(1,3) Rib, Sternum & Shoulder Injuries Flashcards
What populations more commonly experience rib fractures?
adult & geriatric
Which ribs most commonly fracture?
4-9
(1-3 rarely Fx)
What rib is most commonly fractured in benchpressers?
rib 2
What may cause a fracture of rib 1?
throwing athletes, asthmatics, heavy backpacks resulting in fatigue Fx
What imaging should not be relied on for rib fractures?
- thoracic w/ open collimation
- chest x-ray
What radiographic views are best for rib fractures?
- 1 frontal (AP or PA) and 1 oblique (30 deg)
- hemithorax imaging must visualize either rib 1 or 12
What are the imaging findings of rib fractures?
- often radiographically occult
- radiolucent Fx line
- cortical offset of sup. margin
- altered rib orientation (angulation)
- extrapleural sign (swelling displaces lung)
- callus
- diaphragm elevation (splinting)
Name 4 types of rib fractures.
- flail chest
- golfer Fx
- passion (bear hug) Fx
- child abuse
What is meant by flail chest?
1 rib broken in 2 places resulting in compromised respiratory function
What ribs are involved in a golfer fracture?
upper ribs
What is the mechanism of a sternal fracture?
blunt trauma
- steering wheel
- shoulder belt
What is the most common orientation of a sternal fracture?
transverse
What is the best radiographic view for sternal fractures?
lateral sternum
What are the possible complications of thorax trauma?
- pneumothorax
- hemothorax
- chylothorax
- lung contusion
- diaphragmatic rupture
- aortic rupture
- tracheal deviation
What is considered a red flag following a rib fracture?
shortness of breath
What imaging modalities are more sensitive for rib fractures?
bone scan & Diagnostic ultrasound (DxUS)
What is the most common location of clavicle fracture?
middle clavicle Fx
(usually complete Fx)
What imaging modality is best for medial clavicle fractures?
CT scan
What is the mechanism of a middle clavicle fracture?
- FOOSH
- shoulder pointer
What is the common appearance of a middle clavicle fracture?
Bayonet apposition
(shoulder pulls lat. end down, proximal end lifts up)
What are the potential complications of clavicle fractures?
- post-traumatic osteolysis (PTOC)
- AC & SC joint degeneration
- neurovascular damage
- nonunion
- malunion
What complication of clavicle fractures is common in bench press & power lifting?
PTOC
What scapular fracture is associated with anterior GH dislocation?
Bankart Fx
What is a Bankart fracture?
Fx of anterior inferior glenoid rim
What is a reverse Bankart fracture?
Fx of posterior inferior glenoid rim
What is another name for a Hill-Sach fracture?
hatchet Fx
(d/t V-shaped groove)
What is the mechanism of a Hill-Sach fracture?
anterior shoulder dislocation resulting in post/lat compression of humeral head on ant/inf glenoid
What radiographic view is best for a Hill-Sach fracture?
internal rotation
What is the term for a greater tuberosity avulsion fracture?
flap fracture
What is the mechanism of a flap fracture?
anterior shoulder dislocation
What is the most common direction of glenohumeral dislocation?
anterior
What is your next step for a patient with an anterior glenohumeral dislocation?
immobilize and send to ER
What are the 4 subtypes of anterior glenohumeral dislocation?
- subcoracoid
- infraglenoid
- subclavicular
- intrathoracic
What is the most common subtype of anterior GH dislocation?
subcoracoid
(humerus hits coracoid and drops inferiorly)
Name 3 lesions associated with anterior GH dislocation.
- Hill-Sach Fx
- flap Fx
- Bankart lesion
What are the mechanisms of posterior GH dislocations?
- seizures
- electric shock
- FOOSH w/ arm across body
What is the clinical finding of a posterior GH dislocation?
arm stuck in internal rotation
What is the best radiographic view for posterior GH dislocations?
axillary view or scapular Y view
What are the radiographic findings of a posterior GH dislocation?
- lightbulb sign (head in int rot.)
- Trough sign (Reverse Hill-Sach Fx)
- Reverse Bankart
What structure(s) is/are involved in a type 1 AC dislocation?
AC ligament sprain (mild)
What is the MOI of an AC dislocation?
FOOSH
What are the radiographic findings of a type 1 AC dislocation?
normal
What structure(s) is/are involved in a type 2 AC dislocation?
- AC lig tear
- CC lig sprain (mild)
What are the radiographic findings of a type 2 AC dislocation?
- wide AC jt space
- mild clavicular elevation
What structure(s) is/are involved in a type 3 AC dislocation?
AC + CC lig. tear
What are the radiographic findings of a type 3 AC dislocation?
- clavicle elevation >5mm from opposite side, or 100% elevation above acromion
- wide AC jt space
Which type(s) of AC dislocation may require surgery?
type 3
What soft tissue injuries are associated with AC dislocations?
- rotator cuff tear
- long head biceps tear
- glenoid labrum tear
What landmarks are used to determine the type of AC dislocation?
- inf clavicle border
- bottom & top edges of acromion
