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Phys: Bone & Gen Med: Ortho > Fractures 2 > Flashcards

Fractures 2 Flashcards

1
Q

What are the hand fxs?

A
  1. Boxer’s Fracture
  2. Colles’ Fracture
  3. Smith Fracture
  4. Gamekeeper’s Thumb
  5. Scaphoid Fracture
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2
Q

Define boxer’s fx?

A

Fx of metacarpal neck of 5th finger

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3
Q

what is the moi for a boxer’s fx?

A

direct blow

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4
Q

What are the sxs of a boxer’s fx?

A
  1. Examination reveals loss of prominence of 5th knuckle w/ tenderness
  2. Inspect for puncture wound over MCP joint
    A. If fx caused by punch to mouth, need to prescribe abx
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5
Q

What is the tx for fx with >30degree angulation?

A

Frxs with >30deg angulation should be reduced and placed in ulnar gutter cast for minimum 4 weeks

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6
Q

Define Colles’ Fx

A 
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
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7
Q

How is a Colles’ fx managed?

A

Cast immobilization after reduction(if needed) 10-12 wks

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8
Q

What is a Smith’s fx?

A

Fall on a flexed wrist

Reverse Colles’ fx: much less common

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9
Q

Compare Smith’s and Colles’ Fx

A
  1. Smith’s fx: Distal radial fracture. Volar displacement of the distal fragment
  2. Colles’ fx: Distal radial fracture. Dorsal displacement of the distal fragment; MORE COMMON
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10
Q

What imaging do you want for a Colles’ fx?

A

AP, Lateral, +/- oblique

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11
Q

Define gamekeeper’s thumb

A
  1. Sprain or tear of ulnar collateral ligament (UCL) of thumb
    A. Usually hx of sprained thumb or fall on hand
    B. Skiers injury
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12
Q

What are the sxs of a gamekeeper’s thumb?

A
  1. Examination reveals ligamentous laxity of ulnar collateral ligament
  2. Instability & weakness of pinch
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13
Q

What is the tx for a skier’s/gamekeeper’s thumb?

A
  1. Refer to Hand Surgeon -> Surgical repair indicated for complete rupture
  2. Partial rupture -> immobilization w/ thumb spica cast
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14
Q

What is the most commonly fx carpal bone?

A

Scaphoid bone

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15
Q

What imaging is used for a gamekeeper’s thumb?

A

MRI to determine if ligament is entirely ruptured

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16
Q

Why is detection of a scaphoid fx critical?

A
  1. Blood supply is from Radial artery
  2. Proximal pole of scaphoid has poor blood supply that is further compromised w/ fxs thru bone  can lead to avascular necrosis (AVN) of scaphoid
17
Q

What are the sxs of a scaphoid fx?

A
  1. Pain over anatomic snuffbox
  2. Swelling & eccymosis radial wrist
  3. Often confused w/ wrist sprain
    A. Scaphoid fx may not show initially on x-ray*
18
Q

What imaging is used for a suspected scaphoid fx?

A
  1. AP , Lat and Scaphoid views
  2. If neg. initially, repeat films in 10 days - 2 wks
  3. MRI can be used to avoid delay in diagnosis
  4. Bone scan: often ordered by orthopedist
19
Q

What tendons are involved in the anatomic snuffbox?

A
  1. Extensor pollicis longus
  2. Extensor pollicis brevis
  3. Abductor pollicis longus
20
Q

What is the treatment for scaphoid fx?

A
  1. 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
  2. Bone stimulation unit in extreme cases
21
Q

What are the complications of scaphoid fx?

A
  1. Non-union of fracture
  2. Avascular necrosis (AVN)
    A. chronic wrist pain, can lead to collapse of bone & wrist jt dysfunction
22
Q

Define nursemaid’s elbow

A
  1. Most common in children < 5 yo

2. Subluxation of radial head caused by longitudinal traction; displacement of the annular ligament

23
Q

What is the MOI of nursemaid’s elbow?

A

Forearm is pulled or jerked upward

24
Q

What is the presentation of a child with nursemaid’s elbow?

A

Hold affected arm close to the body with the elbow slightly flexed or extended and the forearm pronated

25
Q

What imaging is used for nursemaid;s elbow?

A

AP & Lateral films done to r/o fracture, especially if hx of fall

26
Q

How is nursemaid’s elbow reduced?

A
  1. Reduce subluxation
    A. Hold affected arm just above wrist and just below elbow
    B. Practitioner places their thumb over radial head while fully supinating forearm & applying posteriorly directed pressure
    -Radial head slides back into place
27
Q

What is ganglion cyst?

A
  1. Ganglion cystic structure -> synovial sheath or joint cavity
  2. Viscous, gel-like fluid
28
Q

What is the pathophys of a ganglionic cyst?

A

Arises from herniation of synovial tissue from a joint capsule or tendon sheath

29
Q

What are the sxs of a ganglionic cyst?

A
  1. Dorsal or volar radial aspect of wrist, +/–
    pain (mostly unsightly reasons)
  2. Wrist swelling/lump
  3. +/- aching worse w/ extreme flex/ext.
  4. Transillumination
    A. Differentiates cystic lesion from solid tumor
30
Q

What is the treatment of a ganglionic cyst?

A 
1. May spontaneously regress / recur
A. Reassurance to patient
2. If cyst painful:
A. Aspiration & cortisone injection (Recurrence is rate high)
B. Surgical excision of cyst
  (Recurrence rate 5-10%)
31
Q

What is a mallet finger?

A

Injury to DIP extensor, so finger is stuck in flexion

32
Q

How is a mallet finger treated?

A

Stack splint 24/7 for 6-8 wks

33
Q

What is a dupuytren’s Contracture?

A

Fibrosis of flexor tendon in volar aspect of hand

34
Q

What are the risk factors for Dupuytren’s fx?

A
  1. Etoh
  2. DM
  3. Smoking
  4. M>F
  5. > 40 yo
35
Q

What is the tx for dupuytren’s contracture?

A
  1. No cure
  2. Finger splints not indicated
  3. Refer to Hand Specialist
    A. +/- cortisone inj for painful nodules
    B. Xiaflex injection(indicated for dupuytren’s w/cord)
36
Q

What is stage 1 D contracture?

A

small lump in the plam of the hand, usually just under the digit on the palmar crease

37
Q

What is stage 2 D contracture?

A

The cord is present as the disease spreads uo the fascia and into the fingers

38
Q

What is stage 3 D contracture?

A

Fingers begin to bend inward as the disease spreads up the fingers and creates a tight cord. Unable to straighten

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

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