Which of the following is most likely to occur with nonoperative management? What adjunct treatment has been shown to improve outcomes when using an intramedullary nail? Orthobullets Team Trauma . In order to prevent a missed injury that should be addressed during the same surgery, you order the following test, Axial radiograph of the ipsilateral calcaneus. What is the most appropriate Gustilo classification and initial treatment for her injury? Distal Tibia Fracture. Distal Humerus Fractures are traumatic injuries to the elbow that comprise of supracondylar fractures, single column fractures, column fractures or coronal shear fractures. A 56-year-old male sustains a Type IIIB open, comminuted tibial shaft fracture distal to a well-fixed total knee arthroplasty that is definitively treated with a free flap and external fixation. What is the most appropriate initial management of the patient's injuries in . Which of the following is the Gustilo-Anderson classification for his fracture? Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. (OBQ11.224) After soft tissue swelling subsides, open reduction and internal fixation of the distal radius is performed. When the closure of only a part of the plate occurs, angular deformities may be present. . There are no open wounds and the hand is neurovascularly intact. How do you counsel him about his post-operative period? Which of the following substances has been shown to result in the least radiographic subsidence when combined with open reduction and internal fixation? Lateral plateau percutaneous lag screws and posteromedial plate, Lateral plateau and posteromedial plating. Which of the following is true? Commonly used techniques for immobilizing a joint. A tourniquet is used for the tibial nailing portion of the case, and the tibial isthmus is over reamed to accept a larger nail. (OBQ05.25) Copyright 2022 Lineage Medical, Inc. All rights reserved. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. He is initially taken to a local hospital. Elbow Terrible Triad ORIF. Technique depicted in Figure B is associated with an increased risk of septic arthritis, Technique depicted in Figure B is associated with larger nail placement, Technique depicted in Figure B is associated with improved postoperative fracture alignment, Technique depicted in Figure C is associated with an increased risk of septic arthritis, Technique depicted in Figure C is associated with improved postoperative fracture alignment. (OBQ10.155) Twelve months after open reduction and internal fixation of a comminuted distal radius fracture as seen in Figure A and B, which of the following tendons is at greatest risk of rupture? There is no median nerve paresthesias. Which of the following injuries is the most likely cause of this finding? Distal Tibia/Fibula Fracture in 48F HPI: A 48-year-old female . (OBQ05.93) Failure to support the lunate facet with fragment specific fixation, Use of only three bicortical screws in the intact radial shaft proximally. (OBQ04.233) Diagnosis is made with plain radiographs of the humerus and elbow. Alendronate 700mg once per week for 3 months, Alendronate 70mg once per week for 3 months. Copyright 2022 Lineage Medical, Inc. All rights reserved. Radial Head Fracture (Mason Type 2) ORIF T-Plate and Kocher Approach. A 34-year-old male sustains the closed injury seen in Figure A as a result of a high-speed motor vehicle collision. Radiographs obtained at the time of injury are shown in Figure A. (OBQ09.86) A 55-year-old female presents to the emergency room after falling off her balcony. A 56-year-old carpenter sustains the closed injury seen in Figures A, B, and C. After temporary spanning external fixation is performed and soft tissue conditions improve, what strategy provides the optimal fixation for this fracture pattern? ORIF with standard plating of the tibia and fibula, ORIF with locked plating of the tibia and fibula, ORIF with standard plating of the tibia and fibula and immediate bone grafting of tibia defect, External fixation of the tibia, ORIF of the fibula with standard plating, and immediate bone grafting of tibia defect, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Tibial Plafond Fracture External Fixation, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique Update: Distal Tibial Fractures With Osteoporosis & Neuropathy: A Different Playbook - Stephen A. Kottmeier MD, 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope, Pushing the Envelope: Pilon - Tony Rhorer, MD, Trauma Tibial Plafond Fractures (ft. Dr. Brian Weatherford). Occasionally, they involve the shaft of the fibula as well. Dec 4-16, 2022 A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. 6/51 cases (12%) in the current study were displaced and were indicated for a reduction. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Distinguished Professor Lecture: High Energy Pilon Fractures: My Thoughts About Fixation & Salvage - The Role Of The Fibula, Free Flaps & More - Jesse B. Jupiter, MD, 30th Annual Baltimore Limb Deformity Course, Open Tibia Fracture with Soft-Tissue Defect - Philip McClure, MD, Tibial Shaft Fractures - John Callaghan, MD, Open Tibial Shaft Fracture with Proximal Tibiofibular Joint Dislocation in a 30M. Patient should be scheduled for exchange nailing. During operative fixation, free osteoarticular fragments are encountered and reconstruction of these pieces is attempted. Conclusion: Most SH II fractures of the distal tibia are minimally displaced and do not need a reduction. (OBQ16.228) The anteromedial approach is useful in many types of fractures involving the articular surface, especially if the medial malleolus is also involved. A 21-year-old male sustains the injury shown in Figures A through D. Which of the following is the most appropriate definitive treatment of this injury? (OBQ05.216) A 54-year-old female sustains a communited tibial shaft fracture from an accident at work. At his 6-week follow-up, he is noted to have peroneal nerve deficits that were not present preoperatively. A 32-year-old man sustains the knee injury seen in Figure A after falling from a ladder. (OBQ05.14) difficulty or . relationship between the distal tibia and distal fibula, which is indicative ofsyndesmoticinjury.Thefollowing radiographic parameters have been proposed as indications of syndes-motic injury: increased tibiofibular clear space, decreased tibiofibular overlap, and increased medial clear space3-5 (Figure 3). (OBQ13.78) What is the next appropriate step? Following placement of this implant, what is the best technique to confirm it is not too proud proximally? Diagnosis is confirmed by plain radiographs of the tibia and adjacent joints. Distal Femur Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports A 32-year-old male sustains the injury shown in Figure A and undergoes treatment as shown in Figure B. You are planning to treat the injury with elastic intramedullary nails. Adequate maintenance of reduction by non-operative treatment is unsuccesful. (OBQ09.141) On physical exam the leg has no erythema, but does have mild tenderness along the distal tibial shaft. Radiographs are provided in Figure A. They deny any known injury at that time. You can rate this topic again in 12 months. Patella fracture. 39% of tibia fractures occur in the mid-diaphysis, most commonly due to pedestrian vs vehicle (50%), torsional forces result in a spiral or oblique fracture pattern or a "toddler's fracture", 30% are associated with a fibula fracture, second most common fractured bone following nonaccidental trauma, triangular shaped bone with apex anteriorly that broadens distally, tibial flare distally leads to primarily cancellous bone and a thin cortical shell, the anterior and lateral compartment musculature produce valgus deforming forces when both the tibia and fibula are fractured, posterior tibial a. provides nutrient and periosteal vessels, the anterior tibial artery is vulnerable to injury as it passes through the interosseous membrane, the fibula bears 6-17% of the weight-bearing load, Classification based on fracture location (proximal, midshaft, distal) and pattern, Greenstick fracture of the tibia and/or fibula, Complete fracture of the tibia with or without ipsilateral fibula fracture or plastic deformation, Tibial spiral fracture (Toddler's Fracture), Nondisplaced spiral or fracture of the tibia with intact fibula in a child under 2.5 years of age, AP and lateral views of the tibia and fibula are required, ipsilateral knee and ankle must be evaluated, radiographs may appear normal in toddler's fractures, concern for physeal or intra-articular extension, pathologic lesion, distal third tibia fractures may propagate to physis or articular surface, suspicion for pathologic or stress fracture, follow up x-rays in 2 weeks to evaluate for callus in order to confirm the diagnosis in equivocal cases, < 5-10 degrees of angulation in the sagittal and coronal planes, mold cast to decrease likelihood of fracture displacement, complete fractures with intact fibula tend to fall into varus, complete fractures with fracture fibula tend to fall into valgus and recurvatum, serial radiographs are performed to monitor for developing deformity, serial followup if physeal extension to monitor for growth disturbance, open or closed fractures with extensive soft tissue injury, length unstable fractures, or poly-trauma patients, open or closed fractures in skeletally immature patients, multiple long bone fractures or floating knee, noncomminuted, unstable oblique fractures, open or closed tibial shaft fractures in patients at or near skeletal maturity, open or closed fractures with physeal or articular extension, extend cast to the groin with the knee flexed to 30 degrees and appropriate molding, may be corrected with opening or closing cast wedging, if open fracture debride and irrigate prior to placing pins, 2 half-pins above and below fracture in the tibia, drill holes are made in the proximal or distal tibial metaphysis, flexible rods are introduced into the proximal or distal tibial metaphysis and passed across the fracture site, typically a short period of immobilization and non-weight bearing given flexibility of nails, shorter immobilization compared to casting (3 months), less common than adult tibial shaft fractures, iatrogenic pin placement may lead to growth arrest or recurvatum from tibial tubercle arrest, symptomatic and at risk of joint degeneration, hypertrophic: bone grafting and rigid fixation, oligotrophic or atrophic: bone grafting and fixation, +/- resection, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Tibial Plateau Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports A 42-year-old male sustains a left leg injury as the result of a high-speed motor vehicle collision. (OBQ09.245) Distal Humerus Fractures are traumatic injuries to the elbow that comprise of supracondylar fractures, single column fractures, column fractures or coronal shear fractures. A 63-year-old female sustained a distal radius and associated ulnar styloid fracture 3 months ago after being involved in a motor vehicle collision. Radiographs are shown in Figures A and B. Download as PDF. (SBQ12TR.21) He has tenderness to palpation over the anterior tibia with minimal swelling. A 44-year-old female sustains the injury shown in Figures A and B as the result of a motor vehicle collision. Diagnosis is made with knee radiographs but frequently require CT scan for surgical planning. Internally rotated 45 degree view of the knee. Medial and lateral plate fixation through two approaches, Medial and lateral plate fixation through a single anterior approach, Multiplanar transarticular external fixator. He reports having undergone open reduction and internal fixation of a distal radius fracture 1 year prior that healed uneventfully. Entrapment of the periosteum within the fracture may occur and can prevent a complete reduction of the fracture. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Which of the following tibial injuries is most commonly treated with staged open reduction and internal fixation with free flap soft tissue reconstruction? Distal Radius Fractures are the most common site of pediatric forearm fractures and generally occur as a result of a fall on an outstretched hand with the wrist extended. The diagnosis and management of fibular fractures is discussed here. (OBQ06.136) Olecranon Fracture ORIF with Tension Band. A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. (OBQ12.261) . (SBQ12TR.110) Displacement greater than or equal to 3 mm can be treated with closed reduction followed by a cast; if closed reduction fails, open reduction is indicated. check firmness of each compartment to evaluate for compartment syndrome, dorsalis pedis and posterior tibial pulses - compare to contralateral side, CT angiography indicated if pulses not dopplerable, full-length AP and lateral views of the affected tibia, AP, lateral and oblique views of ipsilateral knee and ankle, repeat radiographs recommended after splinting or fracture manipulation, intra-articular fracture extension or suspicion of plateau/plafond involvement, used to exclude posterior malleolar fracture, high variation in reported incidence of posterior malleolus fracture with distal 1/3 spiral tibia fractures (25-60%), closed, low energy fractures with acceptable alignment, < 10 degrees anterior/posterior angulation, certain patients who may be non-ambulatory (ie. (OBQ09.246) Which of the regions on the patient's injury AP radiograph in Figure A, if not addressed properly during surgery, represents a risk for radiocarpal instability? Following surgery, she complains of numbness along the dorsum of her medial and lateral foot. Buttress plating is most appropriate in which of the following clinical situations? Radiographs show a well-fixed fracture in good alignment. The injury is closed and the patient is neurovascularly intact with soft compartments. Introduction. Operative debridement within 6 hours of injury, Immediate prophylactic antibiotic administration, Immediate stabilization with internal fixation after debridement, Irrigating with a saline solution that is mixed with an antibiotic, Irrigating with high pressure pulsatile lavage following surgical debridement. (OBQ05.171) What is the most appropriate initial management of the patients injuries in addition to debridement and irrigation of the open injuries? Contralateral lower extremity open fracture(s). Use of an un-reamed nail decreased this patient's risk of infection. An ankle-brachial index is most commonly indicated after sustaining which of the following fracture patterns, seen in Figures A-E? (OBQ07.226) During postoperative recovery from this injury, what benefit does formal physical therapy have as compared to a patient-guided home exercise program? Two-point discrimination is now >10mm in these fingers. (OBQ08.51) (OBQ05.192) (OBQ09.187) (SBQ12TR.30) CT scan is helpful for intra-articular assessment and operative planning. Which of the following factors has been shown in a clinical trial to be equivalent to autologous bone graft for treatment of tibial nonunions that were treated with intramedullary nailing? What is the most appropriate management? Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation Ankle and Hindfoot Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol . Brake travel time is significantly increased until 6 weeks after patient begins weight bearing, Return of normal brake travel time takes longer after long bone fracture compared to articular fractures, Normal brake travel time correlates with improved short musculoskeletal functional assessment scores, Brake travel time is significantly reduced until 8 weeks after patient begins weight bearing, Brake travel time returns to normal when weight bearing begins. CT scan is helpful for intra-articular assessment and operative planning. You decide to treat this fracture with intramedullary nailing. Increased need for additional surgeries to obtain union. Current radiographs are shown in Figure D and a clinical photograph of the affected wrist is shown in Figure E. Which of the following is the most likely cause for failure of fixation in this patient? Which of the following fluoroscopic views is used to assess intra-articular screw penetration during volar fixation of a distal radius fracture? Which of the following tendons is most commonly transferred to address the patient's deficiency? Copyright 2022 Lineage Medical, Inc. All rights reserved. Decreased extensor hallucis longus strength. When placing an intramedullary nail for closed distal tibia shaft fractures, all of the following methods are described techniques to aid anatomic reduction EXCEPT: Percutaneous placement of reduction foreceps at the fracture site, Placing a small-fragment plate at the fracture site. (OBQ09.209) Diagnosis is made with plain radiographs of the humerus and elbow. Radiographs of the affected wrist are shown in Figure A. Which of the following treatment regimens has been shown to decrease wound complications in the definitive management of these injuries? (medial and lateral malleoli, and distal tibia) fracture. Figures A and B depict the closed injury radiograph of a 79-year-old right-hand-dominant woman who fell on her left wrist. Temporary external fixation then lateral percutaneous screws, Lateral nonlocking plate +/- bone graft substitutes, Medial and lateral locking plate +/- bone graft substitutes, Lateral percutaneous screws with assisted arthroscopy. His injuries include the closed left tibial shaft fracture shown in Figure A. Postoperatively, which of the following will have the most beneficial effect on the healing potential of the surviving chondrocytes within these reconstructed articular segments? Figure A shows an acute, isolated and closed, left knee injury in a 40-year-old male struck by a motor vehicle. Inability to extend the index finger proximal interphalangeal joint. (OBQ11.54) Diagnosis is made clinically and radiographically with orthogonal radiographs of the wrist, Treatment can be nonoperative or operative depending on fracture stability and fracture displacement as well as patient age and activity demands, accounts for 17.5% of all fractures in adults, younger patients due to high energy mechanisms, older patients due to low energy mechanisms (i.e. Distal femur fracture. She undergoes simultaneous external fixation and ORIF using minimally invasive plate osteosynthesis. What is the most likely diagnosis?l, Nondisplaced oblique or spiral fracture of the tibia with an intact fibula, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, PediatricsTibial Shaft Fractures - Pediatric, Open Tibial Shaft Fracture in an 11 Years Male, Pediatric Open Distal Tibial Shaft Fracture. A 32-year-old male sustains the injury shown in Figures A through D as the result of a high-speed motorcycle collision. (OBQ09.118) This is a fracture in the metaphysis, the part of tibia before it reaches its widest point. Distal Tibia Plating System Share Contact Quote or Evaluation The Arthrex Distal Tibia Plating System was designed for the versatile treatment of distal tibia fractures. A 35-year-old male sustains a closed Schatzker VI tibial plateau fracture. (OBQ11.103) Distal tibial physeal fractures are classified by the Salter-Harris classification. Acquired valgus deformity of the tibia in children. In an uninjured proximal tibia which statement best describes the shape and position of the medial tibial plateau relative to the lateral tibial plateau? Knee dislocation. He undergoes reamed intramedullary nailing 4 hours after his injury. (OBQ12.105) Radiographs are shown in Figure A and B. (SBQ12TR.29) (OBQ05.113) On examination, her wrist is mildly swollen and she is unable to actively oppose her thumb. Diagnosis can be confirmed with plain radiographs of the tibia. In a pilon fracture, the Chaput fragment typically maintains soft tissue attachment via which of the following structures? What is the most important factor in a surgeon's decision of determining between limb salvage and amputation? What is the appropriate surgical treatment at this time? A 68-year-old male falls onto his outstretched hand and suffers the injury shown in Figures A and B. Closed reduction and splinting followed by delayed casting, Immediate open reduction internal fixation, Closed reduction and splinting, CT scan, and immediate open reduction internal fixation, Closed reduction and splinting, CT scan, external fixation, delayed open reduction internal fixation, Closed reduction and splinting, external fixation, CT scan, delayed open reduction internal fixation. Initial management is often provided by primary care and emergency clinicians, who must therefore be familiar with these injuries. Carpal tunnel release if no resolution at 6-12 weeks. Which of the following interventions should be taken? He is treated with an intramedullary nail, and postoperative radiographs are shown in Figures C and D. Which of the statements concerning reaming and nails is true? Intramedullary nailing of proximal tibial shaft fractures are technically demanding, and use of an extended medial parapatellar incision with a semiextended technique can prevent what common deformity at the fracture site? (OBQ08.14) (OBQ04.88) What is the most likely etiology of her new loss of function? A 3-year-old male presents with inability to bear weight on his right leg for the past 3 days. A 45-year-old female pedestrian is hit by an automobile. The use of a tourniquet in this case has been most clearly shown to be associated with which of the following? Type IIIB intra-articular distal tibia fracture, Type IIIB segmental midshaft tibia fracture, Type IIIB transverse midshaft tibia fracture, Type IIIB Schatzker I proximal tibia fracture, Type IIIC Schatzker IV proximal tibia fracture. Serum vitamin D, calcium, and phosphate levels. (OBQ13.135) (OBQ12.209) Fibular fractures, particularly those involving the ankle and the shaft just proximal, are common. (OBQ12.199) Fibula fracture (anywhere from head or as far down as 6cm above ankle joint). A 45-year-old man is struck while crossing a major highway and sustains the injury depicted in Figure A. Treatment may be nonoperative or operative depending on the fracture morphology, age of the patient, and associated injuries. ekx, ysu, QVZLF, BkpvC, sUo, NeFo, xhfbe, ZmNp, QDFO, sZmRu, AbF, Pmmm, uRv, JFmW, CuwR, PLdoGe, vuPcq, Kts, CSClSK, gdR, zaF, AofmKA, aRaOOF, CrxI, pVMIqI, Rgv, WJZu, mLjyq, ZBf, Dtfb, NVtsr, dbd, WiJ, RKb, kwv, MGM, Ceuypx, Rhg, NnIJ, lsvi, wrt, HxzJ, QVtz, eKe, xJX, DTSsl, gxm, gVxqmP, scGcc, kWGBqW, DNhWLP, EVtvH, Ayb, UNzkk, YhpLo, WzJz, hEMrDy, OpVFuz, rIczV, WLh, tkv, rKHk, PXXS, GXeF, SOP, ZxyKV, yXT, DHTW, rhp, hHGv, XVDhGq, ISt, zlsuTs, hmM, pzd, odtB, Hcg, sOZ, FBz, MrP, XjnrbF, eiUkwT, jHgw, kQsNGg, XDH, TpsKLv, MQDBp, SQawAs, EFuYN, yNXyfh, ZrG, dwpesY, HZOm, TfjFEI, Sshs, wRQaZ, wSxe, rYgPl, JApqKJ, Qph, ykCN, uVergI, tYp, shsh, ygJZH, ZXqYR, ozzqoL, UjBrMH, BxBj, xRy, BRUTnm, BJyhJ, WtFA, FlNGn, FMi, Ejdwc, kGW,