Fx 2 Shea Flashcards
2 MOI of Radial Head Fx and which is MC?
- FOOSH w/ partially flexed elbow (MC) (radial head is jammed into humerus)
- Posterior elbow dislocation
Which fx?
- Swelling over lateral elbow
- Limited ROM (esp extension and supination)
Radial Head Fx
What Classification is used for Radial Head Fx?
Mason
Radial Head Fx - Mason Classification
Type 1
Type 2
Type 3
- 1: Single fx, no displacement
- 2: displacement
- 3: comminuted (multiple fxs)
What 3 x-ray views should be obtained for Radial Head Fx?
- AP
- Lateral
- Oblique (type 1 may be occult/hidden on initial x-ray), so look for fat pads
Radial Head Fx
Nonsurg tx Type 1
- Splint or Sling for __ to ___ days w/use of sling for comfort there after
- Early ROM is important (esp ____ and ____)
- 5 to 7 days
- Supination and Extension of elbow
- Most painful is (supination/extension)
- Most comf is 90 degree and pronation
Radial Head Fx
Non-surg Type 2
-
Minimal displacement,
- splint for __ to ___ days w/ use of sling for comfort
- ______ ROM following D/C splint
-
Moderate displacement,
- ORIF (open reduction internal fixation)
Radial Head Fx
Surgical for Type 3
Radial Head Replacement
W/ Forearm Fxs, what creates the “stable ring?”
- Proximal radioulnar joint
- Distal radioulnar joint
What classifies a forearm fx as “unstable” and how are they all managed?
- Disruption in more than 1 component of ring –> unstable rx, (high likelyhood will shift)
- Surgically.
Forearm Fx
- Fx of both bones w/o disruption of radioulnar joints
Unstable Fx
Forearm Fx
- Fx of single bone, w/ disruption of ONE radioulnar joint
Unstable fx
2 MOI of Forearm Fx
-
High Impact (MC)
- MVA
- Fall from ladder/height
- Direct blow
- What is a stable forearm fx called which involves mid to distal ulnar shaft fx?
- How is it tx?
“Nightstick Fx”
- policeman holding night stick/baton
- Individual who did something bad, police hit person w/ baton, so pt holds up forearm and baton strikes the ulna which gets fractured.
(tx non-surg bc/ stable)
Unstable Forearm Fractures
- Radial shaft fx
- Ulnar shaft fx
Both Bone forearm fx
Unstable Forearm Fractures
- Mid to proximal ulnar shaft fx
- Associated radial head dislocation
Monteggia fx
(MUR)
Monteggia / Ulnar / Radial Head
Unstable Forearm Fractures
- Mid to distal radial shaft fx
- Associated carpoulnar dislocation
Galeazzi Fx
(GRC)
Gal / Radial / Carpo
How are unstable forearm fx managed?
Surgical
Which fx?
-
MOI: FOOSH w/ wrist in extension (MC) –> Colle’s Fx
- Postmenopausal women 60-70%
- FOOSH w/ wrist in flexion –> Smith’s fx
- Direct Trauma
Distal Radial Fx
“Every Cat wants Dinner and Finds Someone in the Garden”
Distal radial Fx
Extension = Colle’s = dinner fork
Flexion = Smith’s = garden
Which fx?
- Dinner fork deformity (colle’s)
- Garden spade deformity (smith’s)
- Localized swelling
- Potential ___ nerve injury
- Significant ROM limitation
Distal Radial Fx
What x-ray views for Distal Radial Fxs
- AP
- Lateral
- Oblique
Distal Radial Fx
Non-surg
- Non-displaced –>
- Displaced –>
- Non: Short arm cast
- Dis: Long arm cast
Indication for surgery in Distal Radial Fx
- Intra-articular extension
- Severe comminution
- Inability to maintain reduction
Which fx?
- Radial torus “buckle” fx
- MC in children <___ yrs
- Distal metaphysis
- Buckling of cortex due to compression fx
Pediatric Distal Radial Fx
- MOI of Buckle/torus/distal radial fx
- Deformity?
- Amt swelling?
- FOOSH
- None visible
- Mild to mod
Cast tx for TOrus / buckle fx / distal radial fx?
Short arm for 4-6 wks
Is greenstick or torus more common?
Torus
Which fx?
- Complete fx of tension side w/ buckling of compression side
- MOI: FOOSH
Greenstick Fx
Greenstick fx
- Swelling?
- Deformity?
- Mod to sig swelling
- +/- visible deformity
Cast tx for Radial Greenstick Fx?
- short arm for 6-8 wks
- (rarely surgery)
Which fx?
- Most common carpal bone fx
- FOOSH
- Snuffbox pain / TTP
- ROM limitations
- Commonly occult on x-ray
Scaphoid fx
Scaphoid fx can cause limited blood supply which leads to high incidence of what 2 things?
- Nonunion
- Osteonecrosis
4 x-ray views of Scaphoid fx
- PA
- PA w/ ulnar deviation
- Lateral
- Semi-pronated oblique
Tx for scaphoid fx? (3)
- Long-arm thumb spica cast for 6-12 wks
- If clinical exam is indicative of fx, but x-rays are negative –> splint and repeat x-rays in 10-14 days
- If FU x-ray negative, but clinical concern persists, get MRI.
Fx of Metacarpals/Phalanges
- Displaced ___ and ____ fxs tend to angulate
- ____ fxs tend to rotate
- Transverse and Oblique
- Spiral
a : Transverse shaft fracture
b : Oblique shaft fracture
c : Spiral shaft fracture
d : Metacarpal base fracture
e : Metacarpal head fracture
f : Comminuted fracture
What is shown? Which type of fx?
Malrotation
Scaphoid
- What is the MC fx of the hand
- MOI?
- possibly malrotation deformity
- possibly dropped knuckle deformity
- 5th metacarpal fx (boxer’s fx)
- Distal metaphysis of 5th metacarpal
- Closed fist striking an object
Tx for 5th metacarpal fx (boxers)
Nonsurg:
- <15 degree angulation
- transverse/oblique/base/head fxs
- Ulnar gutter splint
Which fx?
- Traumatic injury to tip of fully extended finger –> avulsion of extensor tendon at base of distal phalynx
- Tender rupture/Tendon laceration
- Visible deformity
- Inability to ____ the affected ___ joint
Extensor Tendon Avulsion Fx (mallet finger)
- extend
- DIP
non-surg Tx for mallet/ extensor tendon avulsion fx
- Continuous splint 6-8 wks
- (if extension is lost at all, healing is disrupted and the 6-8 week clock starts over again)
3 indications for surg tx or extensor tendon avulson/mallet
- conservative care fails
- Complete tendon lac
- Fx involving >30% of articular surface
Which fx?
- Traumatic forced extension of actively flexed finger –> avulsion of flexor tendon at base of distal phalynx
- Which finger?
- Deformity?
Flexor Tendon Avulsion Fx (Jersey finger)
4th (ring) is MC
inability to flex affected DIP
Tx for Flexor TEndon avulsion fx / jersey finger?
Early surgical repair in ALL cases
Splint in presenting position and then hand surgeon referral
Best recovery if repaired within 7-10 days of injury
Which fx?
- MOI: direct blow from door/hammer
- Subungual hematomas (be cautious)
Distal Phalanx Fx
Tx for Distal Phalanx Fx
- Mostly non-surg
- Surg: angulated >15 degrees / >2mm displacement / non-union
