screws and a buttress plate
– the iliac oblique view assesses the posterior column and anterior wall; the obturator oblique view assesses the anterior column and posterior wall, and you see the spur sign on the obturator oblique
– the teardrop is made up medially by the quadrilateral plate, and the anterior acetabular fossa laterally.
– the Chiari osteotomy depends on metaplasia
– the Pemberton osteotomy actually cuts around the acetabulum and hinges it on the tri-radiate cartilage.
– signs of instability in pelvic trauma include symphyseal widening greater than 2.5 cm, and clinical instability.
– the most common cause of cardiac dysrhythmia after citrated massive transfusion is hypocalcemia
– for the metabolic reaction to trauma – serum pyruvate DOES NOT increase. Serum carbonate, lactate, urinary urea excretion, blood glucose all increase.
– remember that the MESS evaluates soft tissue injury, hypotension, ischemia (and ischemia time), and age. So an injury to the tibial nerve, warm ischemia time >6 hours, age >60, and a MESS score of over 7 is predictive of amputation. Segmental bone loss does not predict amputation.
– remember to do the fasciotomies after vascular injury to the limb
– if you choose a starting point too anterior and lateral for starting an IM nail, the fracture will heal in VARUS.
– be wary of using an IM rod to manage the fibular fracture of a pilon injury – you need some rotational stability, and the IM rod will not give you this.
– fix the humeral shaft fracture of the polytraumatized patient – IM nail, or ORIF
– for tibial shaft fracture in cast: 5o of varus/valgus, 10 of flex/ext, up to 5 mm shortening, no rotation is acceptable.
– if you see callus around a plate, the plate is probably abit loose
– an upper tibial injury with bone exposed is probably a Gustillo IIIB injury (will need a flap)
– a deep posterior compartment syndrome has pain on passive extension of the toes