Trauma cal

quickster2008's version from 2015-12-06 18:31


Question Answer
imaging if suspicious of lisfranc fxMRI
vassal phenomenonMT lig will hold all lesser MT as a unit
fixation of MT fracturesscrews, K wire, ex fix, plates
apophysis of 5th MT seen at ages?10F 12M x2yrs to fuse
apophysis vs fx of 5th MT baseapophysis oriented longitudinal to bone & has rounded, corticated edge
Iselin's dzapophysis of base of 5th MT
5th MT base/tuberosity projects ? to cuboidplantar laterally beyond the margin of diaphysis & cuboid
PB functionPF & evert foot
PT functionDF & everter
lateral band of plantar fascia origin & insertionO: L aspect of Lateral calcaneal tub, P&L insertion at styloid process
lateral band of plantar fascia antagonistPB/peroneus teritus
blood supply to 5th MTmetaphyseal-proximally, nutrient-diaphyseal
watershedmetaphyseal-diaphyseal junction
fx ? to tuberosity disrupts the nutrient arterial supply & creates avascularity/watershed regiondistal
proximal 5th MT fx zonestuberosity fx->extra articular(zone 1, jones fx->intra articular(zone 2), diaphyseal stress fx(zone 3)
presentation of 5th MT fxACUTE, inversion
what should you do if pt has a blister w/fxdrain blister but leave skin attached-then put silvadene, adaptic, gauze & jones compression dressing then in posterior splint
common foot structure associated w/MT fxcavus foot-ankle instability, MT adductus, skew foot
most common type of 5th MT fxextra articular (tuberosity fx)
tx for extra articular(tuberosity) 5th MT fxwalking boot x 4 weeks; normal activity-6mon
large, or displaced 5th MT fx txORIF w/bicortical screw(4.0 mm cannulated screw)
jones fx definitionfx of met-diaphyseal junction at or distal to the 4/5 IM articulation
torg type 1 on xrayearly fx-fx line w/sharp margins, minimal perosteal rx, no sclerosis
torg type 2 on xraydelayed fx-fx line associated with periosteal bone rxn, widen fx w/radiolucency, evidence of sclerosis
torg type 3 on xraynonunion fx-periosteal bone rx, wide fx line & further radiolucency, completel obliteration of medullary canal caused by sclerotic bone
jones fx txNWB in short leg cast 6w
tx for delayed union, nonunion or high performance athletes w/jones fxintramedullary screw fixation with 4.5-7.0 screw
how should you place the screwhigh & inside(1 cm proximal to base & 0.5 cm medial)
what happens if you dont orient screw high & insideprominent screw head laterally, perforation of medial cortex-stress riser
free handlet solid drill "find" the canal
“free hand” drill acts as abone graft
complications of drilling cannulated screw past insertion ptstraight drill in a curved bone, guide wire failure
what's better cannulated or solid screwsolid, dont use cannulated screw past insertion pt
proper screw length40-50mm
a 40-50mm screw will screw how far?just past fx site
avoid ? when drillingavoid "straightening" a curved bone
screw vs non op tx?screw 5% failure; no op 44%
complications of screw fixationrecurrent fx
sign of recurrent fxhardware fatigue
avg time to re-fx for MT fx8 mon
5th MT shaft fx tximmobilize, closed reduction, ORIF(MULTIPLE lag screws perpendicular to fx lines in all planes), with an off loaded sx shoe & 2-4w xray follow up to assess healing & alignment
most common location for MT stress fractureneck
how long until a 5th MT stress fx of the neck is apparent on xray10d to 3w
best imaging for 5th MT stress fxMRI(T2 or STIR)
name for subchondral stress fxfreiberg's infraction
freiberg infraction also calledegg shell fx Epiphysitis, Osteocondritis deformans, Malakopathie
freiberg infraction located at2nd MT head
juvenile stress fx can occur bc of epiphyseal disruption. Rapid growth at ? closes at ?growth at 5-8yo, closes 15-18yo


Question Answer
3 types of calcaneal fxtuberosity fx, extra articular, intra articular
tuberosity calcaneal fx MOAcaused by pulling of triceps surae(calf)
extra articular calcaneal fx MOAcaused by twisting forces of the anterior process, medial process, & sustentaculum tali of calcaneus
most common calcaneal fx are what typeintra articular
primary & secondary fx are tuberosity, extra articular or intra articular fx'sintra
primary calcaneal fx runs fromPlantar posterior facet
primary calcaneal fx divides calcaneus into ? & ? fragmentsanteromedial & posterolateral fragments
secondary calcaneal fx begins at ?and extends ?giassane's angle & extends posteriorly
G angle1. posterior facet of cal 2. anterior process of cal
where is G angle locatedinferior to lateral process of talus
fx where superior posterior cal lifts uptongue type fx
what type of fx is a tongue type fxessex lopresti type 1
sanders1-nondisplaced, 2-split(2 parts) 3-split/depressed(3parts) 4-comminuted
sanders tx1 casting 2 casting or ORIF 3 ORIF 4 primary arthrodesis
sanders type 1 txcasting no reduction
sanders type 2 txcasting or ORIF
sanders type 3 txORIF
sanders type 4 txprimary arthrodesis
how does a secondary fx affect calincr width & reduce height
cal fx txsplint or ex fix
best view for cal fxharris axial
harris AXIAL angle45 deg
additional views f/cal fx besides Harris axialisher wood(ant cal) brodens
bohlers normal angle20-40
An increase or decr in bohlers for cal fxdecr
decr in bohlers represents ?collapse in posterior facet
incr in gissanes angle represents ?collapse in posterior facet
normal gissanes angle130-145
an increase or decr in giassanes angle represents cal fxincrease(bohlers decr)
highlihgts subtalar incongruitydouble density sign
in essexlopresti type 1 secondary fx line produces asup, post, lateral frag, no STJ involvement
essex lopresti type 2 secondary fxbegins at giaasne's angle exits Dorsally to Postfacet, STJ involvement
STJ involvement in essex lopresti1 no 2 y
essex lopresti type of fracture1 tongue 2 depression
associated findings w/cal fx
incision for ORIF in callateral or extensile lateral incision
why would u do a lateral extensile incisiongreat exposure, visualization(can see into post facet) & takes into account the vascular supply
current ORIF fixation for cal fxMIPO(minimally invasive plate osteosynthesis), minimal invasive percutaneous fixation
#1 wound complicationsurgical site infection
#2 & #3 wound complicationerythema, dehiscence or separation
best candidatesfor surgeryfemales, non WCB pts
predict late subtalar fusioninitialinjury severity, bohlers <0, WC pt, heavy laborers, fx initially tx nonsurgically
what cal fx's need surgeryanything other than sanders type 1
neglected displaced fx often result inwide, shortened heel, problems w/shoe wear, subfibular peroneal impoingement, posttraumatic arthrosis
the surgical outcome of cal fx correlate with the quality of reduction and number of ? fragmentsintra articular
2 part, 3 part, 4 part fractures are associated with a better outcome2 part