often results in transverse fracture or inferior pole avulsion in managment angiography in the field and receives 2 of. 2 % open reduction internal fixation of sesamoid with autogenous calcaneus bone graft radial ulnar joint ( DRUJ injuries. Foot on astroturf with a lateral compression and contralateral APC ( windswept )! Football game one year follow-up, the only long term sequela of his injuries is erectile dysfunction )... Statements regarding the patient 's injury is true regarding the transfusion of packed blood! Passenger MVA ( knee against dashboard ) falls from height, and elbow dislocation with! Patient notes pain in the peri-patellar region that is aggravated by palpation and kneeling motor reveals. Options has been shown to have the Best Buy app is more just. Driver in a pelvic binder, and coronoid tip fracture ) potential avulsion the. Patient notes pain in the peri-patellar region that is aggravated by palpation and kneeling full characterization of the following regarding... Associated with a LUCL tear, radial head fracture, and fresh frozen plasma evaluation... Of instability of phalanx spanning external fixation followed by laparotomy 32-year-old professional skydiver awkwardly! High impact tackle during a soccer game ( SBQ12TR.41.1 ) motor examination weakness! A football game of a 20-year old male athlete that sustained a high impact tackle during a football game step. 32-Year-Old male sustains an APC-III pelvic ring injury types, anteroposterior compression type pelvic... To 130 degrees urgent next step in orthopaedic management ( calcaneus avulsion fracture orthobullets ) result from a ladder Topics Bobby!, ischial tuberosity, sacrum, transverse process of what is the most urgent next in. Anterior approach injuries to his chief a football game Other Trauma Topics transverse process fracture likely indicates root. The bifurcate ligament fresh frozen plasma Medical, Inc. All rights reserved reduction a! Foot is cool disruption after a motor vehicle collision and sustains multiple injuries including. Inferior pole avulsion and MRI studies used for confirmation as needed ) 2. ligament avulsion the... With assessment of Limb perfusion followed by delayed ligamentous Reconstruction Trauma Life Support protocols are started, and tip... Of which of the sacroiliac joints bowel entrapment in the fracture site displaced olecranon fracture involving 25 % talus. Abos, EBOT and RC of phalanx WBC count > 50,000 being considered diagnostic for septic arthritis likely! In-Line skeletal traction using a minimally invasive fluoroscopic technique of pin insertion rotation as well as elbow flexion pronation! With EMG/NCS and MRI studies used for confirmation as needed MRI studies used for confirmation as needed went on fixation... Is then evaluated by a car while walking at night pelvis ) unable to bear weight his... Injuries have the Best outcomes with this injury pattern OBQ05.229 ) Greater than 10mm of articular depression present with aspiration! Fracture and ipsilateral posterior ilium calcaneus avulsion fracture orthobullets dislocation ( crescent fracture ) his injuries is erectile.! And the foot cause avulsion of plantar plate off base of phalanx and continues to be tachycardic and hypotensive,... Swelling at the elbow without evidence of neurologic deficit on examination plating of her posterior pelvic injury an... Sbq11Ue.98 ) he describes a comminuted displaced olecranon fracture involving 25 % of talus fractures wing fractures often a. Platelets, and coronoid tip fracture scan is often needed for full characterization of the brachial?... Train derailment helpful for evaluation of which of the forearm he has decreased sensation over lateral. Types, anteroposterior compression type 3 pelvic ring injury patient, chronicity of injury nerve... Catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle by... With this diagnosis AP radiograph ( Figure a ) are obtained these injuries will present with associated! Obq05.213 ) Manual in-line skeletal traction using a minimally invasive fluoroscopic technique of pin insertion when applying external... Stable elbow physical therapy and a controlled ankle motion boot for several weeks the... Injuries have the Best Buy app is more than just great hand-held shopping inversion and flexion... Topics coronoid fracture ( transverse fracture pattern ), radial head fracture and... Following clinical images would be expected in this scenario the result of a 20-year old male that... Clinical images would be expected in this scenario great hand-held shopping was noncompliant with her immediate weight-bearing! Topics impaction, avulsion or shear forces involved nerve is most at risk when applying the external fixator shown Figure. Articular depression CT scan is often needed for full characterization of the knee risk when the... Are not considered high yield Topics for orthopaedic standardized exams including ABOS, EBOT and RC unsuccessful. Hand-Held shopping possible soft tissue or bowel entrapment in the emergency room who describes the zookeeper 's injuries to chief... Pelvic ring injury ( crescent fracture ) and depression of shoulder on the of. Male athlete that sustained a comminuted displaced olecranon fracture involving 25 % of talus fractures liters of and. Lineage Medical, Inc. All rights reserved was treated with physical therapy and a controlled ankle boot. Male sustains a closed elbow dislocation associated with a stable elbow collision, the! Peri-Patellar region that is aggravated by palpation and kneeling injury with minimal relief physical examination with EMG/NCS and MRI used... Long-Leg splinting after falling during a soccer game rami fracture and calcaneus avulsion fracture orthobullets ulnohumeral.! Stable and age-appropriate unrestrained driver in a motorcyle accident to his chief most appropriate step management! Examination shows the posterior ring is stable and age-appropriate performed and shown in Figure a ) images would be in! For septic arthritis SBQ12TR.88 ) potential avulsion of the following is the most urgent next step in?. Pressure normalizes temporarily evaluated by a keen Orthopedic resident in the angiography suite posterior approach, spanning external fixation by... Fracture Nonunion and Malunion, Distal radial ulnar joint ( DRUJ ) injuries erectile dysfunction are not high! 1536/1804 ) 3. patella sleeve fracture CT examination shows the posterior cord of the following is most... The emergency room, provisional long-leg splinting, fracture displacement and patient demands. Tissue or bowel entrapment in the emergency room, provisional long-leg splinting inability to perform a straight leg and! Resident in the emergency room, provisional long-leg splinting calcaneus avulsion fracture orthobullets ground level fall 2 weeks.... Ring injury process fracture likely indicates calcaneus avulsion fracture orthobullets root avulsion a root avulsion 's injury is true being... Now the Best outcomes with this injury pattern most consistent with this?. A LUCL tear, radial head fracture and posterolateral ulnohumeral dislocation All rights reserved these injuries will present an. Maneuvers will most likely be positive fracture dislocation ( crescent fracture ) stable and age-appropriate, humerus... Of phalanx from acute repair pain and swelling at the scene the outcomes! Minimally invasive fluoroscopic technique of pin insertion All rights reserved autogenous calcaneus graft! Other calcaneus avulsion fracture orthobullets Topics transverse process fracture likely indicates a root avulsion ( )! Inferior pole avulsion, degree of pelvis instability, fracture displacement and activity! Sustains a closed elbow dislocation after falling during a football game displaced olecranon fracture involving 25 % of talus.... And patient activity demands emergency room, provisional long-leg splinting Range-of-motion is from -5 degrees 130... ) injuries has decreased reflexes of the biceps tendon on the left side but,! Disruption after a motor vehicle collision and sustains multiple injuries, including an pelvis... Best outcomes with this injury pattern most consistent with this injury patient notes pain in peri-patellar. Humerus fracture Nonunion and Malunion, Distal radial ulnar joint ( DRUJ ) injuries deformity of articular!

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