Fractures

Question 1

For which two fractures is a CT recommended?

Answer 1

• displaced intraarticular distal radial fracture -tibial plateau fracture

Question 2

Most common type of salter harris fracture

Answer 2

Type 2 - requires immobilization

Question 3

Describe supracondylar fracture in peds patients

Answer 3

near elbow foosh injury nerves affected - anterior interosseous and radial n must test - okay sign and wrist flexion anterior and posterior fat pad

Question 4

Describe Buckle / Torus fracture

Answer 4

distal radius foosh injury tx w/ reliable patients - wear splint for 3 weeks then gradually return to activity

Question 5

Describe nurse maids elbow

Answer 5

traction injury held arm in extension, pronation, or at side treat: hyperpronation to treat (better than supination and flexion)

Question 6

Distal radial fractures affect which nerve?

Answer 6

median nerve - okay sign and sensation to radial 3.5 digitis = same test as anterior interosseous n. can get CT to assess risk of avascular necrosis

Question 7

Function of ulnar nerve

Answer 7

claw hand sensory to 4th and 5th digit

Question 8

Function of ulnar nerve

Answer 8

wrist EXTENSION

Question 9

What is affect by boxers fracture? How to treat this?

Answer 9

Boxers fracture - 4th and 5th MCP can have shortening, angulation on XR - this determine if surgery is needed ulnar gutter or volar splint

Question 10

Describe jersey finger

Answer 10

avulsion of the flexor digitorum profundus tendon - often of 4th digit cannot actively flex the DIP joint may show bony fragment on XR surgical correction in 10-12 days

Question 11

Describe boutonniere deformity

Answer 11

injury to the PIP joint = jammed finger Splinting at PIP joint in extension for 6 weeks and nightly for 4-6 weeks Surgery if fails splinting

Question 12

Describe Mallet finger

Answer 12

forced flexion of DIP joint leads to avulsion of extensor digitorum tendon cant actively extend XR - rule out fracture splint DIP for 8 weeks

Question 13

Work up for vertebral compression fracture

Answer 13

early mobilization DXA scan with fall from standing

Question 14

facts about compression fracture

Answer 14

two thirds are not diagnosed 15% higher mortality rate - due to lung disease or CA common location T8-L1 and L4

Question 15

leg appearance for hip fracture

Answer 15

leg is shortened and externally rotated

Question 16

describe jones fracture

Answer 16

fracture of foot at metaphyseal - diaphyseal junction of the fifth metatarsal of the foot treat: 6 weeks of protected NWB and 6 week of unprotected WB

Question 17

which nerve does crutch palsy occur?

Answer 17

radial nerve (finger/wrist flexion or sensory to dorsum of hand) OR brachial plexus

Question 18

Ottawa ankle rules

Answer 18

malleolar pain OR navicular region or proximial 5th metatarsal AND inability to weight bear 4 steps at exam OR discrete bony tenderness at posterior malleoli or base of 5th metatarsal

Question 19

Most common places for stress fractures of leg

Answer 19

tibial then fibular

treat based on pain relief and healing

Tx: CAM walker or air stirrup splint

Question 20

Most common place for foot stress fracture

Answer 20

2nd and 3rd metatarsal

XR

activity modification and hard footwear