Exam 3 UE Ortho Emergencies

Question 1

Ortho injury basic rules? (4)

Answer 1

Compare injured to non-injured
Assess neurovasc above and below
Assess joint above and below
Multiple views for all XRays

Question 2

Clavicle Fxr C in what population?

U from what motion?

Answer 2

kids

fall onto outstretched hand

Question 3

Clavicle Fxr of Proximal 1/3 from what?

Middle 1/3?

Distal 1/3?

Answer 3

Direct blow

Most C

Direct blow to top of shoulder

Question 4

Clavicle Fxr diagnostics?

Answer 4

XRay

Note angle of deformity and placement of fxr

Question 5

Clavicle Fxr tx?

Repeat XRay when?

U heals how?

Answer 5

Arm sling
Immobilizer
Figure 8 brace
Refer to ortho

Repeat XRay 1-2 wks

U heals w/ deformity but fxn is normal

Question 6

Scapular Fxr C in what population?

C associated injuries?

Answer 6

Young men but still very rare fxr
Takes extreme force

1st rib fxr
Hemo/Pneumothorax

Question 7

Scapular Fxr diagnostics?

Scapular Fxr in kids suspicious for?

Answer 7

XRay

Abuse

Question 8

Scapular Fxr tx? (4)

Answer 8

Depends on type
U hospitalize to watch for pneumothorax
Refer to Ortho if Hemo
Ice, immob, analgesic

Question 9

Proximal Humerus Fxr C in what population?

Answer 9

Old ladies

Question 10

Proximal Humerus Fxr locations? (4)

Answer 10

Anatomic neck
Greater tuberosity
Lesser tuberosity
Surgical neck

Question 11

Proximal Humerus Fxr presentation? (3)

Answer 11

Mod to severe soft tissue swelling
Ecchymosis
Tender to palp

Question 12

Proximal Humerus Fxr tx?

Answer 12

Minimal displacement = ice, clam shell, sling

Refer to Ortho to preserve ROM

Question 13

Humeral Shaft Fxr U a/w injury to what?

Answer 13

Radial nn

Question 14

Humeral Shaft Fxr exam, important to document what?

Answer 14

Extension of wrist, thumb, fingers BEFORE manipulation

Question 15

Humeral Shaft Fxr tx?

Answer 15

Ortho
Hanging cast
Sugar tong, Clamshell, Sling

Question 16

Shoulder dislocation U where?

Result of?

Answer 16

Anterior

Abduction + external rotation

If posterior, U cause by seizure

Question 17

Shoulder dislocation presentation? (3)

Answer 17

Pt hold arm at slight abduction w/ opp hand
Prominent acromion
Should looks “squared off”

Question 18

Shoulder dislocation XRay views?

Always look for?

Answer 18

AP
Lateral
Y-View

Associated fxr of humeral tubers and glenoid

Question 19

Shoulder dislocation tx? (5)

Answer 19

Immediate reduction
Counter traction
Post-reduction XRays
Sling
Refer to Ortho

Question 20

Shoulder dislocation reduction steps? (4)

Answer 20

1) Pt supine w/ elbow @ 90°
2) Shoulder in 20° forward flex
3) Shoulder externally rotate until forearm in coronal plane
4) Arm internally rotates until forearm in adduction (across belly)

Question 21

Supracondylar Fxr C in what population?

Result of what motion?

a/w injury to what? (3)

Answer 21

< 15 yo

Fall on outstretched hand (FOOSH) w/ elbow locked ->
causes posterior displacement of distal fragment of humerus

Brachial aa, Median nn, Tricep

Question 22

Supracondylar Fxr exam must include assessment of what?

Answer 22

Motor/Sensory Fxn of:
Ulnar, Median, Radial nn

Distal pulses

Question 23

Supracondylar Fxr w/ abrasions/lacerations require what?

Answer 23

Early surgery

Question 24

Supracondylar Fxr XRay findings?

Always look for?

Answer 24

Fluid accumulation POSTERIOR to distal humerus pushes fat pad out = Sail Sign

Associated dislocations
Olecranon

Question 25

Supracondylar Fxr tx? Non-displaced?

Answer 25

Early Ortho for ROM preservation Splint ok

Question 26

Nursemaid Elbow C in what population? Result of what motion?

Answer 26

2-6 yo Pulling on arm or falling -> Subluxation of radial head

Question 27

Nursemaid Elbow presentation? (4)

Answer 27

Pt holds arm slight flex/pronation Guards arm No swelling, bruising or focal tender P wrist/forearm pain

Question 28

Nursemaid Elbow tx?

Answer 28

Full extension in supination -> Hold wrist -> Thumb over radial head -> Arm into flexion Should be using arm in 5-10 min

Question 29

Forearm Fxrs result of what motion? Uncommon forearm fxr?

Answer 29

FOOSH Direct blow Isolated Ulnar (think direct blow/abuse)

Question 30

Forearm Fxrs presentation?

Answer 30

Local tender | Little swelling/ecchy

Question 31

Monteggia Fxr is? Presentation?

Answer 31

Proximal 1/3 of ulna w/ disolcation of radial head "M is More proximal" Very painful Short extremity Radial head palpable in antecubital fossa

Question 32

Galeazzi Fxr is?

Answer 32

Fxrd radius w/ distal radioulnar joint disruption at wrist

Question 33

Colles' Fxr is? U a/w what other fxr?

Answer 33

Wrist Fxr causing Dorsal deformity of Distal Radius (dinner fork) Result of FOOH Ulnar

Question 34

Smiths' and Barton Fxrs are?

Answer 34

Wrist fxrs causing Volar (palm) deformity of Distal Radius | Result of falling on back of hand

Question 35

Wrist Fxr tx?

Answer 35

Ortho Non-displaced = Sugar tong or volar splint Displaced = open/closed reduction Immob 6-8 wks

Question 36

Scaphoid Fxr caused by what motion? Presentation? (4)

Answer 36

(aka Navicular) FOOSH Anatomic snuff tender, esp w/ ulnar deviation Min/No swelling/bruising +/- painful thumb ROM FREQUENTLY not visible on XRay

Question 37

Scaphoid Fxr tx?

Answer 37

+ hx w/ tenderness = long arm thumb splint | Ortho to prevent avascular necrosis