Fractures and joint injuries in adults Flashcards
clavicle fracture
classified into proximal, middle, and lateral third fractures
most are middle third (80%)
most treated with a sling
proximal humerus fracture
violent trauma in younger pts
minor trauma in older patients
most fractures minimally displaced
proximal humerus fracture treatment
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.
humerus shaft fracture
classified based on location of fracture (prox, mid, distal)
watch for radial nerve palsy
humeral shaft fracture treatment
almost all humerus shaft fracture can be tx non surgically
Monteggia-
means proximal or middle third ulna shaft fracture with dislocation of radius proximally (at elbow)
Tx- ORIF ulna and close reduction of radial head
Galeazzi-
means distal third shaft radius fracture with disruption of distal radio ulnar jt
Tx-ORIF radius and close reduction of DRUJ
Distal radius fracture (wrist)
most common fracture of UE
Most frequent in older women
Distal radius fracture classification
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
Distal radius fracture Tx
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.
Scaphoid fracture
FOOSH
described by the location within bone- mid, proximal, distal
classified according to severity of displacement- non displaced and displaced
Scaphoid fx sy/sx
pain and swelling in anatomic snuffbox and on the thumb side of the wrist
Scaphoid fx treatment
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)
Hip fracture
most common fracture of the lower extremity
assoc with OA >60 yo
high energy mechanism in younger adults
hip fracture classification
intra capsular- subcapital and transcervical
extrac capsular- basic cervical and intertrochanteric and subtrochanteric
hip fx treatment
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)
hip fracture complications
nonunion- 30% displaced neck fractures
AVN (fem neck frac)- 30% diplaced
Death
Venous thrombo embolim
Femur shaft fracture
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
Ankle fractures
low energy (torsional) malleoli fractures
Lateral Malleoli weber classifications
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).
tibial shaft fracture
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
tibial shaft fracture tx
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.
