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Disciplines 3 Shea > Fx Shea > Flashcards

Fx Shea Flashcards

1
Q

2 Mechanisms of Injury for Clavicular fx and which is most common?

A
  • Direct fall on shoulder w/ arm at side (MC)
  • Direct blow
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2
Q

List the locations of clavicular fractures from most to least common (3 areas)

A
  1. Middle clavicle (75%)
  2. Distal 1/3 of clavicle
  3. Proximal/Medial 1/3 of clavicle
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3
Q

Why do most clavicle fx happen in middle?

A
  • Weakened
  • Downward pressure fall/blow
  • Sternocleidomastoid pulls superiorly ( so when broken the medial/proximal clavicle is pulled upward)
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4
Q

What 4 groups are at increased risk of clavicular fx?

A
  • Contact sports
  • Males <25-30
  • Males >55
  • Women >75
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5
Q
  • Is there usually displacement and deformity of clavicular fx?
  • What else is seen on clinical presentation?
A
  • Yes, deformity usually at midline
  • Pain and pain w/ palpation
  • Crepitus w/ active ROM
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6
Q

Which 2 vessels should you perform a neurovascular exam on if pt has a Clavicular Fx?

A
  • Subclavian vessels
  • Brachial plexus
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7
Q

What movements can a pt w/ clavicular fx perform and not perform?

A
  • Limited ROM and discomfort w/: shoulder abduction, adduction, and extension (moving shoulder girdle)
  • FROM of: internal/external rotation (not moving shoulder girdle)
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8
Q

What 2 x-rays should you get of clavicular fx?

A
  • AP view
  • 45 degree cephalic tilt (x-ray is below clavicle, important bc/ w/ normal AP you may not be able to identify the fx)
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9
Q

Non-operative tx for clavicular fx?

A
  • Is the “standard of care”
  • sling or figure 8 brace
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10
Q
  • Which tx of clavicular fx has less discomfort?
  • Which has better outcomes? (functional/cosmetic)
  • What do providers prefer to give?
A
  • Sling has less discomfort
  • Both have similar outcomes
  • Provider preference is 50/50
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11
Q

3 “definitive indications” for surgical management of clavicular fx?

A
  • Open fx (broken skin) bone could be contaminated/very displaced
  • Neurovascular injury (surgeon can visualize structures and possibly repair vasculature)
  • Tenting of skin –> can lead to open fx if untreated
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12
Q

What are 5 reasons for surgical intervention of clavicular fx?

A
  • Widely displaced >3cm?
  • Multiple fx segments
  • Displaced lateral 1/3 fx (takes forever to heal due to movement)
  • Dominant extremity in overhead athlete
  • Cosmetic concerns
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13
Q

What is the surgery called of repairing clavicular fx?

A

Open reduction internal fixation

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14
Q
  • What is this?
  • How do you treat and why?
A
  • Clavicular fx
  • Surgical tx w/ Open Reducation Internal Fixation bc/ it is located distal 1/3 and is displaced
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15
Q
  • What is the most common mechanism of injury of Proximal Humerus Fx?
  • What are 3 other MOI?
A
  • Fall out outstretched hand (MC)
  • Direct trauma
  • 75% occur in people over 60yrs w/ simple fall bc at increased risk for fall/decreased bone density
  • High energy trauma in younger pts (fall from roof / bunk bed)
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16
Q

Clinical presentation of Proximal Humerus Fx (5)

A
  • Swelling
  • Delayed Ecchymosis (24-48 hrs bc blood and this will move down arm due to gravity)
  • Significant pain
  • Guarding/cradling bad arm w/ good arm
  • Limited ROM (will not perform internal/external rotation = differentiates from clavicular who will do internal/external)
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17
Q

What is used to classify Proximal Humerus Fxs?

A

Neer Classification

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18
Q

What are the 4 components of the Neer Classification for Proximal Humerus Fx?

A
  • Greater tuberostiy
  • Lesser tuberosity
  • Anatomical neck
  • Surgical neck

(tube/tube/neck/neck)

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19
Q

Proximal Humerus Fx - Neer Classification

  • ANY fx pattern w/ less than 1cm of displacement
A

1 part Proximal Humerus Fx

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20
Q

Proximal Humerus Fx - Neer Classification

  • Neck OR Tuberosity
  • Displaced by 1cm or more
A

2 part Proximal Humerus Fx

21
Q

Proximal Humerus Fx - Neer Classification

  • Neck AND Tuberosity
  • Displaced by 1cm or more
A

3 part Proximal Humerus Fx

22
Q

Proximal Humerus Fx - Neer Classification

  • Neck + both tuberosities (3 things)
  • Displaced by 1cm or more
A

4 part Proximal Humerus Fx

23
Q

3 x-ray views to obtain for suspected Proximal Humerus Fx

A
  • AP view
  • Transcapular / Y view (differentiate fx from dislocation)
  • C axillary view (differentiate fx from dislocation)
24
Q

Which Proximal Humerus Fxs require:

  • non-surgical tx
  • surgical tx? (5 things)
A
  • Non-surg:
    • Neer 1
  • Surg: Open Reduction Internal Fixation
    • Neer 2, 3, 4
    • Neurovasc injury
    • Open fx
    • sig distortion of bicipital groove (rotational deformity)
    • Fx dislocation

*(50% managed surgically get a shoulder replacement instead of ORIF)

26
Q

3 MOI for Midshaft Humerus Fx

A
  • Direct blow
  • Bending force (fulcrum)
  • FOOSH (falling on outstretched hand) = pathologic fx
27
Q

Midshaft Humerus Fx in Peds pts MOI?

A

Suspect abuse

28
Q

2 unique Clinical Presentations of Midshaft Humerus Fx compared to Proximal

A
  • +/- visible shortening
  • Potential for neurovasc injury (radial nerve)
29
Q

Midshaft Humerus Fx - Neuro Screen

  • Radial Nerve
    • sensory
    • motor
A

Sensory: dorsum of hand

Motor: wrist dorsiflexion

30
Q

Midshaft Humerus Fx - Neuro Screen

  • Median Nerve
    • Sensory
    • Motor
A
  • Sensory: palmar aspect of thumb, index, middle fingers
  • Motor: thumb opposition
31
Q

Midshaft Humerus Fx - Neuro Screen

  • Ulnar Nerve
    • Sensory
    • Motor
A
  • Sensory: Palmar aspect of little finger
  • Motor: pinki abduction
32
Q

Midshaft Humerus Fx

  • Vascular Screen (2 major things)
A
  • Distal pulses
    • radial
    • ulnar
    • (these are easier to identify than brachial)
    • document as 2+ and equal bilaterally
  • Cap refill (brisk 2 seconds/eq bi)
33
Q

What are 2 x-ray views to get for Midshaft Humerus Fx?

A
  • AP
  • Lateral
34
Q

Explain why a Midshaft Humeral Fx can be pathologic?

A

If there is a bone cyst (unicameral) area of weakened bone w/ decreased calcium, if force is applied to bone that would otherwise not cause fx, this is pathologic.

35
Q

Non-surgical tx of Midshaft Humerus Fx

A
  • Functional Humerus Brace
  • Early shoulder ROM to reduce risk of adhesive capsulitis (frozen shoulder)
36
Q

Surgical tx for Midshaft Humerus Fx (5 criteria)

A
  • Neurovasc injury
  • Open fx
  • Pathologic Fx (bone cyst unicameral)
  • >3cm shortening
  • >30 degree angulation
37
Q

What should/should not be visible on x-ray of lateral elbow?

A
  • Should see anterior fat pad of elbow on lateral view
  • Should NOT see posterior fat pad (hidden fx)
38
Q

1/3 of the ____ lies in front of the anterior line of the _____. (on elbow lateral view)

A
  • capitellum
  • humerus
39
Q

Pediatric Ossification Centers of Elbow

A

CRITOE

13579 11

  • 1 yr Capitellum (will be marked on exam w/ star)
  • 3 yr Radial head
  • 5 yr Internal/Medial Epicondyle
  • 7 yr Trochlea
  • 9 yr Olecranon
  • 11 yr External/Lateral Epicondyle
40
Q

MOI of Supracondylar Fx (2)

A
  • Hyperextension injury w/ Falling On Outstretched Hand (MC) ==> extension type
  • Direct blow ==> extension or flexion type
41
Q

Which fx is common in Peds pts?

A

Supracondylar Fracture (falling off bike)

42
Q

Clinical Presentation/Complication of Supracondylar Fx?

A
  • Forearm Compartment Syndrome (Volkmann’s Ischemia/contracture)
    • marked swelling of forearm
    • Palpable tenseness
    • Pain w/ passive extension of fingers
43
Q

A supracondylar fx can mimic what?

A

Posterior Elbow Dislocation

44
Q
A

Volkman’s Ischemia / Contracture

(forearm compartment syndrome) from supracondylar fx

  • flexor muscles
  • shortening
  • also called “wolfman”
45
Q

What is the Classification for Supracondylar Fractures called?

A

Garland (judy garland riding a bike)

46
Q

What 2 x-ray views for Supracondylar Fx?

A
  • AP
  • Lateral
47
Q

Non-surgical Tx for Supracondylar fxs (2)

A
  • Type 1 Garland: no displacement, so just immobilize and cast later
  • Type 2 Garland: needs to be reduced
48
Q

Surgical tx for Supracondylar Fx (4)

A
  • Type 2 which was reduced, but is now not alligned again (failed reduction)
  • Type 3
  • Open fx
  • Neurovasc injury
49
Q
  • What is seen here?
  • What fx is it used for?
A
  • Percutaneous pinning
  • Supracondylar Fx

Disciplines 3 Shea (13 decks)

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