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Cuccurullo Book > Ch 4 - MSK: Upper Extremity Fractures > Flashcards

Ch 4 - MSK: Upper Extremity Fractures Flashcards

1
Q

Describe the MOI of scapular fractures.

A

Direct blow to the shoulder usually after a significant, high-velocity trauma

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2
Q

What are fracture sites of the scapula?

A 
Glenoid
Glenoid rim
Coracoid
Scapular neck and body
Acromion
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3
Q

What imaging can be used to diagnosed a scapular fracture?

A
  • Plain films: AP, lateral scapular-Y, and axillary views

* CT scan

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4
Q

What is treatment for nondisplaced scapular fractures?

A

Closed treatment
Arm sling
Early ROM as tolerated w/in 1-2 weeks

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5
Q

What is treatment for large displaced scapular fractures?

A

ORIF

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6
Q

Why should patients with isolated scapular body fractures be hosptialized?

A

Risk of pulmonary contusion

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7
Q

What is the classification of clavicular fractures?

A

Medial
Middle (MC)
Distal 1/3

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8
Q

What imaging should be used for clavicular fractures?

A

AP plain films of the clavicle, AC and SC joints

CXR to evaluate for superimposed pneumothorax complication

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9
Q

Describe treatment for clavicular fractures.

A

– Closed reduction and immobilization with a simple sling or figure-8 sling
– Immobilization 3 to 6 weeks
– Progressive range after 3 weeks

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10
Q

What are indications for surgery for clavicular fractures?

A

– Open clavicle fx
– Grossly displaced fx w/ skin tenting
– Fx w/ significant medialization of shoulder girdle
– Displaced lateral clavicle fx (>1 cm) at the AC joint

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11
Q

Describe the parts of the Four-Part Classification of humerus fractures.

A

– Greater tuberosity
– Lesser tuberosity
– Humeral head
– Humeral shaft

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12
Q

When is a humeral fracture considered displaced?

A

One of the 4 parts must be angulated by 45° or displaced at least 1 cm

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13
Q

Describe a One-part humeral fracture.

A

Nondisplaced, impacted fractures

All parts still in alignment

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14
Q

Describe a Two-part humeral fracture.

A

One fragment is displaced with respect to the other three

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15
Q

Describe a Three-part humeral fracture.

A

Two fragments are displaced

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16
Q

Describe a Four-part humeral fracture.

A

All fragments are displaced

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17
Q

What is the most common site for humeral fracture?

A

Surgical neck

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18
Q

Who does humeral fracture typically occur in?

A

Elderly women with osteoporosis after a fall

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19
Q

What can the supraspinatus cause in surgical neck humerus fractures?

A

Abduction of the proximal fragment of the humerus

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20
Q

When is surgery indicated in humerus fractures?

A

Greater than one part (displaced greater than 2 cm)

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21
Q

What is the most common brachial plexus injury with humerus fracture?

A

Axillary nerve

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22
Q

When can AVN of the humeral head occur after humerus fracture?

A

Anatomic neck fractures 2/2 interruption of the humeral circumflex artery

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23
Q

What is Little leaguer’s shoulder?

A

Stress fracture in humerus through proximal growth plate in skeletally immature athletes

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24
Q

What is the clinical presentation of Little leaguer’s shoulder?

A
  • Insidious onset of pain aggravated by hand throwing
  • Focal tenderness over fx
  • Pain w/ resisted ABD and IR
  • Mild weakness
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25
Q

What is seen on x-ray in chronic Little leaguer’s shoulder?

A

Cortical thickening along the mid-third of the medial cortex

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26
Q

What is seen in adolescents on x-ray in Little leaguer’s shoulder?

A

Widening of the lateral part of the physis w/ sclerosis or cystic changes on ER AP films

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27
Q

When do symptoms resolve in Little leaguer’s shoulder?

A

Activity restriction of 8 weeks in adults and 12 weeks in adolescents

28
Q

What can continued activity with Little Leaguer’s shoulder cause?

A

Spiral fracture of the humerus or premature closure of the physis

29
Q

What are causes of humeral shaft fracture?

A

Direct trauma

FOOSH

30
Q

What nerve can be inured with humeral shaft fracture?

A

Radial nerve

31
Q

What is the treatment of humeral shaft fracture?

A

Splint for 2 weeks

32
Q

When do radial nerve injures typically recover?

A

95% in 6 months

EMG indicated if function does not return

33
Q

What are the types of distal humerus fractures

A

Displaced

Nondisplaced

34
Q

What do displaced distal humerus fractures involved?

A

One or both condyles

Joint surface may or may not be involved

35
Q

What is the treatement of distal humerus fractures?

A

Nondisplaced: splinting and early ROM
Displaced: open reduction

36
Q

Describe the classification of radial head fractures.

A
  • Type I: Nondisplaced
  • Type II: Marginal radial head fx, min displacement
  • Type III: Comminuted fx
37
Q

What is the treatment for a type I radial head fracture?

A

Short period of immobilization (3–5 days) followed by early ROM

38
Q

When is surgery indicated for a type II radial head fracture?

A

Surgical fixation for fx > 2-mm displacement or 30% radial head involvement

39
Q

What is the treatment for a type III radial head fracture?

A

Surgical fixation

40
Q

What are causes of olecranon fracture?

A

Direct blow to elbow
Fall on flexed elbow
FOOSH w/ dislocation

41
Q

What are the types of olecranon fractures?

A
  • Nondisplaced

* Displaced

42
Q

What are treatments for olecranon fractures?

A
  • Nondisplaced: immobilization, PT

* Displaced: Surgical fixation

43
Q

What is the MOI of a scaphoid fracture?

A

Fall or blow on a hyperextended (dorsiflexed) wrist

44
Q

What area of scaphoid is prone to none-union?

A

Middle and proximal portion d/t lack of blood supply

45
Q

What is the most common location of scaphoid fracture?

A

Waist 65%

46
Q

What is a complication of scaphoid fracture?

A

Osteonecrosis, which may lead to carpal bone collapse (scapholunate) if not treated correctly

47
Q

What is the clinical presentation of scaphoid fracture?

A
  • Swelling and tenderness of thumb and anatomical snuff box
  • Pain with extension and radial deviation
  • TTP tuberosity of the scaphoid
48
Q

What are the borders of the anatomical snuff box?

A

– Scaphoid bone
– APL and EPB
– EPL

49
Q

What imaging should be done for scaphoid fractures?

A
  • PA and oblique view of the wrist in ulnar deviation
  • CT scan
  • Bone scan (+) 24 hrs
50
Q

What is the treatment for Nondisplaced scaphoid fractures <2 mm?

A

– Long thumb spica cast for 6 wks wrist in neutral
– At 6 weeks, change to a short thumb spica cast if the plain films show proper healing
– If poor healing at 6 wks, surgical stabilization may be indicated

51
Q

Management of displaced scaphoid fractures >2 mm?

A

Referral to orthopedics

52
Q

How long do scaphoid fractures take to heal?

A

– Distal: 8 wks
– Middle: 3 mo
– Proximal: 4 mo

53
Q

What can cause hamate body fractures?

A

Direct trauma

54
Q

What can cause hook of hamate fractures?

A

End swing while holding a racquet, bat, or club

55
Q

What imaging is needed for hamate fractures?

A
  • X-rays: PA, lateral, carpal tunnel, and 45° supinated oblique views
  • CT: fx at the base of the hook
56
Q

What is treatment for hamate fractures?

A
  • Nondisplaced body fx: 4 to 6 weeks short arm cast
  • Displaced body fx: Surgical referral
  • Acute hook fx: 50% heal after casting 6 wks to 4 mo
57
Q

What causes trapezium fractures?

A
  • Base of the thumb metacarpal is forced by axial load into the trapezium
  • Avulsion fracture
58
Q

What images are needed for trapezium fractures?

A

X-rays: PA, lateral, oblique, carpal tunnel, and Bett’s views

59
Q

Describe a Bett’s view.

A

Thumb ext and abducted Wrist slightly pronated

Beam centered on the scaphotrapeziotrapezium area

60
Q

What is the most common type of distal radius fracture?

A

Colles fracture

61
Q

What is a Colles fracture?

A

Fracture of the distal radius with dorsal displacement and angulation

62
Q

What is a Colles fracture associated with?

A

TFCC tears

Scapholunate dissociation

63
Q

What is a Smith’s fracture?

A

Fracture of the distal radius with volar displacement and angulation

64
Q

What is a Bennett’s fracture?

A

Oblique fracture-subluxation at the base of the thumb metacarpal

65
Q

What is a Rolando’s fracture?

A

Fracture at the base of the thumb metacarpal that may be classified as a T, Y, or comminuted configuration

66
Q

What is a boxer’s fracture?

A

Fracture of the metacarpal neck/shaft usually seen after a person strikes a wall or another person

67
Q

What is the most commonly involved digit in boxer’s fracture?

A

5th digit

Cuccurullo Book (91 decks)

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