Fractures and dislocations Flashcards
What is used as the midline in the hand when describing movements?
middle finger
How is angulation described in regards to bone fractures?
Direction of the apex (tip of triangle formed pointing toward or away from midline)
Medial angulation can be termed ‘varus’, and lateral angulation can be termed ‘valgus’.
How is displacement described in regards to bone fractures?
Relative to midline (toward or away)
What is the “correct” terminology for naming fingers in regard to orthopedic language?
Name the common name of the digit–not the number (?)
How do you correctly state direction in the forearm?
Whether it’s radial or ulnar displaced
What is the key history bit that is needed when seeing an arm/hand injury?
Dominant hand?
What are the four key things that should be checked if there is an extremity injury?
Circulation
Motion
Sensation
Look at joints above and below
What is the epiphysis?
End of a long bone
What is the diaphysis?
Shaft of a long bone
How are trabeculations arranged in long bones?
Along the lines of stress
Which is stronger: a solid or tubular bone?
Tubular
Where does the blood supply come through the bone?
Through the periosteum
What is the technical term for the growth plate?
Physis or epiphyseal plate
What is a type 1 fracture in children?
Runs along the metaphyseal plate
http://radiopaedia.org/articles/salter-harris-fractures
What is a type 2 fracture in children?
Runs along the metaphyseal plate, but then exits before it is completely transected, and heads away from the epiphysis
What is a type 3 fracture in children?
Fracture that begins in the metaphyseal plate, but then immediately exits toward the epiphysis
What is a type 4 fracture in children?
Fracture that transects the metaphysis
What is a type 5 fracture in children?
Crushing injury to the metaphysis, stopping bone growth
What is the blood supply to bones? venous drainage?
Periosteal arteries and epiphyseal veins
True or false: the periosteum is richly innervated
True
How are calluses oriented to the bone fracture?
Follows periosteum
What is the role of the synovial fluid in joint space fractures?
may prevent healing
True or false: cartilaginous lining heals poorly
True
What is a major issue with join space fractures?
Causes misalignment, that may produce issues with weight bearing
What are the two most commonly dislocated joints?
Shoulder and fingers
What three joints that are devastating if dislocated?
Knee
Elbow
Hip
What is the function of the scapula, per Benzoni?
Protect the thorax
What is the treatment for a fractured scapula?
Sling–muscles stabilize the area well
Which is more common: anterior or posterior dislocation of the shoulder?
Anterior
How do shoulder dislocation usually occur?
Force applied to an upraised arm
What is the nerve that may be injured with a shoulder dislocation?
Axillary
Where is the axillary nerve commonly injured?
Surgical neck of the humerus or anterior dislocation
What is the presentation of an axillary nerve injury? (muscle findings, sensation deficits)
- Flattened deltoid
- Loss of arm abduction
- Loss of sensation over deltoid and lateral arm
What are the spinal levels of the axillary nerve?
C5-C6
What are the spinal levels of the musculocutaneous nerve?
C5-C7
What are the findings of a musculocutaneous nerve injury?
- Loss of forearm flexion and supination
- Loss of of sensation over the lateral forearm
Draw the brachial plexus.
https://www.youtube.com/watch?v=gTas7ijp0YE&index=2&list=WL
How is the arm held with a posterior shoulder dislocation?
Forced internal rotation
When should posterior shoulder dislocations always be checked for?
Post sz
What is a major consequence of an inferior shoulder dislocation?
Brachial plexus injury
How is an arm held with a posterior shoulder dislocation?
Luxatio erecta–arm held away from their side
How, generally, do inferior shoulder dislocations occur?
Force applied downward
What is the most common mechanism of shoulder fractures?
Falling on an outstretched arm
What is the most common type of shoulder fracture?
Surgical neck fracture
What is the treatment for shoulder fractures?
Sling with early mobilization
When are shoulder replacements not needed?
If articular surface is intact
What is the mechanism that causes a spiral fracture?
Twisting of the arm (or leg)
Where does the radial nerve run in the proximal arm?
Encircles the humerus from internal to external (counterclockwise)
Wrist drop indicates what nerve is damaged?
radial
What area of the distal humerus is usually injured when FOOSH happens?
humeral condyles
What nerves run in the antecubital region from lateral to medial?
Radial
Median
What nerve runs just posterior to the medial epicondyle of the humerus?
Ulnar
What is the treatment for a distal humeral fracture?
Stabilize with padded posterior splint, and sling
surgery
What is the usual mechanism for elbow dislocation?
FOOSH!
Why do the radius and ulna usually disarticulate together?
Interosseous membrane holds them together
What is the treatment for an elbow dislocation?
- Reduce immediately
- Tight elbow flexion and sling
What is the correct order for reducing a dislocated elbow: axially then posterior, or posteriorly then axially?
posteriorly, and then axillary
What is characteristic about the physical exam with elbow fractures?
Severe pain with RROM
What is the treatment for an elbow fracture?
Padded posterior splint and sling, with a referral to surgeon
What is the “sail sign” associated with elbow fractures?
Fat pad that appears on the posterior aspect of the elbow with fractures
What is a Nursemaid’s elbow?
Pulling the proximal radius through the annular ligament
What is the typical presentation of a nursemaid’s elbow?
Kid refusing to move the arm, with forearm internally rotated, and a 120 degree angulation of the elbow
What is the treatment for a nursemaid’s elbow?
Reduce immediately
What is a pilon fracture?
a type of break that occurs at the bottom of the tibia and involves the weight-bearing surface of the ankle joint. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. A pilon fracture typically occurs as the result of a high-energy event, such as a car collision or fall from height.
What type of load produces a pilon fracture?
Axial load
What type of load produces a transverse fx?
transverse load
