Fractures and joint injuries in adults

Question 1

clavicle fracture

Answer 1

classified into proximal, middle, and lateral third fractures

most are middle third (80%)

most treated with a sling

Question 2

proximal humerus fracture

Answer 2

violent trauma in younger pts

minor trauma in older patients

most fractures minimally displaced

Question 3

proximal humerus fracture treatment

Answer 3

fracture is not displaced: tx with sling and NWB of UE for 6-8 weeks, early ROM after 2-4 weeks, normal function

fracture displaced: surgery indicated, internal fixation, shoulder hemi-arthroplasty where only head replaced.

Question 4

humerus shaft fracture

Answer 4

classified based on location of fracture (prox, mid, distal)

watch for radial nerve palsy

Question 5

humeral shaft fracture treatment

Answer 5

almost all humerus shaft fracture can be tx non surgically

Question 6

Monteggia-

Answer 6

means proximal or middle third ulna shaft fracture with dislocation of radius proximally (at elbow)

Tx- ORIF ulna and close reduction of radial head

Question 7

Galeazzi-

Answer 7

means distal third shaft radius fracture with disruption of distal radio ulnar jt

Tx-ORIF radius and close reduction of DRUJ

Question 8

Distal radius fracture (wrist)

Answer 8

most common fracture of UE

Most frequent in older women

Question 9

Distal radius fracture classification

Answer 9

extra-articular:
colles fracture-dorsal angulation, shortening, and radial deviation.
smiths fracture- shortening and volar angulation (reverse colles).

intra articular: bartons fracture-volar or dorsal

Question 10

Distal radius fracture Tx

Answer 10

extra articular: close reduction and cast, immob for 6-8 wks, ROM exercises after cast, surgery if reduction is not accepted.

Intra articular- a step more than 2 mm is an indication for surgery. ORIF with plate and screws.

Question 11

Scaphoid fracture

Answer 11

FOOSH

described by the location within bone- mid, proximal, distal

classified according to severity of displacement- non displaced and displaced

Question 12

Scaphoid fx sy/sx

Answer 12

pain and swelling in anatomic snuffbox and on the thumb side of the wrist

Question 13

Scaphoid fx treatment

Answer 13

non surgical- fx near the thumb (distal) may recover within 2-4 weeks. X ray follow up recommended.

Surgical- if blood supply limited (avascular necrosis)

Question 14

Hip fracture

Answer 14

most common fracture of the lower extremity

assoc with OA >60 yo

high energy mechanism in younger adults

Question 15

hip fracture classification

Answer 15

intra capsular- subcapital and transcervical

extrac capsular- basic cervical and intertrochanteric and subtrochanteric

Question 16

hip fx treatment

Answer 16

no close reduction-everyone has surgery

no traction is needed

patient needs surgery within 48 hrs

goal is to ambulate patient as soon as possible

eval osteoporosis

if fx intracapsular: displaced (hemiarthroplasty) and non displaced (percutaneous in situ screws fixation

if fx extracapsular: stable (close reduction) and unstable (intra medullary device)

Question 17

hip fracture complications

Answer 17

nonunion- 30% displaced neck fractures

AVN (fem neck frac)- 30% diplaced

Death

Venous thrombo embolim

Question 18

Femur shaft fracture

Answer 18

high energy mechanism in young pts most common

low energy torsional in old patients less common

need R/O pathological fracture in young + low energy mechanisms

Question 19

Ankle fractures

Answer 19

low energy (torsional) malleoli fractures

Question 20

Lateral Malleoli weber classifications

Answer 20

A: both lower malleoli involved. Splint + NWB 6 wks and early ROM

B: ORIF and need stress xrays.

C: fibula broken more than ankle. ORIF and stress xrays.

If both malleoli broken need ORIF (ankle unstable).

Question 21

tibial shaft fracture

Answer 21

carries high risk of compartment syndrome-no space for inflammation

its a subcutaneous bone (high susp of skin injury)

most common large long bone fracture

classified-prox, middle, or distal third. Displaced vs non displaced

Question 22

tibial shaft fracture tx

Answer 22

non surgical- no displacement < 10 deg angulation. <1cm shortening. not comminuted. close reduction and cast immobilization.

surgical tx- displacement, open fracture, compartment syndrome, floating knee, most commonly IM nail fixation.

Need to keep chacking pressure of cast. Ask pt.

Nail keeps bone together.