FOOSH Flashcards
fractures with elbow involvement
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
fracture of the proximal or middle ulna with dislocation of the radial head
monteggia fracture
mechanism of injury of monteggia fracture
fall onto outstretched and pronated forearm and extended wrist
isolated ulna fracture
(parry fracture, nightstick fracture)
typically a defensive injury
galeazzi fracture
radial shaft fracture
subluxation or dislcocation of the DRUJ
fall into an outstretched and pronated forearm and extended wrist
colles fracture
radial and dorsal displacement of the distal fragment of the radius
FOOSH on extended wrist
smith fracture
radial and volar displacement of the distal fragment of the radius
flexion fracture: fall onto palmar flexed wrist
barton fracture
radial avulsion and dorsal displacement of the radiocarpal segment of the radius
extension fracture: FOOSH
reverse barton fracture
avulsion and volar displacement of the radiocarpal segment
flexion fracture
hutchinsion fracture
avulsion of the radial styloid
extension fracture FOOSH
die punch fracture
intraarticular fracture of the lunate fossa of the distal radius
axial loading force applied against the distal radius
initial management
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
indications to consult orthopaedics for fractures
skin tenting
open fractures
potentially operable long bone fractures
comminuted fractures
displaced intra-articular fractures
fracture-dislocations
unstable pelvic fractures
neurovascular compromise
compartment syndrome
clinical features of a monteggia fracture
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
galeazzi fracture clinical features
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
dinner fork deformity
colles fracture
garden spade deformity
smith fracture
signs of fracture
localised pain, oedema, erythema at the site of the injury, deviation from normal longitudinal axis of the body part, palpable unnevennes, crepitus
pinch sign
anterior interosseous syndrome
median nerve injury
proximal humerus fractures are common in
older adults
suprachondylar fractures are common in
children
complications of distal humerus fracture
brachial artery injury is common
absent or diminished radial pulse suggests brachial artery entrapment (especially following reduction) and compartment syndrome
late complication of brachial artery injury
volkmann ischaemic contracture
why is the brachial artery commonly injured during distal humerus fracture
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
distal humerus fracture causing median nerve palsy
anterior interosseous nerve syndrome (pinch sign)
decreased wrist flexion
decreased sensation over thenar eminance and lateral 3.5 fingers
distal humerus fracture causing ulnar nerve palsy
claw hand deformity
decreased sensation over medial 1.5 fingers
distal humerus fracture or humeral shaft fracture causing radial nerve palsy
wrist drop
decreased grip strength
decreased sensation over dorsal hand and posterior arm
proximal humerus fracture causing axillary nerve palsy
flat deltoid
decreased arm abduction at shoulder
4 cardinal signs of compartment syndrome
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)
late features of compartment syndrome
neurologic deficits eg. parasthesia, sensory deficits, muscle weakness or paralysis
impaired perfusion - cold extremities with pallor or cyanosis, absent or weak distal pulses
diagnosis by invasive compartment pressure measurement
difference between diastolic blood pressure and intercompartmental pressure is less than 30
rising compartmental pressure
supportive care for compartment syndrome
remove constrictive dressings, splints, devices
provide analgesia
place the limb at the level of the heart
reduce displaced fractures
admnister supplimental oxygen
what is fasciotomy
incision into the skin and fascia to relieve compartment pressure and restore perfusion
usually delayed primary closure
