Fractures 2 Flashcards
What are the hand fxs?
- Boxer’s Fracture
- Colles’ Fracture
- Smith Fracture
- Gamekeeper’s Thumb
- Scaphoid Fracture
Define boxer’s fx?
Fx of metacarpal neck of 5th finger
what is the moi for a boxer’s fx?
direct blow
What are the sxs of a boxer’s fx?
- Examination reveals loss of prominence of 5th knuckle w/ tenderness
- Inspect for puncture wound over MCP joint
A. If fx caused by punch to mouth, need to prescribe abx
What is the tx for fx with >30degree angulation?
Frxs with >30deg angulation should be reduced and placed in ulnar gutter cast for minimum 4 weeks
Define Colles’ Fx
1. Distal radial fx w/ dorsal angulation A. Most common wrist injury B. Mechanism of injury forced wrist dorsiflexion C. Described as “silver fork” deformity
How is a Colles’ fx managed?
Cast immobilization after reduction(if needed) 10-12 wks
What is a Smith’s fx?
Fall on a flexed wrist
Reverse Colles’ fx: much less common
Compare Smith’s and Colles’ Fx
- Smith’s fx: Distal radial fracture. Volar displacement of the distal fragment
- Colles’ fx: Distal radial fracture. Dorsal displacement of the distal fragment; MORE COMMON
What imaging do you want for a Colles’ fx?
AP, Lateral, +/- oblique
Define gamekeeper’s thumb
- Sprain or tear of ulnar collateral ligament (UCL) of thumb
A. Usually hx of sprained thumb or fall on hand
B. Skiers injury
What are the sxs of a gamekeeper’s thumb?
- Examination reveals ligamentous laxity of ulnar collateral ligament
- Instability & weakness of pinch
What is the tx for a skier’s/gamekeeper’s thumb?
- Refer to Hand Surgeon -> Surgical repair indicated for complete rupture
- Partial rupture -> immobilization w/ thumb spica cast
What is the most commonly fx carpal bone?
Scaphoid bone
What imaging is used for a gamekeeper’s thumb?
MRI to determine if ligament is entirely ruptured
Why is detection of a scaphoid fx critical?
- Blood supply is from Radial artery
- Proximal pole of scaphoid has poor blood supply that is further compromised w/ fxs thru bone can lead to avascular necrosis (AVN) of scaphoid
What are the sxs of a scaphoid fx?
- Pain over anatomic snuffbox
- Swelling & eccymosis radial wrist
- Often confused w/ wrist sprain
A. Scaphoid fx may not show initially on x-ray*
What imaging is used for a suspected scaphoid fx?
- AP , Lat and Scaphoid views
- If neg. initially, repeat films in 10 days - 2 wks
- MRI can be used to avoid delay in diagnosis
- Bone scan: often ordered by orthopedist
What tendons are involved in the anatomic snuffbox?
- Extensor pollicis longus
- Extensor pollicis brevis
- Abductor pollicis longus
What is the treatment for scaphoid fx?
- Treatment- Always Refer to Ortho
A. Long arm thumb spica cast x 2 weeks -> short arm thumb spica cast
B. Displacement of >1 mm requires ORIF - Bone stimulation unit in extreme cases
What are the complications of scaphoid fx?
- Non-union of fracture
- Avascular necrosis (AVN)
A. chronic wrist pain, can lead to collapse of bone & wrist jt dysfunction
Define nursemaid’s elbow
- Most common in children < 5 yo
2. Subluxation of radial head caused by longitudinal traction; displacement of the annular ligament
What is the MOI of nursemaid’s elbow?
Forearm is pulled or jerked upward
What is the presentation of a child with nursemaid’s elbow?
Hold affected arm close to the body with the elbow slightly flexed or extended and the forearm pronated
