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Pelvis trauam on B&J
Pelvis trauma B&J
| Question | Answer |
|---|---|
| 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
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