Fractures Flashcards
Salter Harris fracture type I and its management
“Straight across”
mechanism + tenderness + normal XR
Immobilization
Salter Harris fracture type II and its management
“Above”
Most common fracture type. across physis.
Immobilization
Salter Harris fracture type III and its management
“Lower”
Older children, surgical eval for ORIF
Salter Harris fracture type IV and its management
“Through”
Arrests growth, surgical treatment with ORIF
Salter Harris fracture type V
“ERasure of growth plate”
Crush injury at physis.
Arrests growth, casting or surgery, refer
If a child had an elbow injury and cannot extend elbow fully, what are the changes of elbow fracture
100% chance of fracture
What is nursemaids elbow and how do you treat?
- 2-3 yo most common
- traction injury
- elbow held in extension and pronation, or at side
- Treat with hyperpronation or supination+flexion
When should you refer a clavicular fracture to surgery?
- presence of skin tenting
- neurovascular compromise
- significant displacement
- overriding fragments by > 2 cm
What fracture commonly results from FOOSH injury? What nerve should be tested in this case to ensure it is intact?
- distal radial fracture or scaphoid fracture
- confirm median nerve function via thenar sensation and OK sign
You have a patient who has FOOSH injury, has wrist tenderness, but normal XR? What is your management?
- scaphoid fracture may have occurred
- trauma + tenderness + normal XR = splint and repeat XR in 2 weeks
What is boxers fracture? What is the management?
- fracture of neck of 4th or 5th metacarpal
- radiographs to eval for angulation/shortening of metacarpals
- PE to eval for rotational abnormality
- place in ulnar gutter or volar splint
- short arm cast with 4th/5th digit spica
What is jersey finger and what is management?
- avulsion of flexor digitorum profundus from distal phalanx, ring finger most common
- palmar digit swelling or pain with ecchymosis
- cannot actively flex distal phalanx
Surgical correction within 10-12 days
What is boutonniere deformity
- central slip injury to PIP
- appears bent at PIP
- manage with splinting PIP in extension for 6 weeks followed by night splinting for 4-6 weeks
What is mallet finger?
- forced flexion of an extended DIP results avulsion of extensor digitorum tendon
- appears flexed at DIP
- splint DIP joint in full extension continuously for 8 weeks
Management in patient with vertebral compression fracture
- early mobilization to maintain strength and function
- analgesia
- obtain DXA to eval for osteoporosis
- may refer for kyphoplasty or vertebroplasty if unable to control pain with these measures
