Digital Fractures
Fracture pattern seen in INDIRECT sagittal place digital injuries?
Transverse
5th metatarsal ‘Distal Diaphyseal’ fracture mechanism
Plantarflexion with subsequent inversion injury
Common with dancers
The central aspect of the navicular often has a difficult time healing after fracture due to what anatomical aspect?
Blood supply is more abundant peripherally (DP and PT)
Typical displacement of TMTJ and why
Dorsal subluxation/dislocation
Weaker dorsal ligaments results in earlier failure
A patient sustains a dislocated injury of the right 2nd digit PIPJ. What would complicate/prevent closed reduction?
Flexor tendon interposition
When tapping a 5th metatarsal IM canal for screw fixation, you notice an absence of chatter. What is your next step?
Increase the diameter of the tap, larger screw
If soft tissue compromise delays ORIF of a navicular fracture, what are the 3 things that can be done in the meantime for initial reduction?
External fixation (distract)
Percutaneous pin fixation (stabilize)
Postreduction CT (surgical planning, better evaluation of injury)
Even though low energy injuries may be associated with soft tissue damage, what must be ruled out?
Compartment syndrome
Name the fracture patterns of the digits in order from most common to least common
Sagittal (direct crush, indirect transverse), Transverse (abduction/adduction; bedroom fracture), Frontal (inversion/eversion; rotational)
Name 3 of the noted 5 indications for surgical intervention of 1st Metatarsal fractures
Angulation >10deg
Displacement >3-4mm
Articular involvement
Rotational deformity
Shortening
What is surgical management of cuboid fractures typically reserved for? (2 items)
1mm of joint incongruency
3mm of lateral column shortening
In a laterally dislocated TMT injury, what is the first step at reduction?
Distraction and elongation of the lateral column
Describe the mechanism of the Mallet Injury
Hyperflexion injury; avulsion of the proximal dorsal lip of the distal phalanx. Evaluate EHL strength/patency
This technique has been shown to be biomechanically stronger than the intramedullary technique for zone 1 fractures
Bicortical technique
What is the most common isolated cuneiform fracture
Avulsion from the tibialis anterior tendon
Majority of TMTJ injuries occur as a result of what mechanism
Axial load
Plantarflexed foot
SURGICAL treatment of a Mallet Injury? (When would it be performed?)
ORIF if avulsion involves greater than 1/3 of the HIPJ surface or if there is joint instability with subluxation
What is the female athlete triad of metatarsal stress fractures?
Abnormal menstrual cycles
Low bone mass
Deficient energy needs
Navicular-Cuneiform arthrodesis is known as the
Hoke
Non operative, closed reduced, ligamentous injuries typically lead to post traumatic arthritis because what kind of collagen formation?
Type III (replaces the native Type I)