Wedge fracture pattern
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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
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Figures A through E are paired diagrams depicting the anteroposterior and lateral profiles of the proximal tibia. Which of the following figures has arrows that correspond to the ideal entry point for intramedullary nailing of a proximal third diaphyseal tibial fracture?
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A 75-year-old-male presents after being struck by a vehicle while crossing the street. He complains of right leg pain, and physical exam reveals no evidence of an open fracture. Initial radiographs are shown in Figures A and B, and intramedullary nailing of the fracture is planned. What is the proper blocking screw technique to prevent apex anterior and valgus deformity of the fracture?
Insertion of blocking screws lateral and posterior to the nail
Insertion of blocking screws medial and posterior to the nail
Insertion of blocking screws lateral and anterior to the nail
Insertion of blocking screws medial and anterior to the nail
Insertion of blocking screws medial, lateral, and posterior to the nail
A 45-year-old male sustains a proximal third tibia fracture as an isolated injury and elects to undergo operative treatment with intramedullary nailing. Post-operative radiographs show excessive procurvatum deformity. Which of the following operative techniques would have helped to best avoid the procurvatum deformity?
Tibial nailing with increased knee flexion
Lateral blocking screw in the proximal fragment
Medial blocking screw in the proximal fragment
Anterior blocking screw in the proximal fragment
Posterior blocking screw in the proximal fragment
A 28-year-old female is struck by a motor vehicle while crossing the street and suffers the injury seen in Figure A. What technical adjunct could have prevented the operative complication seen in Figure B?
Nail of a lesser radius of curvature
Nail with a more distal Herzog curve
Application of an anterior unicortical plate
Nailing while in a hyperflexed position
A more distal and medial nail entry site
A 34-year-old female sustains a proximal third tibia fracture as an isolated injury and elects to undergo operative treatment with intramedullary nailing. Which of the following operative techniques would help to best avoid a procurvatum deformity of the tibia?
Semiextended position during nailing
Lateral blocking screws in proximal tibia fragment
Use of a radiolucent triangle to flex the knee
Anterior blocking screw in the proximal tibia fragment
Medial parapatellar arthrotomy avoiding the patellar tendon
Which of the following techniques has not been shown to prevent valgus angulation during intramedullary nailing of proximal one-third tibia fractures?
Use of a blocking screw lateral to midline in the proximal segment
Use of femoral distractor
Use of a lateral tibial nail starting point
Use of supplementary plate and screw fixation
Use of a suprapatellar nailing portal
A 38-year-old male sustains the closed injury shown in Figures A and B. When treating this injury with an intramedullary nail, addition of blocking screws into which of the following positions can prevent the characteristic malunion deformity?
Anterior to the nail in the proximal segment; medial to the nail in the proximal segment
Anterior to the nail in the proximal segment; lateral to the nail in the proximal segment
Posterior to the nail in the proximal segment; lateral to the nail in the proximal segment
Anterior to the nail in the distal segment; lateral to the nail in the distal segment
Posterior to the nail in the distal segment; medial to the nail in the proximal segment
A 37-year-old male sustains the closed injury seen in figure A. What technique can be utilized to avoid the characteristic deformity seen in this fracture pattern if an intramedullary nail is used for treatment?
Medial starting point
Lateral starting point
Aiming the nail posteriorly in the proximal segment
Anterior blocking screw in the proximal segment
Medial blocking screw in the proximal segment
All of the following techniques can help to prevent apex-anterior angulation during intramedullary nailing of proximal one-third tibia fractures EXCEPT:
Posterior blocking screw
Posterior starting hole
Interlocking the nail in a semi-extended knee position
Anteriorly directing the nail
Anterior blocking screw
A 25-year-old man sustains a left leg injury during a motorcycle accident. A radiograph is provided in Figure A. The fracture is treated in a minimally invasive manner with a lateral locking plate and percutaneous screw fixation. A post-operative radiograph is provided in Figure B. Which of the following complications has been associated with this fixation construct?
Common peroneal nerve injury
Superficial peroneal nerve injury
Deep peroneal nerve injury
Popliteal artery injury
Which of the following is an advantage of using blocking screws for tibial nailing?
Decrease risk of nail breakage
Eliminate use of interlocking screws
Allow for larger nail use
Enhance construct stiffness
Decrease torsional rigidity
A 22-year-old female is struck by a truck and sustains the injury seen in figure A. What deformities are most commonly seen in treating this injury with an intramedullary nail?
Apex anterior and varus
Apex anterior and valgus
Apex posterior and varus
Apex posterior and valgus