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Emergency Med - Exam 2 > 15 - Upper Extremity Injuries > Flashcards

15 - Upper Extremity Injuries Flashcards

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1
Q

The shoulder

A
  • Clavicle, scapula and ball of humerus

- Supposed to be very flexible and very stable

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2
Q

A/C separation

A
  • Term confused clavical dislocation
  • Injury to the ligaments that connect the clavicle to the scapula
  • Very common injury
  • Mechanism of injury (MOI)
    o Fallen on outstretched hand (FOOSH)
    o Direct blow
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3
Q

Types of A/C separation

A

Types of A/C separation

  • Do NOT need to know the types
  • Type I: probably won’t see on x-ray
  • Type II: more visible on x-ray
  • Type III: more visible on x-ray
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4
Q

Type I A/C separation

A
  • Type I is a minor sprain

- Acromioclavicular joint

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5
Q

Type II A/C separation

A
  • Type II is a rip of acromicoclavicular ligament and partial coracoclavicular
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6
Q

Type III A/C separation

A
  • Type III is a tear of acromioclavicular and coracoclavicular ligament
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7
Q

Treatment for A/C separation

A
  • Sling for a few weeks
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8
Q

Clavicular fractures

A
  • MOA – usually direct blow or FOOSH
  • Mainly mid shaft and distal
  • Usually do not require surgery
  • Proximal can have serious issues
  • Very common in young males
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9
Q

Shoulder dislocation

A
  • Anterior direction 98% of time
  • Posterior only if seizure/electrocution
  • Most common dislocation seen in ER (1.7% US population)
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10
Q

Mechanism of injury for shoulder dislocation

A
  • FOOSH

- Mechanisms involving shoulder abd., extension and external rotation (volley ball spike)

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11
Q

Age groups for shoulder dislocation

A
  • Primarily in young males (9:1) and older women (3:1)
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12
Q

Shoulder dislocation

A
  • Proper sedation, pain meds, muscle relaxation (Etomidate is much better to use than versed because they will not be so groggy. With versed, patient acts like a head injury)
  • Shoulder immobilizer (about 2 wks)
  • Refer
  • Xray before and after - Not as easy as you would think to know if you have gotten it back in place
  • CHECK NERVE before and after reduction ***
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13
Q

Long term consequences for shoulder dislocation

A
  • Nerve damage (axillary esp.)
  • Vessel injury – rare
  • Re-dislocate
  • Rotator cuff injury fairly common
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14
Q

Recurrence of shoulder dislocation

A
  • VERY LIKELY

- If first happened 40, 10% chance

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15
Q

Humeral fractures MOI

A
  • Direct blow
  • Axial load at ELBOW
  • Little old ladies, high energy, pathological fx
  • Arm wrestling
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16
Q

Treatment of humeral SHAFT fracture

A

Humeral shaft
o ***Hard brace and PT
o Risky surgery with no better healing (radial nerve is commonly injured)

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17
Q

Treatment of PROXIMAL humeral fracture

A
  • Proximal Fracture: +/- ORIF, joint replacement or sling with PT
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18
Q

NOTE: big fractures in elderly

A
  • It’s not just hip fractures that can have extreme consequences for elderly patients
  • Patients can also rapidly decline following a humeral fracture
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19
Q

Biceps rupture

A
  • Looks like a big bump on the arm where the biceps is located
  • Either do surgery or just leave it – typically if the patient is elderly, it will not be addressed surgically
  • Can do PT to get some function back without surgery
20
Q

Elbow fracture MOI

A
  • Fallen on outstretched hand (FOOSH)
  • Twisting
  • Direct blow
21
Q

Ped’s elbow fracture

A
  • Most common is supracondylar fractures
  • Radial head
  • Olecrenon
22
Q

X-ray signs of elbow fracture KNOW THIS!!!

A
  • Posterior Fat Pad (fat pad is visible in the back – blood)
  • Anterior Sail Sign (beak in the front)
  • Anterior humeral capitulum line
  • Radial capitulum line
  • Figure 8 (in the bone, you can see a figure 8)
23
Q

Sugartong

A
  • A splint that doesn’t allow elbow or wrist movement

- Used for elbow or wrist fracture

24
Q

Pediatric elbow – Nursemaids

A

Nursemaids elbow aka Radial Head Subluxation
o MOI - Sudden pull upwards, usually of hand/wrist
o Symptoms – child won’t move the elbow
o Treatment – fast flexion with supination or pronation (works best if done right away)

25
Q

Colles fractures

A
  • Distal Radial fracture with dorsal displacement
  • Can involve ulna as well
  • Treatment depends in severity, patient age
  • MOI: FOOSH – usually falling forward
  • VERY common injury
  • Elderly females are common victims
26
Q

Smith’s fracture

A
  • Distal radial fracture with volar displacement
  • From falling on flexed hand (just goes the opposite way as a Colles fracture)
  • More likely falling backwards
27
Q

Scaphoid fractures

A
  • Most common carpel fracture (71%)
  • High incidence AVN, non-union, delayed union, decreased strength, OA, decreased ROM (why you don’t want to miss)
  • Treat all possible scaphoid fractures as fractures
28
Q

Anatomy for scaphoid fracture

A
  • Why fracture is so bad…
  • Because blood supply is distal to proximal, proximal fractures worse. If proximal 5th of bone, probably isn’t going to heal
29
Q

Scaphoid injury

A
  • MOI: FOOSH with hyper-extended/radial deviation
30
Q

Symptoms of scaphoid fracture

A
  • Snuff Box tenderness
  • Scaphoid tenderness
  • Pain with thumb compression
  • If they have ANY OF THESE, they need to follow up
31
Q

Diagnosing scaphoid fracture

A
  • X-ray 86% sensitive (you will miss 14% of these)
  • This is bad because it is a “million-dollar fracture” – if you miss it, you will be sued for 1 million
  • Follow up: MRI or bone scan if suspicious
  • Can wait a week and re-x-ray
32
Q

Treatment for scaphoid fracture

A
  • If nondisplaced – cast (usually), but can take 10-12 weeks to heal, may need bone stimulation
  • If displaced, ORIF
33
Q

4th or 5th metacarpal fracture

A
  • AKA Boxer’s Fracture
  • Usually from untrained punch thrower
  • Rarely need surgery or reduction
34
Q

Mallet finger

A
  • Inability to extend DIP joint
  • Unlike mallet toes, usually caused by acute trauma (unlike mallet toes, which are usually formed chronically)
  • Usually can splint for 6 weeks, UNDISTURBED
  • Often involves fracture but not always
35
Q

Dislocation reduction

A
  • Anesthesia?? She does not do this for digital dislocation, but she does offer a digital block
  • Make it (dislocation) worse and pull, then splint
  • X-rays before and after
  • Neurovascular before and after
36
Q

Closed fist injuries

A
  • Aka clenched fist injury
  • Aka fight bite
  • Closed fist hits another person’s teeth
37
Q

Fight bite

A
  • Usually don’t see until infected
  • Cultures, I & D (usually in OR) – do not close
  • ABX that cover mouth flora
  • Often look benign initially – still treat with fast follow up
  • X-rays
  • Neurovascular checks
  • Referral
  • Splint
38
Q

Animal bites

A
  • Antibiotics for hands, feet and face
  • Don’t close puncture wounds
  • Augmentin is the drug of choice
  • Cat scratches
39
Q

High pressure injury

A
  • High pressure device injects material into (usually) hand
  • Look benign but are SURGICAL emergencies
  • Cause severe inflammatory response
  • Paint solvents – 60-80% amputation
  • Grease – 22%
  • Even water needs surveillance
  • Usually Male, non-dominant hand
40
Q

High pressure injury – ER treatment

A
  • Abx
  • Td
  • X-rays
  • Neurovascular check
  • Consultation – EXTREMELY IMPORTANT (needs surgical consult)
  • Splint
41
Q

CASE STUDY - “Boxer’s fractures”

A

o 4th or 5th metacarpal fracture (but usually the 5th)
o 50-40-30-20
o If you have less than 50 degrees of angulation, you don’t need to do anything else

42
Q

CASE STUDY - “Fighter’s bite”

A

o Culture first
o Check the tetanus status
o Drain the wound initially in the ER, but needs a pulse lavage in the OR
o Antibiotics: Augmentin (oral) or Zosyn (IV) ***
o She uses Rocefen (cefazolin) as well
o If they are pen-allergic, you cannot use Augmentin, but clindamycin would work
o Treatment is to splint it (even if there is no fracture, because it will feel better)

43
Q

CASE STUDY - Other concerns

A

o Possible tendinitis (infection)
o Osteomyelitis
o 18% amputation from a fight bite – very serious, needs to be addressed immediately
o As soon as she sees a bite (human, dog, cat), she gives antibiotic prophylaxis

44
Q

Drug of choice for ALL bites

A

Drug of choice for ALL bites = AUGMENTIN

45
Q

What to know for fighter’s bite

A

o Need to treat aggressively, always need a surgical consult
o Give prophylactic antibiotics (augmentin) for fight bite
o I & D is needed when there are signs of infection – abx are not enough!

Emergency Med - Exam 2 (11 decks)

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