ABFAS - Trauma Section Flashcards - Quizlet

8/7/2018 ABFAS - Trauma Section Flashcards | Quizlet
ABFAS - Trauma Section 107 terms quizlette7878025
Achilles tendon rupture Sprinters

is likely to occur in this
position
Gastroc-soleal complex Tibial nerve (S1 - S2)

is enervated by:
Runs between the Plantaris

gastrocnemius and
soleus. Assists in
plantarfexion of the
foot and flexion of the
knee
Nerve enervation of the L4, L5, S1

plantaris
The narrowest part of 4cm proximal to its insertion

the achilles tendon
An Achilles tendon 2-6cm proximal to attachment (watershed area) of the left

rupture is likely to occur lower extremity (due to handedness: Right handed
at what anatomical individuals more commonly push off with the left foot).
location?
Name the Test: Thompson Test

squeezing of the calf
muscle does not result
https://quizlet.com/204203212/abfas-trauma-section-flash-cards/ 1/21
in plantar flexion of the

foot
Name the Test: A 25 O'Brien Test

gauge needle is
inserted at a right angle
to the leg through the
skin of the calf muscle
just medial to midline.
This should be
performed 10 cm
proximal to the
calcaneal insertion of
the Achilles tendon.
Motion of the hub of
the needle in a
direction opposite that
of the tendon during
passive dorsiflexion and
plantarflexion of the
foot confirms an intact
tendon distal to the
level of needle
insertion.
The parameters of Anterior border: FHL, Posterior border: Achilles Tendon,

Kager's triangle are. . . Inferior Border: Superior cortex of the calcaneus
What classification is Kuwada (1: partial tear 2: complete tear up to 3, 3: 3-6cm

used for achilles tendon tear, 4: greater than 6cm tear
ruptures?
Case: 34 year old male End-to-end anastomosis

presents with left 2cm
Achilles tendon rupture
confirmed on MRI. No
other comorbidities.
What is the best
treatment of choice?
Case: 36 year old 1. Gastroc recession, 2. Turn down with tendon graft and or
female presents with synthetic graft.
7cm Achilles tendon
rupture occurring just
yesterday while skiing.
She states that she had
been on levofloxacin
for 2 weeks for abscess
in her left thigh. She has
no other significant past
medical history. What is
the best treatment of
choice?
Case: a 42 year old Following surgical debridement of the tendon ends to

male presents with an healthy tissue. Recommended treatment: Tendon graft flap,
Achilles tendon rupture +/- a synthetic graft augment. Additionally a V-Y
to the left lower advancement, a Bosworth turndown, tendon transfer, or a
extremity occurring combination of these may also be used for type 3 injuries.
while running a
marathon the previous
day. He denies taking
any medications and
has no significant /
contributory past
medical history. MRI
reveals a 4cm complete
rupture of the left
Achilles tendon. Which
of the following is the
most appropriate
treatment of choice.
Which component of Tibiocalcaneal

the deltoid ligament
blends with the spring
ligament?
Which component of Anterior tibiotalar
the deltoid ligament is

deep to the others?
What two tendons pass FDL and Tibialis posterior

over the Deltoid
ligament?
What is the strongest of Posterior talofibular ligament

the lateral collateral
ligaments of the ankle?
Which of the lateral Posterior talofibular ligament

collateral ligaments of
the ankle are
extrasynovial but
intracapsular?
Which of the CFL

extracapsular lateral
collateral ligaments of
the ankle are just deep
to the peroneal
tendons?
Which is the shortest ATFL

lateral collateral
ligament of the ankle?
A surgeon is inverting CFL

the foot with the ankle
in a dorsiflexed
position. The surgeon is
preparing to do a
modified brostrum.
Which ligament are they
specifically assessing?
The proximal plain synovial joint

tibiofibular joint is best
described as what type
of joint?
A patient presents to CFL

the office complaining
that they "rolled their
ankle". X-rays reveal soft
tissue inflammation. If
the patient were to
have, hypothetically,
inverted their foot while
the foot was in neutral
position (neither
dorsiflexed nor
plantarflexed) on the
sidewalk, which
ligament would be at
stake?
What degree of talar tilt 10 degrees

with reference to the
contralateral side
requires surgical
correction?
All of the following Christman Snook and Elmslie address correction of the
lateral ankle stabilizing CFL and the ATFL. All the other procedures listed address
procedures address only the ATFL
one ligament except. . .
A. Lee and Evans
B. Watson Jones
C. Nilson
D. Christman Snook
Avulsion fracture of the Chaput-Tilleaux Fracture

tibia from anterior
inferior tibial fibular
ligament
Avulsion fracture of wagstaff

fibula from anterior
inferior tibial fibular

ligament
Occurs because of a Tillaux Kleiger

closure of the medial
tibial physis before the
lateral physis.
Fracture of the Volkmann's

posterior tibia
(posterior malleolus)
from the posterior
inferior tibiofibular
ligament.
Lauge Hansen Supination-Adduction Stage I

Classification:
Rupture of lateral
collateral ligaments or
classic transverse
avulsion fracture of
lateral malleolus. The
fracture is transverse
(horizontal) at or below
the ankle joint level.
Lauge Hansen Supination-Adduction Stage II

Classification:
With further force of
talus, there is an
abutment of talus
against the medial
malleolus causing a
short oblique fracture
(classic vertical fracture
of the medial
malleolus).
Lauge Hansen Supination-Adduction

Classification
The tibial-fibular
syndesmosis and
syndesmotic ligaments
are always intact in this
fracture pattern.
Lauge Hansen Pronation Abduction Stage I

Classification
Rupture of the deltoid
ligament or transverse
medial malleolus.
Lauge Hansen Pronation Abduction Stage II

Classification
Rupture of the anterior
and posterior inferior
tibial-fibular ligaments
or avulsion of small
fragments of bone from
tibial or fibula.
Lauge Hansen Pronation Abduction Stage III

Classification
Classic short oblique
fracture of the lateral
malleolus.
Lauge Hansen SER Type I

Classification
Disruption of the
anterior-inferior tibial-
fibular ligaments or
avulsion fractures of
Wagstaffe or Chaput-
Tillaux
Lauge Hansen SER Type II

Classification
Classic spiral fracture of
the lateral malleolus,

beginning at the joint
line. The fracture line
runs laterally from
anterior inferior to
superior posterior.
Lauge Hansen SER Type III

Classification
Disruption of posterior-
inferior tibial-fibular
ligaments or avulsion
fracture of the posterior
inferior portion of the
tibia from Volkman
triangle (posterior
malleolus).
Lauge Hansen SER Type IV

Classification
Rupture of deltoid
ligaments or transverse
fracture of medial
malleolus.
Lauge Hansen PER Type I

Classification
Disruption of deltoid
ligament or transverse
medial malleolus
occuring with external
rotation.
Lauge Hansen PER Type II

Classification
Rupture of anterior-
ligament or fracture of
Wagstaf or Tillaux-
Chaput.
Lauge Hansen PER Type III

Classification
Interosseous membrane
torn above syndesmosis
and below fibular head
and then a classic high
fibular fracture occurs
approx. 4-5 cm above
joint line.
Lauge Hansen PER Type IV

Classification
Disruption of posterior-
ligaments or avulsion
fracture of tibia
(Volman) or fibula
Lauge Hansen immediately to within 6 hours of injury; from 6-12 hours of

Classification injury the patient will develop hematoma / edema that will
The ideal time to fix an prevent adequate soft tissue coverage. Will have to wait 4-
ankle fracture would be 14 days until fracture blisters heal to correct the injury.
within . . .
For fibular fractures interfragmentary screws (4.0mm cancelous / 3.5mm

mid-diaphyseal level or cortical) augmented with a 1/3 tubular neutralization plate.
lower, the accepted
technique for ORIF
would entail . . .
A fracture of the distal transfixation through the plate.

fibular diaphysis would
best be reduced with . .
.
The goal of tibiofibular stabilization of the ankle mortise. YOU DO NOT want
transfixation is . . . compression here.
Tibiofibular transfixation two 3.5mm or one 4.5 fully threaded cortical screws
can be achieved using . angled posterior lateral to anterior medial at an angle of
.. 25-30 degrees from the sagittal plane. THE SCREW MUST
PURCHASE: both cortices of the fibula and at least the
lateral cortex of the tibia.
A patient presents with Lumbar Spine films. The most common is L1 fracture in
a calcaneal fracture. association with calcaneal fractures.
Besides the standard
imaging (CT) after plain
films of the foot. What
other imaging should
be ordered.
A normal Bohler's angle 25-40 degrees

is:
You are observing a CT Sanders 2a; remember had the fracture been through the
and notice the fracture central part of the posterior facet, it would have been a 2b.
pattern of a calcaneal
fracture to form a "Y"
with medial and lateral
exit points. Importantly,
the origin of the
fracture is in the lateral
aspect of the posterior
facet. What type of
fracture is this?
Any fracture of the 4; remember that the order of classifying Sanders is from
posterior facet of the lateral to medial. I like to remember it as "C" stands for
calcaneus with more "center of the body". So fractures passing near the medial
than 2mm of articular aspect of the posterior facet.
displacement on a CT is
automatically grade . . .
What are Palmer's three 1. Vertical shearing fracture

constant components 2. Fracture of the lateral cortex
of intra-articular 3. Depression fracture of the lateral posterior subtalar joint
fractures.
What is the normal 8mmHg

compartment pressures
in the foot?
After obtaining 1. serum myoglobin and CK levels (assess muscle damage

compartment pressures 2. BUN / creatinine (assess kidney damage)
with a Wicks catheter, 3. Potassium (to assess fatal rhabdomyolysis)
you also need to order
labs for a compartment
syndrome work up.
Which specific labs will
you likely order in the
workup?
Which compartment of Anterior compartment

the leg is the most
commonly affected by
compartment
syndrome?
Closed reduction of a dorsiflexion, longitudinal traction, and then plantar flexion

dislocated MPJ is best
accomplished by. . .
Poliglecapone is best subcuticular closure (it is the generic name for monocryl
used for . . . and is absorpable).
Polyglactin is best used deep closure (capsule and subcutaneous tissue)

for . . .
What are the three main 1. Zone of growth

parts of the physis? 2. Zone of cartilage maturation
3. Zone of cartilage transformation
What is the weakest Zone of maturation , this is due to loss of intracellular

zone of the physis? matrix
A 10 year old male Likely during the trauma the epiphyseal arteries were
presents to your office damaged causing premature arrest / closure of part of the
with his mother for physis. This would be the cause of the angulation of the
concerns of a possible bone.
fracture after trauma to
the left foot a few

months prior. The
mother states that she
thought her son would
be fine with "ice" and
rest after the injury. On
plain film you notice the
presence of an angular
deformity to the first
metatarsal. What is the
most likely
pathogenesis of the
presenting condition?
What important Osseous Ring of Lacroix

structure stabilizes the
physis at the Zone of
Ranvier (the area where
the physis interfaces
with the metaphysis)?
Trauma to a bone This area does not provide extensive blood supply to the
during childhood, is physis; epiphyseal and perichondrial vessels do, however.
least concerning with it
involves vessels to the
metaphysis, why?
During your computer minimum of 3 views of the affected and contralateral limb
simulation of the ABFAS
you will make sure to
order what for peds
fractures?
What force is most compression force

likely to cause growth
arrest in a child with a
fracture?
Epiphyseal fractures are 1. Salter Harris

classified by . . . 2. Aiken
3. Mueller
The resulting pediatric closure of the middle portion of the distal tibial epiphysis
tri-malleolar fracture is
possible due to what . . .
Salter Harris Type I and closed reduction as long as it is accomplished within 7

II injuries are best days of the injury. After 7 days, closed reduction is ill-
managed by . . . advised due to rapid healing at this area.
Salter Harris Types III- one may initially attempt closed reduction, however, ORIF
VI are best managed is usually required with careful attention to not disrupt the
by. . . physis with internal fixation (attempting to place internal
fixation in the metaphysis).
A 46 year old male Gustillo Anderson Grade 3B - recommends ancef with

presents with a gunshot gentamycin followed by a series of debridements and
wound to the lateral washouts until the wound is clean / stable for a free or
right ankle extending to rotational flap for coverage.
the proximal
anterior/lateral fibula
measuring 11.5cm with
appreciable loss of the
periosteum and
exposed bone. Patient
was shot by his wife
after being caught with
his secretary (I mean
administrative assistant)
at work. There was no
significant arterial
damage noted. What is
the best treatment
course given these
findings?
The guy who just had Yes. The patient was exposed to salt water. Doxycycline or
the guy shot wound by ceftazadime should be considered in lieu of a first
his wife remembers to
tell you that he was generation cephalosporin. (fluoroquinolones could also

actually shot on his be used)
yacht and fell into the
water. Does this change
your treatment plan?
After a serve soft tissue 1. Deflate the tourniquet and assess color change of skin
injury, what are two from pale
ways that you can 2. Fluorescein Test - inject 10-15mg/kg and assess diffusion
assess the viability of of dye into tissues under woods light.
the skin?
According to the At 3 months when no callous formation is seen and the

original literature wound has been rendered free of infectious agents.
regarding Gustillo
Anderson management
of traumatic soft tissue
injuries, when should a
bone graft be
employed in instances
of severe bone loss?
Type I and Type II Primarily as long as patient presents within 8 hours of injury
Gustillo Anderson and NO:
wounds should be 1. Tension
closed . . . 2. Contamination
3. Crush injury
Type I and Type II By delayed primary closure within 3-10 days of the
Gustillo Anderson traumatic event.
wounds occurring after
the 8 hour window or
that have tension,
contamination, or crush
injury characteristics
should be closed . . .
Type I and Type II bacterial burden is less than 10 bacteria within a gram of
Gustillo Anderson tissue
wounds should be
closed by secondary
intention when . . .
The primary force that hyperextension

results in first
metatarsophalangeal
joint dislocation . . .
What Stage and Type I MTP joint dislocation - rarely treated by closed
Treatment ? reduction due to interposed soft tissue.
Proximal phalanx,
plantar capsule, and
sesamoids dislocated
dorsally on the first
metatarsal head
with the first metatarsal
protruding through the
capsule, depressed
plantarly by the hallux
retrograde forces.
In this type of MTP joint Type IIA - closed reduction can be achieved. The
dislocation the sesamoids are located on either side of the first metatarsal
sesamoids will be seen because the intersesamoid ligament has ruptured.
on the medial and
lateral aspect of the first
metatarsal head
respectively.
The presence of a Type IIB MTP joint dislocation. Usually this can be closed
fractured sesamoid reduced.
would suggest seen in
Turf toe would suggest
what type of MTP joint
dislocation.
This can be seen as a Type IIC

combination type of
MTP joint dislocation
where the
intersesamoidal
ligament is ruptured
and the sesamoid is
fractured.
A Type I closed Dorsiflexion and longitudinal traction followed by pushing

reduction of a MTP joint the proximal phalanx onto the first metatarsal head then
dislocation is plantarflexed into the reduced position. This should be
sometimes closed done under general anesthesia. A splint is placed for 3-4
reduced by . . . weeks followed by a CAM walker.
A 43 year old patient Bernt Hardy Stage II - have concerns for lateral collateral
presents to your office ligament rupture. Stage I is the only level of injury that
s/p severe right ankle does not necessitate lateral collateral ligament injury.
sprain. MRI reveals a
partially detached
osteochondral
fragment. What else are
you concerned about?
Bernt Hardy Stages I, II, Cast 6-12 weeks

and III (medial ONLY)
are usually treated with
...
Bernt Hardy Stages III excise fragment, saucerize crater, drill holes to aid
(Lateral) and IV are best revascularization and produce fibrocartilage
managed by . . .
What amount of the 2/3

talus is articular
cartilage?
This key arterial blood Artery of the tarsal canal (remember that this artery
supply to the body of supplies the middle third of the talus)
the talus enters through
the inferior talar neck
and originates from the
posterior tibial artery.
This secondary means Deltoid branch
of blood supply to the

body of the talus
originates from the
posterior tibial artery
and enters on the
medial surface of the
body of the talus . . .
Subchondral bone viability. This is Hawkin's sign, and suggests that at least
atrophy in the body of 40% of the talar blood supply is intact.
the talus forming
approximately 6 weeks
(but may take up to 6
months) after injury, is a
sign of . . .
Vertical non-displaced Type I Hawkins

fracture of talar neck
which occurs with 20%
frequency. Only blood
supply to neck
disrupted with reports
of 0-7% avascular
necrosis.
Vertical fracture Type II Hawkins

through neck with
dislocation of STJ not
ankle with an
occurrence rate of 42%.
There are tow areas of
blood supply disrupted
resulting in an incidence
rate of 46% avascular
necrosis.
Vertical fracture of neck Type IV Hawkins

with displacement of
STJ, ankle, and T-N joints
with an occurrence rate

of approximately 4%
with nearly 100% of
avascular necrosis.
Vertical fracture of the Type III Hawkins

neck of the talus with
displacement of STJ and
ankle joint. Has an
occurrence rate of 34%
and disrupts all 3 areas
of blood supply with
88% avascular necrosis.
Treatment of Hawkins I . BK cast for 6-8 weeks

..
Treatment of Hawkins II, Can attempt closed reduction, but usually requires ORIF
III, IV
Soft tissue burns at >115 degrees Fahrenheit

what temperature?
Sunburn, characterized Partial Thickness - superficial (epidermis only)

by erythema and
possibly flat red
macules without
blistering associated
with mild to moderate
pain levels would best
be described as what
type of thermal tissue
injury?
Thermal Tissue Injury Partial Thickness-Deep (Epidermis with partial Dermis)
Characterized by
erythema,
blisters/bullae
formation, motte skin,
spotty white skin and

severe pain
Thermal Tissue Injury Full Thickness (All of Epidermis/Dermis and any part of sub
Characterized by Q tissue)
mottle white or black
skin with eschar present.
This particular type of
injury is painless due to
total nerve destruction
and may appear
leathery. The burn may
be deep enough to
involve tendon, capsule,
or bone.
Why is immediate Energy absorbed from the time of burn progresses from
cooling an important superficial to deep. Even when removing the cause, the
step in the treatment of damage continues to progress unless countered with
burns? cooling measures.
What are the three 1. Epidermis (zone of coagulation)

zones of tissue injury 2. Dermis (zone of stasis)
(thermal)? 3. Subcutaneous Tissue (zone of hyperemia)
A 43 year old lab 1. Tetanus prophylaxis

assistant breaks a 2. Pain control (opioids)
beaker of sulfuric acid 3. Topical silvadene and broad spectrum antibiotics
spilling it down the front 4. Cooling with towels NOT direct ice
of her apron and onto 5. Rules of Nines: Chest: 18%, Arm: 4.5%, Groin: 1%, Anterior
her lab. Laboratory legs: 9% x2 = 18% for a total of 41.5%, using Parkland
personnel flushed formula and Baxter's Rule of replacement: (4mg
disrobed the patient crystalloid) X (120lbs = 54 Kg) X (41.5% surface area) = 6889
and flushed the or approximately 7 liters of lactated ringers with 4mg of
affected sites with crystalloid within the first 24 hours. After 48 hours monitor
buffering agents as is electrolytes and serum urine osmolarity to adjust fluid
the standard protocol. replacement.
EMT presents the
patient to the
emergency room where

you are consulted. A
thorough exam reveals
full thickness damage to
chest, right anterior
arm, groin, and the
anterior aspect of both
lower extremities.
Patient was weighed in
at 120lbs. Given these
findings what is the
most appropriate
course of treatment?
Tscherne Soft Tissue Grade 3

Injury Classification
Extensive Soft tissue
contusion or crushing,
compartment
syndrome, vascular
injury and multi-
fragmentary fracture
pattern

Superficial abrasion
with local contusional
damage to skin or
muscle with mild
fracture pattern

Minimal soft tissue
damage indirect injury
to limb (torsion) simple
fracture pattern. Little
or no soft-tissue injury

Deep abrasion skin or
muscle contusion
severe fracture pattern
direct trauma to limb
associated with
localized muscle
damage
OTHE R S E TS BY T HIS CREATOR
54 terms 61 terms
Surgical Techniques Random Facts to Memori
ze for Boards - TRAUMA

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8/7/2018 ABFAS - Trauma Section Flashcards | Quizlet

ABFAS - Trauma Section 107 terms quizlette7878025

Achilles tendon rupture Sprinters

Gastroc-soleal complex Tibial nerve (S1 - S2)

Runs between the Plantaris

Nerve enervation of the L4, L5, S1

The narrowest part of 4cm proximal to its insertion

An Achilles tendon 2-6cm proximal to attachment (watershed area) of the left

Name the Test: Thompson Test

in plantar flexion of the

Name the Test: A 25 O'Brien Test

The parameters of Anterior border: FHL, Posterior border: Achilles Tendon,

What classification is Kuwada (1: partial tear 2: complete tear up to 3, 3: 3-6cm

Case: 34 year old male End-to-end anastomosis

Case: a 42 year old Following surgical debridement of the tendon ends to

Which component of Tibiocalcaneal

Which component of Anterior tibiotalar

the deltoid ligament is

What two tendons pass FDL and Tibialis posterior

What is the strongest of Posterior talofibular ligament

Which of the lateral Posterior talofibular ligament

Which of the CFL

Which is the shortest ATFL

A surgeon is inverting CFL

The proximal plain synovial joint

A patient presents to CFL

What degree of talar tilt 10 degrees

Avulsion fracture of the Chaput-Tilleaux Fracture

Avulsion fracture of wagstaff

inferior tibial fibular

Occurs because of a Tillaux Kleiger

Fracture of the Volkmann's

Lauge Hansen Supination-Adduction Stage I

Lauge Hansen Supination-Adduction Stage II

Lauge Hansen Supination-Adduction

Lauge Hansen Pronation Abduction Stage I

Lauge Hansen Pronation Abduction Stage II

Lauge Hansen Pronation Abduction Stage III

Lauge Hansen SER Type I

Lauge Hansen SER Type II

the lateral malleolus,

Lauge Hansen SER Type III

Lauge Hansen SER Type IV

Lauge Hansen PER Type I

Lauge Hansen PER Type II

Lauge Hansen PER Type III

Lauge Hansen PER Type IV

Lauge Hansen immediately to within 6 hours of injury; from 6-12 hours of

For fibular fractures interfragmentary screws (4.0mm cancelous / 3.5mm

A fracture of the distal transfixation through the plate.

A normal Bohler's angle 25-40 degrees

What are Palmer's three 1. Vertical shearing fracture

What is the normal 8mmHg

After obtaining 1. serum myoglobin and CK levels (assess muscle damage

Which compartment of Anterior compartment

Closed reduction of a dorsiflexion, longitudinal traction, and then plantar flexion

Polyglactin is best used deep closure (capsule and subcutaneous tissue)

What are the three main 1. Zone of growth

What is the weakest Zone of maturation , this is due to loss of intracellular

the left foot a few

What important Osseous Ring of Lacroix

What force is most compression force

Epiphyseal fractures are 1. Salter Harris