Fractures Flashcards
A child (or adult) presents with a displaced clavicle fracture in the medial third. What is your management?
immediate referral to orthopaedic services
A child (or adult) presents with a displaced clavicle fracture in the lateral third. What is your management?
immediate referral to orthopaedic services
What is the management of undisplaced clavicle fractures?
broad arm sling
- 2-3 weeks for middle third fractures or until comfortable
- 4 weeks for lateral third fracture or until comfortable
Generally, middle third clavicle fractures can be managed conservatively, especially in young children. List three criteria for referring to orthopaedic services (out of a possible 6)
- completedly displaced
- shortening >2cm
- comminution
- open fracture
- pathological fracture
- neurovascular injury
What treatment should be given for an undisplaced and non-impacted surgical neck of humerus fracture?
Triangular sling and pendulum exercises in sling when pain subsides
What are 3 features of proximal humerus fracture that warrant prompt referral to orthopaedic services? (5 listed)
- Displacement (amount depends on age)
- Impaction
- Shoulder dislocation
- Neurovascular complications
- involving anatomical neck (not surgical neck) - see link
https: //en.wikipedia.org/wiki/Surgical_neck_of_the_humerus
Which type of humeral shaft fracture is suspicious for non-accidental injury in children?
spiral fracture
What is the management of humeral shaft fractures?
Collar and cuff sling and non-urgent ortho review unless any red flags for fractures in general present. Traction from the weight of the arm tends to repair angulation and displacement without the need for manipulation. May need reduction in ED if very displaced/angulated.
What is the management of an undisplaced supracondylar fracture?
above-elbow backslab in 90 degrees elbow flexion with sling for 3 weeks
What is the management of a displaced supracondylar fracture?
Refer for urgent orthopaedic input - especially if fully displaced
List two possible major complications of a supracondylar fracture
- vascular injury - check for radial pulse
- nerve damage - check median, ulnar and radial nerve function
Do all lateral and medial epicondylar fractures of the elbow need to be referred to orthopaedic services (either urgently or non-urgently)?
Yes, due to high rates of poor outcomes
What other injury is commonly associated with medial epicondyle fracture?
elbow dislocation - in 50% of cases
What is a Monteggia fracture and how is it managed?
- A fracture of ulnar associated with radial head dislocation
- requires urgent orthopaedic review for reduction
Galeazzi fracture-dislocation is a distal radial fracture associated with disruption of which joint (which should always be assessed on imaging if a radial fracture is found)?
distal radio-ulnar joint
What is the first-line investigation of a suspected scaphoid fracture?
wrist xray
If there is a high clinical suspicion for a scaphoid fracture despite a normal initial xray, what is the preferred second line option for further investigation
MRI of the wrist. CT can be used if MRI unavailable/contraindicated. If neither are available, repeat x-ray in 7-10 days
What is the management of a scaphoid fracture?
Spica cast and orthopaedic review within 2 weeks. Urgent review not needed unless open fracture of trans-scaphoid peri-lunate fracture-dislocation
What is the management of SUFE?
Non-weight bear and urgent ortho review
What is the management of femoral shaft fractures?
Urgent orthopaedic review
Which bone is involved in a Toddler’s fracture?
Tibia. It’s an oblique or spiral fracture where the periosteum stays intact
Which toe is mostly likely to effect gait if fractured and therefore requires referral to orthopaedic services if fractured?
The big toe
Fractures of toes 2 to 5 can require reduction if significantly displaced. Other than this scenario, what is one other situation where fracture requires urgent orthopaedic input?
Open fracture including when nailbed is involved (Seymour fracture)
Which type of 5th metatarsal fracture is associated with poorer outcomes and therefore required orthopaedic input?
Jones fracture (distal to avulsion fracture)
For the management of a Mallet finger (at the distal phalange), what position should the DIP joint be splinted in?
full extension
How long does a Mallet finger need to be splinted for?
6-8 weeks
If a mallet finger is diagnosed, what percentage of the joint space can be involved before referral to orthopaedic services is required?
30%
What type of splint is required for a displaced/angulated 5th metacarpal fracture?
Ulnar gutter splint
What distance between the scaphoid and the lunate is suggestive of a scapholunate injury and therefore warrents hand surgeon review?
> 3mm
