Extremity trauma Flashcards
compression causes what type of fracture
oblique
tension causes what type of fracture
Transverse fracture
Rotation causes what type of fracture
Spiral fracture
angulation causes what type of fracture
transerverse
what causes a spiral fracture
torque and axial compression
define Apposition
the closeness of the bony contact at the fracture site
how do you discribe apposition
describe the offset of the distal in relation to the proximal
define alignment
describes the position of the distal fragment in rlation to the proximal in the longitudinal axis
define rotation
produced by a twisting force along the longitudinal axis
what are falls on outstretched hand injuries commonly referred too as?
FOOSH injuries
<5yrs old FOOSH injury
supracondylar fracture
5-10yr FOOSH injury
transverse radial metaphysis fx
10-16 yr FOOSH injury
epiphyseal separation radius
16-35 yr FOOSH injury
scaphoid or other carpal fx
> 40 yr FOOSH injury
Colles fx or ulna fx
> 70 yr FOOSH injury
Surgical Neck of humerus fx
what are the indirect signs of fx as diagnostic clues
Joint effusions soft tissue swelling double cortical line buckling of the cortex intracapsular fat-fluid level periosteal or endosteal reactions displacement or obliteration of fat stripe
what is the rate of fracture repair in infants
rapids and complete in 4-6 weeks
what is the rate of fracture repair in adolescents
less rapids and complete in 6-8weeks
what is the rate of fracture repair in adults
union is slow 10-12 weeks or sometimes 16-20 weeks
when is the first radiographic visualization of callus?
about 14 days
what are the steps to bone healing
1) hematoma formation
2) fibrocartilaginous callus formation
3) bony callus formation
4) bone remodeling
what is clinical union of a fx
when the callus is sufficiently developed to allow weight bearing or similar stress
what factors influence the rate of repair
degree of local trauma age of the patient vascularity of the fragments separation of the fragments inadequate immobilization presence of infection of other focal pathologies
what are the complications of fractures
nonunion delayed union arrest of growth stimulation of growth malunion or angular deformities avascular necrosis of infection DJD
complications AWAY from site of fracture
shock synovitis fat embolism sub periosteal ossification intra and periarticular adhesions reflex sympathetic dystrophy
complications of soft tissue (with fractures)
injuries to nerves, blood vessels, tendons, Ligs, muscles bowel, bladder, lungs kidneys etc…
what salter harris fx is though the physis and metaphysis
type 2
what type of salter harris is through the physis and epiphysis
type 3
what type of salter harris fracture is through the physis metaphysis and epiphysis
type 4
what type of salter harris fx has normal radiographs until cessation of growth develops deformity?
type V
what is the normal AC width
< 2-3 mm difference between sides
what is the normal distance between coracoid and clavicle
11-13mm with <5mm bilateral difference
what is the typical mechanism for injury of the AC joint
FOOSH or direct blow to top of the shoulder
what is the most common location of clavicle fracture
middle third (80%)
with a middle third clavicle fracture the proximal fragment is elevated by____ and the distal fragment is depressed by ____
elevated by the SCM and depressed by the weight of the shoulder
complications of clavicle fx’s
exuberant callus may cause neurovascular comprimise
malunion or nonunion
laceration of the subclavian artery or brachial plexus
distal DJD
what is a “Flap” fx
avulsion of the greater tuberosity of the humorous
how much displacement indicates a rotator cuff disruption with a flap fx?
1cm
what is the most common type of shoulder dislocation
anterior (97%)
what are the three subcategories of ant. shoulder dislocation
subcorcoid
subglenoid
intrathoracic
what are the mechanisms of ant. shoulder dislocation
forceful extension or abduction
forcful elevation and external rotation
direct blow
foosh
what creates the Hill sachs defect
impaction fracture of the humeral head and glenoid fossa
what is a bankart lesion
avulsion of the inf. glenoid rim
which type of shoulder dislocation is due to hyperabduction
inferior dislocation
tennis racquet, light bulb sign
trough sign
rim sign
are all indications of what?
post. shoulder dislocation (very rare and hard to see on x-ray)
what does Luxatio erecta mean?
inf. dislocation
what make up the rotator cuff?
supraspinatus
infraspinatus
teres minor
subscapularis
what is the gold standard for rotator cuff injuries
MRI
what are the radiologic findings of a rotator cuff tear
acromiohumeral joint space less than 6mm
erosion of inf. aspect of acromian process
flattening of grater tuberosity
what is the MC spot of a rotator cuff tear
supraspinatous (inf. outer edge of acromion)
what is the Critical zone
an area of decreased vascular supply in the supraspinatus tendon where most tears occur and is about 1cm from insertion
what is the MC elbow injury in children
supracondylar fx (60%)
what is the MC elbow injury in adults
radial head or neck (50%)
what are radiographic signs of elbow injury
positive fat pad sign
radio- capitellar line
ant. humeral line
hockey stick appearance
what is a chisel fracture
vertical radiolucancy in radial neck
what is the Numonic for ossification centers of the elbow
C.R.I.T.O.E - (capitellum,radius,internal epicondyle,trochlea,olecranon,external epicondlye)
1.3.5.7.9.11 (YEARS)
discribe nursemaids elbow
fx in toddlers 2-5yrs from sudden jerk on forearm while in pronation with normal radiographs causes entrapment of annular ligament by radial head
what are the MC joint dislocations in adults in order
1) shoulder
2) interphalangeal joints of fingers
3) elbow
what is the MC elbow dislocation
Post./posterolateral (90%)
what is a minimally displaced oblique fracutre of the distal ulnar shaft
Nightstick fracture
what view is a torus fx best seen
lateral view
what is normal volar tilt range
10-15 degrees
