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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
Q

Detachment of anterior labrum from glenoid rim is defined as what and a/w what UE injury?

A

Bankart lesion

A/w glenohumeral dislocation

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26
Q

Depression of the humeral head is defined as what and a/w what UE injury?

A

Hills Sachs lesion

A/w glenohumeral dislocation

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27
Q

Decreased sensation to the lateral aspect of the shoulder (acute) and decreased deltoid function (chronic) is a/w what UE injury?

A

Axillary nerve injury/ glenohumeral dislocation

28
Q

What concerning signs on x-ray should warrant referral even if a fx is not evident?

A

Fat pad sign

Sail sign

29
Q

How can you differentiate between subluxation and dislocation?

A

Subluxation- may spontaneously reduce, can become recurrent

Dislocation- clinically deformed, painful, decreased ROM, requires surgical reduction

30
Q

What imaging is ordered for a subluxation or dislocation?

A

Plain xrays = diagnostic

CT to eval alignment, fractures, avulsions

MRI to eval ligament integrity

31
Q

What is included in the tx for a subluxation/ dislocation?

A

Immediate reduction

Casting vs sling/ early mobilization +/- PT

Surgery if complex/ NV involvement

32
Q

Pt presents w/ localized pain, swelling +/- wrist/ elbow pain and hx of direct impact. What should you eval for?

A

Forearm fx

ALWAYS consider 2 fxs (radius + ulna) OR fx + dislocation

33
Q

Pt with forearm fx will display restricted ROM with what movements?

A

Supination and pronation

34
Q

What imaging should be ordered for suspected forearm fx?

A

AP/ lateral xray

*if only 1 fx seen, look for another and assess joints*

35
Q

What should be ruled out w/ “isolated” ulnar shaft fractures and how is it dx?

A

Ulnar shaft fracture w/ dislocation of radial head (Monteggia fx)

Dx w/ xray (include elbow)

36
Q

What is included in the management for a nondisplaced forearm fx?

A

Splint + refer for casting (6-8 wks)

NSAIDs, elevation, sling, ice

37
Q

Pt with nondisplaced forearm fx should refrain from sports activity for how long?

A

4-6 mos

(high risk of re-fx)

38
Q

What is included in the management for a displaced forearm fx?

A

Emergent reduction

ORIF: IM rods

39
Q

What does ORIF stand for?

A

Open reduction internal fixation

40
Q

What does CRPPF stand for?

A

Closed reduction percutaneous pin fixation

41
Q

What does DRUJ stand for?

A

Distal radioulnar joint

42
Q

What is a Colles and Smiths wrist fx?

A

Colles- dorsal displacement (dinner fork deformity)

Smiths- volar displacement

43
Q

What xrays should be ordered for a wrist fx?

A

AP, lateral, oblique

+/- scaphoid

44
Q

What is included in the tx for wrist fx?

A

Splinting +/- reduction

Casting 4-6 wks

Surgery- ORIF vs CRPPF

45
Q

What is defined as a distal radius fx w/ disruption of DRUJ/ TFCC and what is the management?

A

Galeazzi fracture

Refer w/i 2-3 days w/ wrist fx protocol

Casting in slight pronation

46
Q

What is the most common carpal bone fractured in the wrist and how is it dx?

A

Scaphoid

Clinical dx- “anatomic snuffbox” TTP

47
Q

What xrays are ordered for scaphoid fx?

A

AP, lateral, scaphoid

(scaphoid = AP w/ 30 deg ulnar deviation)

48
Q

What is the protocol if initial imaging is negative but suspicion for scaphoid fx?

A

Repeat imaging in 10-14 days

MRI if elite athlete

49
Q

What is the tx for a scaphoid fx?

A

Thumb spica cast

Surgery if displaced

50
Q

What complication is a/w a scaphoid fx?

A

Avascular necrosis (AVN)

Proximal aspect at highest risk

51
Q

Pt presents w/ pain, swelling and ecchymosis and you suspect fracture of the hand. What needs to be determined?

A

Dislocation vs fx

Eval of rotational/ angular deformity (curl fingers down)

52
Q

What xrays are ordered for a finger fx?

A

AP, lateral, oblique

53
Q

What is included in the tx for a finger fx?

A

Conservative (splinting, casting, buddy tape)

Surgical

+/- reduction

54
Q

What injury should you be concerned about if hx of ball contact injury or “jamming” finger?

A

IP dislocation

(dorsal > volar)

55
Q

What is the tx for IP dislocation?

A

Conservative- reduction, splinting, buddy tape

Surgical- CRPPF vs ORIF (depending on fx involvement/ superimposed tissue)

56
Q

Crush injury may result in accumulation of blood under the nail causing increasing pressure/ pain, aka?

A

Subungal hematoma

(nail matrix trauma can lead to nail loss/ permanent deformity)

57
Q

What is the management for subungal hematoma?

A

+/- nail trephination

Abx if a/w distal phalanx fx

58
Q

Pt presents w/ inability to flex DIP joint with pain over volar aspect on ring finger. What type of injury are you concerned for?

A

Jersey finger injury (flexor tendon rupture (FDP))

+/- avulsion fx in children

59
Q

What is a mallet finger injury?

A

Rupture of extensor tendon (DIP)

= inability to extend DIP

60
Q

What is the tx for mallet finger (rupture of extendor tendon- DIP)?

A

STAX extension splint x 6-8 wks

Surgery if large fx fragment or subluxation at joint

61
Q

What is injured if Boxer’s fx?

A

Neck of 5th IMC

62
Q

What is the tx for Boxer’s fx (neck of 5th IMC)?

A

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
Q

What is a Bennett’s fx and what is the tx?

A

Fx to base of 1st IMC w/ extension into joint

Tx w/ splinting then casting
(CRPPF or ORIF)

64
Q

What is a game keepers thumb (skiers thumb)?

A

Injury to MCP joint resulting in ulnar collateral ligament tear and instability of the MCP joint

65
Q

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)

A

Thumb spica splint/ cast

Surgery (soft tissue involvement)

3. E Med & Surgery (19 decks)

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