7 MSK

Question 1

Distal radius fx types

their differences

Answer 1

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

Question 2

Triquetral fx

how appears on XR?

Answer 2

2nd most common carpal fx

Question 3

scapholunate dissociation

• what to look for
• tx

Answer 3

widening btwn scaphoid and lunate

3mm suggestive

5mm diagnostic

complete tear requires operative intervention

Question 4

perilunate dislocation

-how does it look on AP hand view

Answer 4

Look at the 3 arcs (Gilula’s arcs) and look for overlap

Question 5

What is piano key sign

Answer 5

indicative of DRUJ dislocation

push down on distal ulna–if it comes up again like a piano key, then DRUJ completely disrupted

Question 6

How to reduce a finger volar dislocation

Answer 6

assoc with central slip injury with bouteonniere deformity

Difficult–sometimes require open reduction

Try doing digital block

Question 7

Finger tuft fracture

1. What if the nail has been avulsed on the proximal side
2. what not to miss

Answer 7

1. tuck it in underneath the fold
2. caution, could be open fracture because communicates with nail bed

Question 8

Do not mistake Boxer’s fx for ?

Answer 8

midshaft metacarpal fx.

(Boxers is the metacarpal neck)

The angle rotation numbers do not apply

Question 9

Boxer’s fx

what to look for and tx?

Answer 9

metacarpal neck fx

Look for rotation, which needs reduction and immobilization

acceptable angulation: 40-50% 5th, 30% 4th, 20% 3rd, 10% 2nd digit

Question 10

Thumb fractures

what are the different types and their presentations

Answer 10

fx/dislocation of base of 1st metacarpal:

1. Bennett– intraarticular fx (image)
2. Rolando–comminuted Bennett’s
3. Skier’s/gamekeepers

ulnar collateral ligament damaged

may have avulsion fx

Question 11

flexor tenosynovitis

criteria

Answer 11

kanaval’s signs:

fusiform swelling

volar surface ttp

passive extension of finger causes pain

finger held in flexion

Question 12

de quervain’s tenosynovitis

-dx, tx

Answer 12

Finkelstein’s test–ulnar deviation and flexion causes pain

apply splint, NSAIDs,

Question 13

supracondylar fx

who can you discharge home?

Answer 13

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

Question 14

Elbow lateral XR

what to look for to make sure it is a true lateral

Answer 14

hourglass sign

Question 15

clavicle fracture

• which ones need ED ortho consult?
• which ones are dc home with urgent ortho f/u?

Answer 15

-skin tenting, open fx, neuro deficit

urgent f/u: “rule of 2s”

displacement >2cm, or fx >2 pieces. likely need operative intervention

Question 16

Elbow fx:

you see posterior fat pad but don’t see obvious fx

think what

Answer 16

always look at radial head/neck, as well as consider supracondylar

Question 17

posterior shoulder dislocation causes

Answer 17

“3 Es”

electricity, etoh, epilepsy

Question 18

you suspect ACL tear

what to look for on knee XR

Answer 18

Segond fracture

avulsion. seen only in 5% of ACL tears, is very specific

Question 19

tibial plateau fx

what to know

Answer 19

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

Question 20

Knee dislocation

-how to dispo?

Answer 20

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

Question 21

5th metatarsal fractures

Answer 21

Dancer’s vs Jones vs midshaft fx

vs normal extra bone