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Pelvis trauam on B&J

Pelvis trauma B&J

What are the 2 basic types of acetabular fxs? posterior rim fx/dashboard fx, and central acetabular fx
What are the causes of acetabular fxs? Femoral head driven into acetabulum by MVA, or auto vs pedesterian.
With acetabular fxs you get indirect forces from injury to? foot, knee, greater trochanter
What is the mech of posterior rim frac/dashboard fx? leg in flexed and adducted position during injury
With dashboard fx/post rim fx also see? And damages what soft tis struc? Also see post hip disloc, and damage to labrum
What is the MC acetabular fx? Central acetabular fx//exlposion fx//acetabular blow out fx
Are central acetabular fxs stable no
How does one get a central acetabular fx? fall from ht
What are the two types of ways one can get an avulsion fx of the pelvis? 1. single episode of actue trauma 2. repeat chronic trauma
Who do avulsion/tug fxs of the pelvis occur most in adolescents and young adults, sprinters, runners, long jumpers, gymnasts, hurdlers, cheerleaders, and rodeo riders
ASIS avulsion fx due to which mm? Sartorius
AIIS avulsion fx due to which mm? By Rectus femoris, with inf displacement of fragment.
Avulsion fx of isch tube due to which mm? Often with who? Due to Hamstrings, often with hurdlers, long jumpers, and horse riders.
Which avulsion fx of pelvis is assoicated with Crussians dz, which is myositis ossificans of the adductors? Avulsion of isch tube
Which avulsion fx is associated with asymmetry while sitting after healed? Isch tube because heals a little separated
What is the MC form of unstable pelvis fx? straddle fx
What is straddle fx? Bilateral vertical fxs of both superior pubic rami and inf ischiopubic rami
What are the complications of 20% of pts with straddle fx? Bladder rupture (due to fragment displacement), and urethral tears
What is sprung pelvis? Complete diastasis of symphysis pubis and complete diastasis of one or both si joints
Is sprung pelvis stable? no
What is also known as open book injury? straddle pelvis
What is damaged with sprung pelvis? pelvic viscera
What are normal measurements of pubic symphysis? 8 mm max in nonprego adult and 10 mm max in child
What is pubic diastasis? Shearing separation of pubic articulation
If you have pubic diastasis what else must be assessed? si joints and sacrum for associated injuries
How many hips fx annually? 240,000
what % of hip fx pts die within year? and what % of survivors can't live on their own? 12-20% die within yr, and 50% can't live on their own
The mc proximal femoral fxs occur in who? geriatrics with minimal trauma with osteoprosis
Prox femoral fxs occur in the young due to? severe acute trauma, stress (fatigue fx), or patho
By age 80 what % of males and females have had a prox fem fx? and by age 90? 80: 10% white fems, and 5% white males 90: 20% white fems, and 10% white males
What is the avg age of prox fem fx? 70
What type of prox fem fxs have a higher incidence of AVN and nonunion? Intracapsular
What is the MC type of intracapsular fx? subcapital(head neck junc)
Why is there a higher incidence of avn in intracapsular fxs? Due to damage of med and lat fem cirumflex As which ring around with fem neck
What are the 3 types of intracapsular fxs? subcapital, midcervical, basicervical
Subcapital is either impacted or displaced, and is classifed by the? Garden classification
Where do path fxs of the femoral neck commonly occur? basicervical
Subcapital fxs are often difficult to see, but can notice what? disruption of cortex, and zone of impaction
If see AVN of subcapital it takes how long? and what is seen? Takes about a year to form, and see sclerosis.
After 24 hours and 72 hours post prox fem fx, with a bone scan how much is not visible? 24 hrs - 20% of acute fxs not detected 72 hrs - 5-10% not visible
What is extremely sensitive when looking for prox fem fxs? MRI
Greater trochanter can be avulsed by? By gluts, in extracapsular fxs
Which region of the extracapsilar fem fxs are usually pathologic subtrochanteric
what are the three dif extracapsular prox fem fxs types intertochanteric, trochancteric, and subtrochanteric
Extracapsulars are located where? outside joint capsule
Extracaosular prox fem fxs are usually what orientation? comminuted
Lesser trochanter avulsion is usually? pathologic
What is the mc type of hip dislocation? Posterior
post hip dislocations occur by? blow to the knee, with hip flexed (dashboard) and leg adducted
What fxs are possible with post hip dislocs? And what can help find fragments post acetabular rim fx, and ant femoral head fx, and ct can help find frags
What is the mc complication of post hip dislocs? sciatic nerve paralysis
If a subtle post hip disloc what can be seen? Sclerosis of acetabulum
What is the mech of ant hip dislocs? forced abduction and extension of femur
In ant fem dislocs the fem head lies near? obturator foramen
What is the most sensitive xray view for scfe? frog leg
What is the most common hip disorder of adolescence? scfe
What line may be abnormal or asymmetrical in scfe? kleins
What type of sh fx is a scfe most like? sh type I
What is the mc race, sex, and side for a scfe? males, black, left
IF have scfe what is the % of getting scfe in other hip next yr? 30%
bilateral scfes occur more in who? females
What happens to the fem neck in scfe in relation to femhead? fem neck translates upwards, ext rot, and adduction, while the head remains in the acetabulum
Where does a pt with scfe have pain? pain referes to thigh and knee!
What will a pt with a scfe have limited, and what mm will be weak? Limited abduction, and int rot, also have a limp. Glut medius weakness
What happens to fem head height in scfe? decreased ht
What is capeners sign and where is this seen? seen in scfe, when metaphysis is lateral to acetabulum
What happens to the teardrop space in scfe? it widens
With scfe see a ____ growth plate wide, irregular
With scfe there is ______ vertical epiphyseal ht decreased
With scfe there is a _____ deformity of fem head, AKA ____ curved deformity of fem head, aka pistol grip appearance
What is the tx for scfe surgery pins and screws
what is the mc complication of scfe? djd
what are some other complications of scfe? coxa valga deformity, fem neck boradening, fem neck shortening, AVN of fem hea, and chondrolysis
Majority of knee and ankle injuries are? soft tis injuries
What are the ottawa knee rules to get a film of the knee 1. Age <55 2. fibular head tenderness 3. isolated tenderness of patella 3.inability to fex 90 degrees ( if cant get 60 = frac) 4. inability to bear wt 4 steps after injury and in clinic
Where is the mc location of osteochondritis dissecans? knee
what is osteochonritis dissecans, and what is the etiology? osteochondral fx of traumatic etiology
In osteochonritis dissecans who is mostly affected? kids and adolescents
what is the shape of the fragment of osteochonritis dissecans ellipitcal or ovoid osseous fragment
where is a common location of osteochonritis dissecans non wt bearing surface of lat aspect of med fem condyle
osteochonritis dissecans has diplaced what? and non displaced? displaced joint mice, loose body, and non displaced separated by femur radiolucent cleft
spontaneous osteonecriosis of the knee (SONK) is what? articular collapse related to decreased blood flow and degeneration
SONK occurs primarily in the/ eldery
Where is a common location of SONK? weight bearing surface of med fem condyle
common findings on film of SONK? articular flattening and collapse concave articular defect loose body "joint mice" djd
what is chondral defect of osteochonritis dissecans injury limited to cartilaginous layer, bone bruise
What are other names for tibial plateau fxs? bumper, or fender fxs
Most pts with tibial plateua fxs are what age group? over 50 -osteoporosi
What is the mech of tib plateau fxs? valgus injury, fem conyle driven into tib plateua
What plateau is mc affected in tib plateua fx? lateral 80%
What sign is seen in tib plateau fxs? FBI sign
what is a complication of tib plateau fxs? djd
What if the depression is greater than 1 cm in tib plateau fxs? need surgery
what is the mc orientation of patellar fx? transverse in midportion
Patellar fxs are due to? direct or indirect rauma
With patellar fxs there are ___ margins, and ___ jagged margins and displacement
What are the three orientations of fxs of patterlar fxs? transverse 60% stellate 25% vertical 15%
vertical patellar fxs are best seen in what view? skyline/sunrise
common peroneal nerve injuries which lead to lat compartment syndrome of the knee are seen withwhat? prox fib fxs
Prox fib fxs are associated with what three things? 1.knee ligamentous injury 2. lateral tib plateau fx 3. ankle injury (maisonneuve fx)
What is Maisonneuve fx? ankle injury with prox fib fx
What is the mech of maisonneuve fx? inversion, ext rotation @ ankle
What soft tis injuries are associated with maisonneve fx? rupture of tibiofibular syndesmosis/tibiofibular ligament widening, and deltoid ligament injury due to fx of med malleolus
What fx has a very high incidence of acl tears? segonds fx
What is segonds fx? Avulsions fx of IT band @ TFL insertion on the lat aspect of lat tib plateau
Segonds fx is associated with what soft tis injuries? ACL 90% and meniscal tear 70%
In segonds fx where does the fragement go? adjacent to lat tibia
What is the mech of prox fib fxs? eversion and est rotation
What injury is associated with injury to the popliteal artery and peroneal nerve? tibiofemoral dislocation
Tibiofemoral disloc is a ___ injury severe
Tibiofemoral disolcation can be what direction? post or anterior
Tibiofem dislocation occurs due to a? mva or high fall
what is ruptured in tibiofem dislocation? all intra and extra capsular ligamentous structures
What type of patellar disloc is mc? lateral
What is best view to assess if patellar disloc has an osteochondral fx vs bone bruise? sunrise/tangential view
Patellar dislocs may occur from trauma or torsional stress, when direction suddenly changed
Osteochondral fxs, and bone bruises of patellar dislocs can occur where? at medical facet of patella, or lateral fem condyle
Kissing contusion due to patellar disloc? medial facet patella and lat fem edema
The mc mech of an acl injury is? pivot shift (ankle rotation (pivot) with valgus stress)
What sex gets acl injuries more? females
What sports most get acl injuries? basketball, soccer
What does pt feel with acl injury? pop and knee gives out
what is needed with acl injury? mri
Tears of acl often exist with bone contusion of? kissing contusions, bone bruises of: ant-lat fem condyle and post-lat tibia
What is odonoghue's unhappy triad? What causes it? acl tear, posterior horn medial meniscal tear, and medical collateral lig tear all due to valgus force
Acl tears are associated with what fx? segonds fx
ACL avulsion fx pulls off? pulls off anterior tibial spine
Acl tx? non-surgical, or surgical paterlla tendon graft, or semitendionsis graft from hamstrings
What causes a pcl tear? direct anterior blow to the knee
PCL injuries have a higher incidence of what? of partial thickness tears
What is the mc meniscus to get injured? and why? post horn of medial meniscus, because most wt bearing here
Meniscal injuries due to what two things? 1. traumatic tears - twisting injuries 2. degenerative tears - fraying
What is the tx for meniscal injuries? 1. nonsurgical 2. surgery - suture anchors, partial meniscectomy, grafts
If MCL or LCL injury when should u do an ortho test? within 1st 6 mins
MCL injury is due to? valgus stress, superfical and deep layer affected
LCL injury due to? varus stress
What is the mc mech of ankle injuries? inversion
What is the mc shoft tissue injured in ankle injuries? anterior talofibular ligament (ATFL)
what is the mc fracture of the ankle due to inversion? 5th metatarsal base fx
Ottawa ankle rules for x-ray 2.bone tenderness along dist 6 cm of the post edge of the tib or tip of med mall 3." " of the fib or tip of lat mall 4. bone tenderness @ base of 5th metatar 5.bone tenderness @ navic 6. inability to bear wt asap & in clinic for 4 steps
What is webers classification for classification for malleolar fxs, below mortise joint, at level, and above mortise joint
What is the mech of a medial malleolar fx? eversion injury
What is the mech of lat malleolar fxs? inverison
Trimalleolar fxs include fx of the? include fx of the post malleolus which is the post margin of the tibia
What view must be used for trimalleolar fxs and what is the mech? must see in lateral view mech is ext rot of foot
Dupuytrens fx, potts fx, cottons fx, juvenille tillaux, bosworth fx-disloc, wagstaffe-lefort fx, and triplane fx are? All ankle injuries
What is pilon fx and what is mech? Pilon fx//pestle fx is a fx that is comminuted in tibia and fibula distally. mech is when a person lands from ht talus breaks everything.
What is mc malleolar to fx? lateral due to inversion and ext rot
Tillaux fx is? A sh Type III fx of ankle
Avulsion fx of the ankle are very _____. Will see ____. Often in ___ players very common see flakes in soccer players
What is toddlers fx? undisplaced spiral fx of the distal tibia
What is the age range and mech of toddlers fx? 9 months to 3yrs mech: fall out of crib, leg caught in slats then rolls over
What view is best for toddlers fx? Most ap!
What is a boot top fx and who is it seen in? Fx of tib and fib, adjacent to top of high boots, Seen in adults who ski
osteochonritis dissecans of the talar dome usually occurs in who? due to? and ratio of medial to lateral? Occurs in young pts, due to inversion injury, plantar flexed or dorsi flexed, and medial = lat
osteochonritis dissecans of talar dome is associated with what? with avulsion of fib
what is the mc ankle disloc? posterior
All ankle dislocs are? very unstable
What are four dif types of ankle dislocs? anterior, posterior, tibiotlara, and subtalar
Achilles tendon injury mc in what sex? males
Where is the usual location of achilles tendon injury? 2-5 cm above insertion
tx for achilles tendon? non srug- boot with plantar flexion or surgery
What is the mc tarsal bone to fx? calcaneus
What is the mc cause of calcaneal fx? fall from ht, land on ft
Two types of calcaneal fxs 1. compressive, 2. non compressive - avulsion
calcaneal fx: ___% subtalar joint and body, ____% processes of bone 75% subtalar joint and body 25% processes
Compressive calcaneal fx aka? Lovers/suicide jumpers fx - calc and tl junc burst fx
What line is abnormal with calc fxs? boehlers
If subtalar joint involved with calc fx its? intraarticular fx
With avulsion fxs of calc what is the mc part to avulse? anterior process
What is the 2nd mc tarsal bone to fx? talus
What is the most common type of talar fx? avulsion of the ant process
Talar fxs can also be located in what spots? body, neck, head
What is aviators fx? talar neck fx
What are complications of aviators fx? talar neck fx - complication is AVN, osteonecrosis
What is cause of aviators fx? usually mvas - firm foot on break forces talus onto anterior lip of tibia
What is the most common bony injury of the foot? jones/dancers fx
What is jones/dancers fx? and what is the mech? A transverse fx of the 5th metatarsal base, and is due to inversion and plantar flexion
How do jones/dancers fx heal? usually nonunion
In jones/dancers fx can be tip avulsed by what? by peroneous brevis tendon
What are the most common sites of metatarsals for stress fxs? 2nd and 3rd metatarsals
Metatarsal stress fx aka? seen in who>? march fx, seen in long dist runners
What is a crush phalangeal fx? fx due to dropping heavy object, usually comminuted
What is bedroom phalangeal fx? stubbing toe, esp 5th toe
what is chip phalangeal fx? avulsion from felx or ext
What is hallux rigidus phalangeeal fx? complication of hallux fx, arthritis can occur
Tarsometatarsal disloc aka? lisfranc disloc
What is tarsometarsal disloc? disloc of 1st and 2nd metatarsal bases, with frac-disloc extending laterally
Where are the mc fxs of tarsometarsal disloc? Base of 2nd metatarsal and lat cuboid surface
Tarsometarsal disloc in high associated with what? neuropathic arthropathy, diabetes
Rib fxs are uncommon in who? kids
Which ribs rarely fx? 1-3
Who fxs 2nd rib? wt lifters, bench press
Who stress fxs 1st rib? throwing athletes, asthmatics, heavy back packs
What are imaging findings of rib fxs radiolucent fx line cortical offest altered rib orientation (sharp deviation) extrapleural sign (indented look of lung due to hematoma) callus pneumothorax diaphragm elevation
Which area of ribs are mc fxed? and what location Middle ribs (4-9), usually lat location
What is flail chest? 2 fxs on same rib, when resp rib goes in opps direction, and therefore decreases ventilation
What is golfers fx lat margin of rib fx when strike ground with club
what is passion (bear hug) fx fx of ribs in those with osteopenia
what is cough fx fx of ribs d/t violent cough, usually rib 6 & 7
What is the mc orientation of sternal fx? transverse
What are the mc sites of sternal fx? body or manubriosternal junc
What is the mech of sternal fx? blunt trauma, steering wheel in mva
What is needed to assess sternal fx? ct and mri
what complications may arise from sternal fx? cardiac complications
What are complications of thoracic trauma? pneumothorax hemothorax chylothorax lung contusion diaphragmatic rupture aortic ruptue tracheal rupture
What area of clavical mc to fx? middle
Medial clav fracs are the most ____, and need ___ to assess rare and need ct to assess
With lateral clav fxs what views may be helpful to assesss status of coracoclavicular lig? wt bearing views
lateral clav fxs may be____ intraarticular
What is common with middle clav fxs? bayonet apposition
In middle clav fxs you get displacement in 50% due to ____ elevating medial frag, and ____ depressing lateral frag scm elevates medial frag, later grag depresses with shoulder wt
Middle clav fxs are usually what? complete
what is the mech of middle clav fxs? shearing effect from force from dist end
How does mid clav fx heal? with extensive callus
What is tx of mid clav fx? sling
What is the mc fx of skeleton during birth and childhood? clavicle
What are clav fx complications? neurovac damage ( subclav A, brach plexus, symph chain) nonunion malunion degeneration post traumatic osteolysis
Who is prone is clavicle post-traumatic osteomyelitis? weight lifters
What parts of the scapular are mc to fx? body and neck
Scapular fxs are due to? severe trauma, and usually have other fxs and injuries
What is bankart fx? fx of the anterior inferior glenoid rim
What is bankart fx associated with? anterior gh disloc
what is proximal humeral neck fx associated with? Hill sachs fx
Created by: margaretrhager