7 MSK Flashcards
Distal radius fx types
their differences
Colles– must be extra-articular
Reverse Colles (Smith)
Barton–intraarticular fx of radial styloid process, involves dorsal surface but not volar.
Reverse Barton– volar surface, not dorsal
Chauffeur’s–intraarticular fx of the radial styloid process, both dorsal and volar invovlement
Triquetral fx
how appears on XR?
2nd most common carpal fx
scapholunate dissociation
- what to look for
- tx
widening btwn scaphoid and lunate
3mm suggestive
5mm diagnostic
complete tear requires operative intervention
perilunate dislocation
-how does it look on AP hand view
Look at the 3 arcs (Gilula’s arcs) and look for overlap
What is piano key sign
indicative of DRUJ dislocation
push down on distal ulna–if it comes up again like a piano key, then DRUJ completely disrupted
How to reduce a finger volar dislocation
assoc with central slip injury with bouteonniere deformity
Difficult–sometimes require open reduction
Try doing digital block
Finger tuft fracture
- What if the nail has been avulsed on the proximal side
- what not to miss
- tuck it in underneath the fold
- caution, could be open fracture because communicates with nail bed
Do not mistake Boxer’s fx for ?
midshaft metacarpal fx.
(Boxers is the metacarpal neck)
The angle rotation numbers do not apply
Boxer’s fx
what to look for and tx?
metacarpal neck fx
Look for rotation, which needs reduction and immobilization
acceptable angulation: 40-50% 5th, 30% 4th, 20% 3rd, 10% 2nd digit
Thumb fractures
what are the different types and their presentations
fx/dislocation of base of 1st metacarpal:
- Bennett– intraarticular fx (image)
- Rolando–comminuted Bennett’s
- Skier’s/gamekeepers
ulnar collateral ligament damaged
may have avulsion fx
flexor tenosynovitis
criteria
kanaval’s signs:
fusiform swelling
volar surface ttp
passive extension of finger causes pain
finger held in flexion
de quervain’s tenosynovitis
-dx, tx
Finkelstein’s test–ulnar deviation and flexion causes pain
apply splint, NSAIDs,
supracondylar fx
who can you discharge home?
Types 1-4:
Type 1: nondisplaced (eg you see sail sign). these can dc home with outpt ortho in 48h
Others: involvement displacement. ortho consult in ED, usually admit
Elbow lateral XR
what to look for to make sure it is a true lateral
hourglass sign
clavicle fracture
- which ones need ED ortho consult?
- which ones are dc home with urgent ortho f/u?
-skin tenting, open fx, neuro deficit
urgent f/u: “rule of 2s”
displacement >2cm, or fx >2 pieces. likely need operative intervention
Elbow fx:
you see posterior fat pad but don’t see obvious fx
think what
always look at radial head/neck, as well as consider supracondylar
posterior shoulder dislocation causes
“3 Es”
electricity, etoh, epilepsy
you suspect ACL tear
what to look for on knee XR
Segond fracture
avulsion. seen only in 5% of ACL tears, is very specific
tibial plateau fx
what to know
commonly missed, hard to see on XR
Do CT if you suspect. (classic: peds vs auto by car bumper)
typically require OR, and risk for compartment syndrome
Knee dislocation
-how to dispo?
NOTE: controversial management
Get CTA, do ABI
If good pulses and ABI>0.9, admit to hospital for serial vascular exams
If ABI<0.9, pulse present but weak–vascular surgery consult, CTA
Weak or no pulses/ischemia–emergent vascular surgery consult, go to OR
5th metatarsal fractures
Dancer’s vs Jones vs midshaft fx
vs normal extra bone
