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3. E Med & Surgery > 4- Upper Extremity > Flashcards

4- Upper Extremity Flashcards

1
Q

What is the SALTR Harris classification system for fractures?

A

S- separation of physis (growth plate)

A- above physis, through metaphysis

L- lower than physis, through epiphysis

T- through physis, metaphysis, and epiphysis

R- rammed/ crushed physis

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2
Q

What should be considered in the proximity of an open fracture until proven otherwise?

A

Soft tissue wound, risk of osteomyelitis

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3
Q

What surgical/ provider related interventions affect the risk of osteomyelitis?

A

Quality of surgical debridement

Prophylactic abx

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4
Q

What bone is most commonly involved with an open fracture?

A

Tibia

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5
Q

What should be checked as part of the neurovascular exam for an open fracture?

A

Pulses, sensation, passive stretching (r/o compartment syndrome)

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6
Q

What abx are prescribed for an open fracture?

A

IV cephazolin

+ gentamicin (aminoglycoside), if contaminated

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7
Q

What is included in the management of an open fx aside from abx?

A

IM tetanus prophylaxis

MSK tx after initial trauma survery (+/- OR)

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8
Q

What complications are a/w an open fracture? (4)

A

Compartment syndrome (risk NOT decreased)

NV compromise

Limb salvage

Osteomyelitis

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9
Q

What is the typical MOI for a scapula fx?

A

High energy injury

(typically a/w other trauma- UE, torso, spine)

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10
Q

What xray views should be ordered for a scapula fx?

A

AP

Trans-scapular “Y”

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11
Q

What is the typical healing time for a scapula fx?

A

6 months- 1 yr

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12
Q

What are the conservative txs for scapula fx?

A

Sling/ shoulder immobilizer

Rehab/ PT

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13
Q

When is surgery indicated for a scapula fx? (3)

A

Articular surface displacement (goes into glenohumeral joint)

Impingement syndrome

Associated injuries

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14
Q

Pt presents with severe pain and swelling to upper arm +/- limited ROM and guarding. What fx do you suspect and what is the typical MOI?

A

Proximal humerus fx

MOI- high energy trauma if younger, simple fall if elderly

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15
Q

What classification is used for a humerus fx?

A

Neer classification

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16
Q

What xray views should be ordered for suspected proximal humerus or humeral shaft fx?

A

AP

AP w/ external rotation

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17
Q

Pt presents w/ localized pain, swelling, +/- displacement. What should you evaluate for if you suspect a humerus fx?

A

NV eval- wrist drop if radial nerve involvement

Associated forearm fx- “floating elbow” (fx above + below elbow)

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18
Q

If you note a pathologic fx on xray of a peds pt, what is it most commonly a/w?

A

Benign unicameral bone cyst (UBC)

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19
Q

What is the tx for a humeral shaft fx?

A

Shoulder immobilizer, humeral cuff, early motion to prevent frozen shoulder

+/- surgery

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20
Q

Pt presents w/ hx of blow to shoulder in abduction, extension, and external rotation (often overhead). On PE you note the arm is held in position of protection. What UE injury do you suspect?

A

Anterior glenohumeral dislocation

(most common than posterior)

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21
Q

What specialized PE tests should you perform if suspicion of glenohumeral dislocation? (2)

A

Sulcus sign

Apprehension + relocation

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22
Q

What imaging should be ordered for glenohumeral dislocation?

A

AP xray +/- MRI

Axillary view if posterior dislocation

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23
Q

What is included in the tx for glenohumeral dislocation? (4)

A

Immediate reduction

+/- shoulder immobilizer 2-4 wks

PT

Surgery if repeat dislocations

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24
Q

What further injuries should you consider if ROM does not return following reduction of glenohumeral dislocation?

A

Axillary nerve injury and rotator cuff tear

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25
Detachment of anterior labrum from glenoid rim is defined as what and a/w what UE injury?
Bankart lesion A/w glenohumeral dislocation
26
Depression of the humeral head is defined as what and a/w what UE injury?
Hills Sachs lesion A/w glenohumeral dislocation
27
Decreased sensation to the lateral aspect of the shoulder (acute) and decreased deltoid function (chronic) is a/w what UE injury?
Axillary nerve injury/ glenohumeral dislocation
28
What concerning signs on x-ray should warrant referral even if a fx is not evident?
Fat pad sign Sail sign
29
How can you differentiate between subluxation and dislocation?
Subluxation- may spontaneously reduce, can become recurrent Dislocation- clinically deformed, painful, decreased ROM, requires surgical reduction
30
What imaging is ordered for a subluxation or dislocation?
**Plain xrays = diagnostic** CT to eval alignment, fractures, avulsions MRI to eval ligament integrity
31
What is included in the tx for a subluxation/ dislocation?
Immediate reduction Casting vs sling/ early mobilization +/- PT Surgery if complex/ NV involvement
32
Pt presents w/ localized pain, swelling +/- wrist/ elbow pain and hx of direct impact. What should you eval for?
Forearm fx ALWAYS consider 2 fxs (radius + ulna) OR fx + dislocation
33
Pt with forearm fx will display restricted ROM with what movements?
Supination and pronation
34
What imaging should be ordered for suspected forearm fx?
AP/ lateral xray \*if only 1 fx seen, look for another and assess joints\*
35
What should be ruled out w/ "isolated" ulnar shaft fractures and how is it dx?
Ulnar shaft fracture w/ dislocation of radial head (Monteggia fx) Dx w/ xray (include elbow)
36
What is included in the management for a nondisplaced forearm fx?
Splint + refer for casting (6-8 wks) NSAIDs, elevation, sling, ice
37
Pt with nondisplaced forearm fx should refrain from sports activity for how long?
4-6 mos (high risk of re-fx)
38
What is included in the management for a displaced forearm fx?
Emergent reduction ORIF: IM rods
39
What does ORIF stand for?
Open reduction internal fixation
40
What does CRPPF stand for?
Closed reduction percutaneous pin fixation
41
What does DRUJ stand for?
Distal radioulnar joint
42
What is a Colles and Smiths wrist fx?
Colles- dorsal displacement (dinner fork deformity) Smiths- volar displacement
43
What xrays should be ordered for a wrist fx?
AP, lateral, oblique +/- scaphoid
44
What is included in the tx for wrist fx?
Splinting +/- reduction Casting 4-6 wks Surgery- ORIF vs CRPPF
45
What is defined as a distal radius fx w/ disruption of DRUJ/ TFCC and what is the management?
**Galeazzi fracture** Refer w/i 2-3 days w/ wrist fx protocol Casting in slight pronation
46
What is the most common carpal bone fractured in the wrist and how is it dx?
Scaphoid Clinical dx- "anatomic snuffbox" TTP
47
What xrays are ordered for scaphoid fx?
AP, lateral, scaphoid (scaphoid = AP w/ 30 deg ulnar deviation)
48
What is the protocol if initial imaging is negative but suspicion for scaphoid fx?
Repeat imaging in 10-14 days MRI if elite athlete
49
What is the tx for a scaphoid fx?
Thumb spica cast Surgery if displaced
50
What complication is a/w a scaphoid fx?
Avascular necrosis (AVN) Proximal aspect at highest risk
51
Pt presents w/ pain, swelling and ecchymosis and you suspect fracture of the hand. What needs to be determined?
Dislocation vs fx Eval of rotational/ angular deformity (curl fingers down)
52
What xrays are ordered for a finger fx?
AP, lateral, oblique
53
What is included in the tx for a finger fx?
Conservative (splinting, casting, buddy tape) Surgical +/- reduction
54
What injury should you be concerned about if hx of ball contact injury or "jamming" finger?
IP dislocation (dorsal \> volar)
55
What is the tx for IP dislocation?
Conservative- reduction, splinting, buddy tape Surgical- CRPPF vs ORIF (depending on fx involvement/ superimposed tissue)
56
Crush injury may result in accumulation of blood under the nail causing increasing pressure/ pain, aka?
Subungal hematoma (nail matrix trauma can lead to nail loss/ permanent deformity)
57
What is the management for subungal hematoma?
+/- nail trephination Abx if a/w distal phalanx fx
58
Pt presents w/ inability to flex DIP joint with pain over volar aspect on ring finger. What type of injury are you concerned for?
Jersey finger injury (flexor tendon rupture (FDP)) +/- avulsion fx in children
59
What is a mallet finger injury?
Rupture of extensor tendon (DIP) = inability to extend DIP
60
What is the tx for mallet finger (rupture of extendor tendon- DIP)?
STAX extension splint x 6-8 wks Surgery if large fx fragment or subluxation at joint
61
What is injured if Boxer's fx?
Neck of 5th IMC
62
What is the tx for Boxer's fx (neck of 5th IMC)?
Ulnar gutter splint then cast x 3-6 wks Surgery- CRPPF or ORIF (closed allows up to 30 deg angulation but no rotational deformity)
63
What is a Bennett's fx and what is the tx?
Fx to base of 1st IMC w/ extension into joint Tx w/ splinting then casting (CRPPF or ORIF)
64
What is a game keepers thumb (skiers thumb)?
Injury to MCP joint resulting in ulnar collateral ligament tear and instability of the MCP joint
65
What is the tx for game keepers thumb (skiers thumb)? (injury to MCP joint resulting in ulnar collateral ligament tear and instability of the MCP joint)
Thumb spica splint/ cast Surgery (soft tissue involvement)

3. E Med & Surgery (19 decks)

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