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Phys: Bone & Gen Med: Ortho > Fractures 1 > Flashcards

Fractures 1 Flashcards

1
Q

What are the general characteristics for a humeral head fracture?

A

Most occur in older pts w/ osteoporosis

F:M = 2:1

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2
Q

What are the sxs of humeral head fracture?

A
  1. Pain, swelling, tenderness esp. in region of greater tuberosity
  2. Pt holds affected extremity against chest wall
  3. Look for injuries to brachial plexus and/or axillary nerve/artery
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3
Q

Where is the most common area for a humeral fx?

A

surgical neck fracture of humerus

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4
Q

What imaging studies are used for a humeral head frx?

A

AP, lateral and “Y” view (outlet view), axillary

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5
Q

What is the tx for a humeral head fx?

A
  1. Sling for most nondisplaced fxs (check axillary nerve)
    A. Early mobilization w/ pendulum exercises to prevent frozen shoulder
  2. Refer to Ortho for ORIF -> displaced fxs
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6
Q

What is the best true lateral view of the shoulder?

A
  1. Axillary view

A. Superior to inferior or inferior to superior

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7
Q

What is pendulum exercises?

A

The arm is hung downward and rotated in large circles in order to regain shoulder range of motion

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8
Q

What is the MOI of a humeral shaft fx?

A
  1. MVA
  2. Fall on outstretched hand
  3. Penetrating injuries, i.e. gunshot wound
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9
Q

What are the sxs of a humeral shaft fx?

A
  1. Pain, swelling, deformity and arm shortening

2. Radial nerve must be assessed for possible injury, as well as ulnar nerve and median nerve

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10
Q

What nerve does the thumbs up sign test?

A

Wrist extension also for

radial nerve function

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11
Q

What imaging is used for humeral shaft fx?

A

Xray: AP & Lateral views of shoulder & elbow

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12
Q

What is the tx for humeral shaft fx?

A
  1. Specialized splints: long arm splint/proximal sugar tong splint/coaptation splint/clamshell brace
  2. Operative repair: ORIF
    A. Displaced fracture
    B. Neurovascular compromise
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13
Q

What are the complications of humeral shaft fx?

A
  1. Radial nerve injury: 18% of cases
    A. Occurs @ time of frx
    B. May also develop after reduction
    C. Delayed complication as a result of incorporation of nerve by callus formation (healing bone)
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14
Q

What is the MOI for a supracondylar fx?

A

Fall on outstretched hand

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15
Q

What are the sxs of a supracondylar fx?

A

Gross swelling and tenderness proximal to elbow

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16
Q

What neurovascular injury may occur for a supracondylar fx?

A
  1. Radial artery, Brachial artery

2. Median, Radial & Ulnar nerves

17
Q

When and where does vascular injury occur in a supracondylar fx?

A

*vascular injury occurs in 5-20% of children w/ supracondylar frx (brachial artery injured)
Most nerve palsies from supracondylar frx are neuropraxias, and will resolve spontaneously
Median nerve can be up to 50%
Radial nerve can be up to 25%

18
Q

What does the OK sign test?

A

Median nerve integrity

19
Q

How is ulnar nerve integrity tested?

A

Hold a piece of paper between fingers

20
Q

What imaging is used for supracondylar fx?

A
  1. AP & lateral views (include elbow and wrist)
    A . 5-6% can have distal radius frx too
  2. In children, always bilateral views to compare
21
Q

What is the tx for a supracondylar fx?

A
  1. Long arm cast for children w/ nondisplaced fx
  2. Closed reduction in OR w/ post. splint application for displaced fxs (post reduction x-rays and neurovascular checks)
  3. Adults should always have ORIF
22
Q

What are potential complications of supracondylar fx?

A
  1. Compartment syndrome (< 1%) and the resulting sequelae of Volkmann’s contractures
    A. Injuries to Brachial artery and Median nerve (and radial nerve)
  2. Varus or valgus deformities of elbow
23
Q

What is volkmann’s contracture?

A
  1. Type of forearm ischemic contracture from injury to brachial artery asst w/ supracondylar fx
    What happens?
  2. Fixed flexion of the elbow, pronation of the forearm, flexion at the wrist, and joint extension of the metacarpal-phalangeal joint
24
Q

What is the most common elbow fx in adults?

A

Radial head/neck fx?

25
Q

What is the MOI of a radial head/neck fx?

A

Fall on outstretched hand

26
Q

What are the sxs of a radial head fx?

A
  1. Pain over lateral aspect elbow
    A. Worsens w/ forearm rotation (pronation / supination)
  2. Tenderness on palpation over radial head
27
Q

What imaging is used for radial head/neck fx?

A
  1. AP & lateral views

2. Displacement of anterior fat pad +/- posterior fat pad -> hemarthrosis, fracture

28
Q

What treatment is used for radial head/neck fx?

A
  1. Sling for non-displaced fxs -> conservative tx & Ortho referral
  2. Operative repair for complex fractures
  3. Early ROM
29
Q

What are complications of a radial head fx?

A
  1. may not regain full flexion/extention of elbow

Phys: Bone & Gen Med: Ortho (14 decks)

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