FOOSH

Question 1

fractures with elbow involvement

Answer 1

Montaggia fracture: fracture of the proximal or middle ulna
dislocation of the radial head
Isolated radial head fracture: fracture of the radial head
olecranon fracture: fracture of the olecranon process

Question 2

fracture of the proximal or middle ulna with dislocation of the radial head

Answer 2

monteggia fracture

Question 3

mechanism of injury of monteggia fracture

Answer 3

fall onto outstretched and pronated forearm and extended wrist

Question 4

isolated ulna fracture

Answer 4

(parry fracture, nightstick fracture)
typically a defensive injury

Question 5

galeazzi fracture

Answer 5

radial shaft fracture
subluxation or dislcocation of the DRUJ
fall into an outstretched and pronated forearm and extended wrist

Question 6

colles fracture

Answer 6

radial and dorsal displacement of the distal fragment of the radius
FOOSH on extended wrist

Question 7

smith fracture

Answer 7

radial and volar displacement of the distal fragment of the radius
flexion fracture: fall onto palmar flexed wrist

Question 8

barton fracture

Answer 8

radial avulsion and dorsal displacement of the radiocarpal segment of the radius
extension fracture: FOOSH

Question 9

reverse barton fracture

Answer 9

avulsion and volar displacement of the radiocarpal segment
flexion fracture

Question 10

hutchinsion fracture

Answer 10

avulsion of the radial styloid
extension fracture FOOSH

Question 11

die punch fracture

Answer 11

intraarticular fracture of the lunate fossa of the distal radius
axial loading force applied against the distal radius

Question 12

initial management

Answer 12

neurovascular examination
consult ortho if needed
consider adding imaging of the elbow and wrist to check for associated injuries
evaluate for signs of compartment syndrome in any patient with high-energy trauma
analgesia for acute fractures

Question 13

indications to consult orthopaedics for fractures

Answer 13

skin tenting
open fractures
potentially operable long bone fractures
comminuted fractures
displaced intra-articular fractures
fracture-dislocations
unstable pelvic fractures
neurovascular compromise
compartment syndrome

Question 14

clinical features of a monteggia fracture

Answer 14

pain, crepitus, and limited range of motion at the elbow
radial head may be palpable at the antecubital fossa in anterior dislocation
shortened forearm
posterior interosseous nerve injury can occur
- paresthesias of the dorsal spects of the thumb, second and third fingers
- loss of thumb extension

Question 15

galeazzi fracture clinical features

Answer 15

pain and deformity of the distal radius
limited range of motion at the wrist
palpable displacement of the ulnar head
neurological injury is rare, but anterior interosseous nerve palsy can occur
almost all require open reduction

Question 16

dinner fork deformity

Answer 16

colles fracture

Question 17

garden spade deformity

Answer 17

smith fracture

Question 18

signs of fracture

Answer 18

localised pain, oedema, erythema at the site of the injury, deviation from normal longitudinal axis of the body part, palpable unnevennes, crepitus

Question 19

pinch sign

Answer 19

anterior interosseous syndrome
median nerve injury

Question 20

proximal humerus fractures are common in

Answer 20

older adults

Question 21

suprachondylar fractures are common in

Answer 21

children

Question 22

complications of distal humerus fracture

Answer 22

brachial artery injury is common
absent or diminished radial pulse suggests brachial artery entrapment (especially following reduction) and compartment syndrome

Question 23

late complication of brachial artery injury

Answer 23

volkmann ischaemic contracture

Question 24

why is the brachial artery commonly injured during distal humerus fracture

Answer 24

the brachial artery bifurcates into the radial and ulnar arteries within the cubital fossa
local trauma may induce brachial artery vasospasm, compromising arterial blood flow so patients can have absent or diminished radial pulse and delayed capillary refill in the affected arm

Question 25

distal humerus fracture causing median nerve palsy

Answer 25

anterior interosseous nerve syndrome (pinch sign)
decreased wrist flexion
decreased sensation over thenar eminance and lateral 3.5 fingers

Question 26

distal humerus fracture causing ulnar nerve palsy

Answer 26

claw hand deformity
decreased sensation over medial 1.5 fingers

Question 27

distal humerus fracture or humeral shaft fracture causing radial nerve palsy

Answer 27

wrist drop
decreased grip strength
decreased sensation over dorsal hand and posterior arm

Question 28

proximal humerus fracture causing axillary nerve palsy

Answer 28

flat deltoid
decreased arm abduction at shoulder

Question 29

4 cardinal signs of compartment syndrome

Answer 29

pain out of proportion to the injury (often described as deep, burning, poorly localised
pain worsens on passive stretch and tender to touch
soft tissue swelling
tight, wood like muscles (shiny)

Question 30

late features of compartment syndrome

Answer 30

neurologic deficits eg. parasthesia, sensory deficits, muscle weakness or paralysis
impaired perfusion - cold extremities with pallor or cyanosis, absent or weak distal pulses

Question 31

diagnosis by invasive compartment pressure measurement

Answer 31

difference between diastolic blood pressure and intercompartmental pressure is less than 30
rising compartmental pressure

Question 32

supportive care for compartment syndrome

Answer 32

remove constrictive dressings, splints, devices
provide analgesia
place the limb at the level of the heart
reduce displaced fractures
admnister supplimental oxygen

Question 33

what is fasciotomy

Answer 33

incision into the skin and fascia to relieve compartment pressure and restore perfusion
usually delayed primary closure