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122 visible knowledge nodes in trauma
O’Brien / Metaizeau — Paediatric Radial Neck Fractures
O’Brien Angulation: I (60°). Displacement/translation also matters; >3 mm or severe angulation predicts need for reduction/fixation. Metaizeau (elastic stable intramedullary nailing) classification is treatment-oriented with percutaneous leverage, intramedullary nail reduction, or open reduction for severely displaced injuries.
Open topicOpen Fractures — BOAST Principles
BOAST 4 guidelines: antibiotics ASAP, tetanus, debridement, stabilization, soft tissue cover. Do not remove bone fragments unless grossly non-viable. Definitive cover within 72 h (preferably 48). Stabilization with external fixator/IM nail/plate as appropriate. Complications: infection, nonunion, flap failure.
Open topicPatella — Pattern-Based (AO/OTA 34)
Transverse, comminuted (stellate), polar avulsion, vertical; AO: 34-A extra-articular pole, 34-C transverse/comminuted. Displacement/extensor disruption → ORIF; minimal displacement → brace.
Open topicPatella Fractures — Tension Band Wiring
Indications: displaced transverse fractures with intact extensor. Principle: converts tensile quadriceps force into compression at fracture site. Technique: 2 parallel K-wires + figure-of-8 SS wire. Avoid in comminution → partial patellectomy/plate fixation. Complications: hardware prominence, migration, stiffness.
Open topicPauwels Classification — Femoral Neck (Shear Angle)
Type I: 50° (most vertical → highest shear). Higher angle = higher shear → instability, nonunion risk; stronger fixation needed.
Open topicPelvic Ring Injuries — ATLS & Tile
ATLS: binder early for unstable pelvis; hemorrhage control is priority. Tile A stable, B rotationally unstable, C rot + vertical unstable. Hemorrhage control: binder, ex-fix, C-clamp, packing, angio. Fixation: anterior plating/ex-fix, posterior SI screws/lumbopelvic. Complications: hemorrhage, urethral/bladder, neuro injury.
Open topicPeri-implant Fractures
Definition: fracture adjacent to fixation device or prosthesis. Differentiate peri-implant vs periprosthetic. Causes: stress risers, osteopenia, trauma. Management: depends on implant stability, bone stock, fracture pattern. Principle: retain stable implant, revise/replace if loose.
Open topicPeri-implant fractures - Case Based Discussion
Case Presentation A 68-year-old female presented to the emergency department following a trivial fall at home with severe pain and inability to bear weight on the left lower limb. The patient had previously undergone fixation of an intertrochanteric fracture with a Proximal Femoral Nail (PFN) two years earlier. She reported sudden pain around the distal thigh following the fall. Pain and deformity of distal thigh Inability to bear weight Previous surgical scar over proximal femur Localized tende...
Open topicPerilunate Dislocation
Perilunate dislocations and fracture-dislocations are high-energy carpal injuries in which the lunate loses its normal articulation with the surrounding carpal bones — the capitate, scaphoid, triquetrum, and hamate are displaced dorsally while the lunate remains (at least initially) in the lunate fossa of the distal radius. They result from a fall onto an outstretched hand in hyperextension, ulnar deviation, and intercarpal supination, and are classified by the Mayfield progressive perilunar ins...
Open topicPeripheral Nerve Injury — Sunderland Classification
Seddon: neuropraxia, axonotmesis, neurotmesis; Sunderland expands to 5 degrees based on structural disruption. Degree I: conduction block; II: axonal disruption intact endoneurium; III: endoneurial disruption; IV: perineurial disruption intact epineurium; V: complete transection. Prognosis worsens with increasing degree; surgical exploration/grafting typically for IV–V. EMG/NCS guide prognosis and timing; Tinel’s progression marks regeneration (~1–3 mm/day).
Open topicPeriprosthetic Distal Femur Fracture
Lewis–Rorabeck and Su classifications guide treatment; stability of the femoral component is the key decision point. Stable TKA → fixation (locking plate or retrograde nail if intercondylar box permits). Loose TKA → revision arthroplasty with long stem or distal femur replacement in poor bone stock. Biologic fixation with long, locked constructs reduces nonunion/varus collapse. Early ROM; weight‑bearing tailored to construct stability.
Open topicPilon Fractures — Strategy
High‑energy axial load injures distal tibial plafond with severe soft‑tissue compromise. Standard of care is staged protocol: **span → scan → settle → ORIF**. Restore length and alignment initially with spanning external fixation; obtain CT with ex‑fix in situ. Definitive fixation addresses articular fragments (anterolateral/posteromedial approaches) and metaphyseal voids. Complications remain common: wound issues, infection, post‑traumatic arthritis.
Open topicPipkin Classification — Femoral Head
I: inferior to fovea (non–weight-bearing); II: superior to fovea (weight-bearing). III: I/II with femoral neck fracture; IV: I/II with acetabular fracture. II–IV worse prognosis; urgent reduction and fixation as indicated.
Open topicPisiform Fractures
The pisiform is a sesamoid bone located within the flexor carpi ulnaris (FCU) tendon on the medial side of the wrist, articulating with the triquetrum at the pisiotriquetral joint. Pisiform fractures are uncommon injuries, typically caused by a direct blow to the hypothenar eminence or a fall onto the outstretched hand. They account for less than 2% of all carpal fractures and are frequently missed on standard PA and lateral wrist radiographs, requiring a carpal tunnel view or a supinated obliqu...
Open topicPolytrauma — Damage Control Orthopaedics
Concept: balance early fixation vs systemic insult. ETC = early total care in stable patients; DCO = staged for unstable. Indicators for DCO: ISS >40, hypothermia, acidosis, coagulopathy. DCO: temporary ex-fix → definitive fixation after stabilization. Goal: prevent ‘second hit’ phenomenon.
Open topicPolytrauma — Damage Control vs Early Total Care
ETC: definitive fixation within 24 h for stable patients. DCO: temporary stabilization in unstable patients; definitive fixation after stabilization. Second hit phenomenon: surgery can worsen SIRS/ARDS in unstable patients. DCO techniques: external fixation, splinting, traction. Completion after normalization of lactate, coagulation, and temperature.
Open topicPolytrauma Scores — ISS, RTS
ISS: anatomical score using AIS; 1–75; >15 = major trauma. RTS: physiological score (GCS, SBP, RR);
Open topicPosterior Malleolus — Indications for Fixation
Fix if fragment >25–30% of tibial plafond, >2 mm displacement, syndesmotic instability, or posterolateral fragment involving PITFL. CT-based morphology guides approach: posterolateral approach common; direct reduction restores incisura and syndesmotic stability. Sequence: posterior malleolus first to stabilize syndesmosis, then fibula/medial malleolus. Fixation: screws posterior‑to‑anterior or buttress plate via posterolateral approach. Restoring posterior fragment reduces need for trans-syndesm...
Open topicProximal Fibula (Maisonneuve)
Maisonneuve injury = proximal fibular fracture + syndesmotic disruption + medial injury (deltoid/medial malleolus). Mechanism: external rotation with pronation. Examine entire fibula in ankle injuries; knee pain/tenderness is a clue. Management centers on syndesmotic stabilization; proximal fibula usually non-op. Avoid missing saphenous nerve injury or peroneal nerve palsy proximally.
Open topicProximal Humerus Fractures
Neer classification (parts displaced >1 cm or >45°): guides management. Non‑operative for minimally displaced; ORIF (locking plate) for displaced 2–3 part; hemiarthroplasty/RSA for unreconstructable 3–4 part or head‑split in elderly. Assess vascularity: medial hinge, calcar length; tuberosity integrity crucial for outcomes. Complications: AVN, stiffness, tuberosity nonunion/malposition, screw perforation.
Open topicProximal Ulna/Olecranon — Tension Band Wiring (TBW)
Indication: simple, non-comminuted transverse olecranon fractures (AO 21-B1) with intact dorsal cortex. Principle: converts triceps tensile force into compression at the articular fracture line during elbow flexion. Technique: two parallel K-wires + figure-of-8 wire anterior to axis. Avoid in comminution, osteoporosis, or Monteggia — plate preferred. Complications: hardware prominence, wire migration, loss of reduction, stiffness.
Open topicRadial Head & Neck Fractures (Adults & Paediatrics)
Radial head and neck fractures are common elbow injuries caused most often by a fall on an outstretched hand that transmits axial force through the forearm to the elbow. In adults, radial head fractures are typically intra-articular and are classified using the Mason classification, with treatment ranging from early mobilization for minimally displaced fractures to open reduction, fixation, or radial head replacement for displaced or comminuted injuries. In children, fractures usually occur at t...
Open topicRegan–Morrey Classification — Coronoid Fractures
I: tip avulsion; II: 50% height. II–III indicate elbow instability, commonly part of terrible triad → fixation required.
Open topicRockwood Classification — AC Joint Injuries
I: sprain; II: AC torn, CC intact; III: AC+CC torn with superior displacement. IV: posterior displacement; V: marked superior displacement; VI: inferior displacement (rare). I–II non-op; III individualized; IV–VI require surgery.
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