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18 ORR > Fractures UE > Flashcards

Fractures UE Flashcards

1
Q

mechanisms of injury

A
  • unloaded
  • tension
  • compression
  • bending
  • shear
  • torsion
  • combined loading
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2
Q

primary healing of fracture

A
  • end-to-end fracture contact
  • no callus formation
  • healing in the intramedullary canal (ENDOSTEAL)
  • visible on xray after months
  • secondary to rigid fixation
  • compression plating
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3
Q

secondary healing of fracture

A
  • no fracture compression
  • callus formation
  • healing is OUTSIDE intramedullary canal (PERIOSTEAL)
  • callus/bridging callus can be seen in xray after 2 weeks
  • micromotion present
  • casting, intramedullary nailing, neutralization plating
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4
Q

inflammation stage of fracture healing

A
  • day 1-14
  • blood vessels torn -> hematoma formation
  • activated platelets release products and cause influx of inflammatory cells
  • subperiosteal and endosteal cell proliferation
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5
Q

products released by activated platelets and cells of repait

A
  • fibronectin
  • pdgf
  • tgf-b
  • fibroblasts, endothelial cells, osteoblasts
  • macrophages and neutrophils
  • osteoprogenitor cells
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6
Q

repair stage of fracture healing

A
  • 2nd to 6th week

- initiation of healing through restoration of blood supply to unite fracture fragments

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7
Q

what is soft callus formation

A
  • osteoblasts form a bridge of woven bone over fracture site which provides support
  • formation of connective tissue and angiogenesis = FIRST RADIOGRAPHIC SIGN of reuniting bones
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8
Q

remodeling stage of fracture healing

A
  • consolidation
  • woven bone is replaced by compact lamellar bone
  • osteoclastic resorption + osteoblastic deposition
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9
Q

principles of fracture treatment

A
  • restore articulating surface (only 2 mm displacement allowed)
  • rigid fixation
  • allow early range of motion
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10
Q

shoulder trauma is composed of __

A

clavicle, scapula, proximal humerus

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11
Q

t/f muscle attachments allow motion and don’t cause deformity when fractured

A

false, when fractured, muscles act as deforming force resulting in displacement

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12
Q

parts of the shoulder joint

A
  • scapula: rotator cuff origin, fractured in high energy trauma
  • proximal humerus: rotator cuff insertion
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13
Q

common sites of fractures on shoulder

A
  • body of scapula
  • spine of scapula
  • glenoid
  • coracoid process
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14
Q

first bone to ossify at 5th fetal week, and last to fuse at 25 years

A

clavicle

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15
Q

displacement due to clavicle in fractures

A

medial end is pulled inferiorly, lateral end is puller superiorly

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16
Q

t/f the longer the lever arm, the easier it is to perform range of motion

A

true, shortening = dec function because of dec in length of lever arm (more effort needed for elevation)

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17
Q

critical length for lever arm

A

2-2.5 cm

18
Q

clavicular third fractures

A
  • middle!!: allowable displacement of 2 cm shortening
  • lateral: depending on location of fracture to coracoclavicular ligament
  • medial: least common, only posterior displacement needs emergency surgery
19
Q

absolute indications for fracture fixation

A
  • open fractures
  • skin tearing
  • vascular injuries
20
Q

relative indications for fracture fixation

A
  • shortening more than 2 cm

- delayed union leading to nun-union within 3 mos

21
Q

types of lateral third fractures

A
  • type 1 and 3 are non-surgical
  • type 2 is surgical
  • fracture that displaces medial fragment superiorly = coracoclavicular ligament is torn
  • coracoclavicular ligament= main stabilizer against vertical displacement
22
Q

treament for clavicle fracture

A
  • restores length/position to permit healing and maintain lever arm position
  • internal fixation using intramedullary nail
  • plates and screws
23
Q

deformations from proximal humerus

A
  • subscapularis = internal rotation
  • infraspinatus and teres major = external rotation
  • supraspinatus = abduction of shoulder
24
Q

majority of rotator cuff muscle insertions are in __

A

greater tuberosity of proximal humerus

25
Q

key issues in treatment of proximal humeral fractures

A
  • viability of fragments (4 part fx = vascular necrosis)
  • quality of bone
  • degree of displacement (1 cm allowable)
  • surgical skill, medical center support, post-op compliance
26
Q

types of proximal humerus treatments

A
  • open reduction internal fixation

- joint replacement

27
Q

t/f humeral shaft fractures can almost always be treated non-surgically

A

true !! read

28
Q

bony anatomy of elbow

A
  • humerus
  • ulna = flexion-extension
  • radius: pronation-supination
  • arc of motion is uniplanar (hinge joint)
29
Q

common fracturs in the distal humerus

A
  • supracondylar
  • unicondylar lateral condyle
  • intercondylar
30
Q

t/f only supracondylar fractures are common in children

A

false, both supracondylar and lateral condylar are common in children

31
Q

what are supracondylar fractures

A
  • due to: thin cortices of distal humerus OR ligamental laxity
  • tx: closed reduction and pinning
  • cubitus varus deformity
32
Q

what are lateral condylar fractures

A
  • physeal fracture (growth plate injury)
  • prone to displacement due to attachment of common extensors
  • tx: open reduction, internal fixation, with pins
  • deformity: cubitus valgus with tardy ulnar nerve palsy
33
Q

clinical value of radial head

A
  • pronation and supination

- 2nd stabilizer of elbow

34
Q

what are radial head fractures

A
    • fall on outstretched upper extremity with valgus force to elbow
  • tx: save or replace radial head
35
Q

what are coronoid fractures

A
  • lose the power of elbow flexion
  • stabilizes against posterior dislocation
  • occur due to posterior elbow dislocations
36
Q

regan morrey classification of coronoid fractures

A
  • type 1: avulsion/shearing
  • type 2: <50%
  • type 3: >50% (needs fixation)
37
Q

what are olecranon fractuers

A
  • stabilizes against anterior dislocation
  • fractured by avulsion or direct fractures
  • tx: tension band wiring or plating
38
Q

t/f adult forearm fractures are almost always indicated for surgery

A

true, conservative treatment allowed for children

39
Q

deforming forces in the forearm

A
  • supinator
  • pronator teres
  • pronator quadratus
40
Q

what is monteggia fracture

A
  • fracture of ulna with radial head dislocation

- tx: open reduction and plating

41
Q

what is galeazzi fracture

A
  • fracture of radius with ulnar head dislocation

- tx: open reduction and plating

18 ORR (21 decks)

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