Acute Fractures Flashcards
supracondylar elbow fractures risk injury to what nerve and artery?
median nerve and brachial artery
what is the most common comorbid nerve injury in a humeral shaft fracture?
radial nerve injury
what type / location of humerus fracture is most associated with nerve injury?
transverse mid-diaphyseal fracture
if intramedullary nailing is used to treat humerus fracture, what is the most common complication to warn the athlete about?
shoulder pain
in most cases, what is the typical appropriate management for humerus shaft fracture?
non operative management / functional bracing/ROM and isometric exercises
most distal humerus fractures require what type of treatment?
surgical stabilization
what is the two step initial management for a patient with non displaced radial head fracture?
sling and early elbow ROM
for non surgical management of distal radius fracture, for how long should immobilization in cast last?
4-6 weeks
after 4-6 weeks casting for minimally displaced distal radius fracture, what is the next step?
removable splint
most scaphoid fractures are treated in what way?
surgical - ORIF
what imaging modality can be helpful for assessing healing of scaphoid fractures and return to play decisions?
CT
an acute olecranon fracture that is < 2mm displaced and with intact extensor mechanism can be treated with what?
cast or splint immobilization
in the case of a middle third clavicle fracture, the medial portion is pulled in what direction? by what muscle?
superiorly by the SCM muscle
dislocations of the PIP should be treated with what type of splint?
extension block splint
how are minimally displaced phalanx fractures of the hand treated?
buddy taping
how are metacarpal neck or shaft fractures treated?
cast or splint
what degree of overlap of a clavicle fracture indicates the need for surgery?
> 2cm
t/f operative management of displaced midshaft clavicle fracture improves return to sport compared with non operative management
true
t/f conservative care for midshaft clavicle fracture can increase risk of nonunion compared to operative management
true
what is a monteggia fracture?
fracture of the ulna with dislocation of the radial head
what is a Galeazzi fracture?
fracture of the radial shaft with injury to the distal radioulnar joint
what is the recommended treatment for skeletally mature athletes with displaced radial or ulnar shaft fractures?
surgical treatment
what is the typical time for return to sport after forearm fracture?
4-6 weeks
how do you manage a non displaced ulnar fracture?
bracing or casting until clinical and radiographic evidence of fracture union
in a concominant fracture of the ulna and radius diaphysis , after ORIF, for how long do you need to immobilize in a long arm cast post-surgery?
6-8 weeks
in the most common type of Monteggia fracture, in what relative direction will the humeral head dislocate?
anterior
in a fracture of the radius distal to the insertion of the pronator teres, the distal fragment of the radius will be pullsed into pronation by what muscle?
pronator quadratus
what complication of radial and/or ulnar fracture can cause difficulty pronating the forearm due to elimination of natural radial lateral bowing?
malunion
compartment syndrome of the forearm is most likely to occur in what compartment?
volar
what two criteria must be met to treat a tibial plafond fracture with long leg cast?
- minimal displacement
- no damage to the articular joint surface
what type of surgery is indicated for Jones fracture?
intramedullary screw fixation
fractures of the foot that are minimally displaced can be treated with what?
short leg cast
the duration for which a hip dislocation is ongoing is directly correlated to what complication of the femoral head?
osteonecrosis
MRI performed after hip dislocation/reduction can assess for what two complications?
- AVN
- injury to labrum / capsule
before reduction of a hip dislocation is attempted, what two things must you do?
- radiographs
- Neurovascular assessment
what is an important complication from displaced femoral neck fracture?
AVN of the femoral head
weakness in what muscle group is a common complication from anterograde intramedullary nailing for treatment of a femoral neck fracture?
abductor muscle weakness
what is the typical mechanism of a knee dislocation?
hyperextension with foot fixed
what is a normal ABI?
0.9 or greater
which nerve function is especially important to assess after suspected knee dislocation?
peroneal nerve function
what is the most common comorbid fracture in the case of knee dislocation?
tibial plateau fracture
if you assess a knee dislocation and find that the pulses are different side to side, what is the next step?
eval for vascular injuries with CT or MR angiography
what type of splint should be used for on field stabilization of tibial shaft fracture?
air or vacuum splint
t/f in the case of tibial shaft fracture, you should splint the fracture as it lies
true
which artery is most at risk in a knee dislocation?
popliteal artery
anterior and posterior dislocation of the knee refer to what segment?
direction that the tibia moves in relationship to the femur
what is a Maisonneuve fracture?
complete disruption of the tibiofibular syndesmosis, fracture of the proximal fibula and medial ankle injury (such as deltoid ligament tear)
what is the typical movement of the talus that serves as the MOI for Maisonneuve fracture?
external rotation
what is a type A rotational fracture of the ankle?
avulsion fracture of the lateral malleolus and shear fracture of the medial malleolus caused by medial rotation of the talus
what is a type B rotational fracture of the ankle?
shear fracture of the lateral malleolus and avulsion fracture of the medial malleolus from lateral rotation of the talus
what is a type C rotational ankle fracture?
disruption of the tibiofibular ligaments and syndesmosis by external rotation of the talus also resulting in more proximal fracture of the fibula
how can closed, stable fractures of the tibial shaft be managed?
cast and functional bracing
when performing external rotation stress testing of the ankle, if stability is found and there is no pain with this maneuver, what etiology can be mostly ruled out?
unstable ankle fracture
the Weber system of ankle fracture classification classifies fractures in relationship to what structure?
tibial plafond
when evaluating ankle fracture on XR, what are the cutoffs for increased widening at the medial clear space and at the distal tibiofibular space?
> 4mm medial clear space
6mm tibiofibular space
in general, what is the treatment for bimalleolar or trimalleolar fractures of the ankle?
ORIF
what is the particular surgical treatment of choice for repair of the syndesmosis when diastasis is present?
suture fixation device such as Tight Rope
what are the earliest and most reliable indicators of acute compartment syndrome?
pain out of proportion and pain with passive stretch
what are the 5 p’s of compartment syndrome?
pain
pallor
pulselessness
paresthesia
poikilothermia
t/f firm compartments and severe pain, especially with passive stretch are adequate to make the diagnosis of compartment syndrome even in the absence of compartment testing
true
how long should screws be left in place for a fifth metatarsal base fracture?
until the athlete has finished competitive sports
