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Hippos > Hand and forearm/elbow fx > Flashcards

Hand and forearm/elbow fx Flashcards

1
Q

How do you describe finger dislocations (distal relative to proximal, or proximal relative to distal)?

A

Distal relative to proximal

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2
Q

What is the treatment for an unstable vs stable finger dislocation?

A 
Stable = buddy tape
Unstable = formal splinting
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3
Q

Volar PIP dislocations are concerning for what other injury? What, then, is the management for these?

A
  • Dosal slip injury

- Splint and close f/u with hand

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4
Q

What is the treatment for a tuft fx?

A
  • Since can be open under the nail bed, thorough cleaning and splint for comfort.
  • Abx probably not
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5
Q

How many degrees of angulation are acceptable for each metacarpal neck fx? (note cannot be midshaft or proximally)

A 
5th = 40 degrees
4th = 30 degrees
3rd = 20 degrees
2nd = 10 degrees
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6
Q

How do you determine the angle of a metacarpal neck fx?

A

Intersection of the lines through the metacarpal bone and the line through the fx part

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7
Q

What must always be assessed with metacarpal fractures? How?

A
  • Rotation

- have patient make fist and assess if fingers are at all rotated. Must splint in anatomic position

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8
Q

What is a Bennett’s/rolando fx?

A

Fx and dislocation of the base of the first metacarpal

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9
Q

What is a skier’s/gamekeeper’s thumb?

A

Hyperabduction injury of the ulnar collateral ligament of the thumb. Skier’s is acute, gamekeeper’s is chronic

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10
Q

What are the four Kanavel’s signs?

A
  • Fusiform digit
  • Pain with passive extension
  • Pain with palpation of over the flexor tendon
  • Finger is held in slight flexion
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11
Q

How do you incise a felon vertically or horizontally?

A

Vertically (proximal to distal)

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12
Q

What causes a mallet finger?

A

Hyperflexion injury, break at the extensor tendon

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13
Q

How do you splint a mallet finger?

A

In hyperextension

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14
Q

Can a person with a mallet finger take the splint off?

A

No–will have to start all over again, and it takes 8 weeks to heal due to poor blood supply to tendon

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15
Q

What are the tendons that are inflamed with de Quervain’s tenosynovitis?

A
  • Extensor pollicis brevis

- Abductor pollicis longus

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16
Q

What is a nightstick fx?

A

midshaft ulnar fx

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17
Q

A line drawn through the radius should always intersect with what part of the elbow?

A

Capitellum

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18
Q

What are the components of the FUME mnemonic for galeazzi or monteggia fractures?

A
  • Fx of
  • Ulna is called
  • Monteggia when at the
  • elbow joint
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19
Q

What is a Monteggia fx?

A

Fracture of the ulna at the elbow, with radial head dislocation

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20
Q

What is the Galeazzi fracture?

A

Fractures of the radius at the wrist with ulnar dislocation

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21
Q

What is an Essex-Lopresti fracture?

A

A fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint and disruption of the interosseous membrane.

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22
Q

What are the two radiographic signs of an elbow injury?

A
  • Anterior sail signs

- Posterior fat pad

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23
Q

True or false: a posterior fat pad on an elbow radiograph is always abnormal

A

True

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24
Q

What lines should pass through the capitellum on a lateral elbow radiograph?

A
  • Anterior humeral (should be at the middle third)

- Radial

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25
Q

What is the most likely fracture of an elbow in a child if there is/are anterior sail sign, posterior fat pad, but no obvious fracture? Adult? How do you splint these?

A
  • Child = Supracondylar fx, posterior splint

- Adult = radial head/neck, sling

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26
Q

With severe fractures, how should you splint them?

A

In the position they’re in, to avoid possible neurovascular injury. And call ortho.

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27
Q

True or false: the x-ray of a nursemaid’s elbow is typically normal

A

True

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28
Q

What is the treatment for a nursemaid’s elbow that you are unable to reduce (and are sure there is no occult fracture)?

A

Sling and attempt again tomorrow

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29
Q

What is the management for non-septic bursitis?

A

Compression dressing and NSAIDs

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30
Q

What are the indications for surgery for clavicle fractures?

A

-More than 2 cm displaced (from bone to bone)
-More than 2 cm shortened
-Skin tenting
-

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31
Q

What should you do to the skin for a tenting clavicle fx?

A

Sterilize it and place sterile dressing to prevent infx if does break through

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32
Q

What defines “distal” clavicle fractures?

A

Distal to the coracoid process

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33
Q

What is the treatment for a displaced vs nondisplaced clavicle fx? Why?

A
  • Nondisplaced = sling

- Displaced = Surgical due to torn coracoclavicular ligaments

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34
Q

How do AC joint injuries typically occur?

A

Falling directly onto a shoulder tip

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35
Q

What are types I-III AC joint separations?

A 
I = stretched
II= partial tear
III = complete tear (operative)
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36
Q

When are scapular fractures surgical?

A

If they involve the glenoid

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37
Q

What bones, if fractured, should you suspect other injuries? (4)

A
  • Scapula
  • First rib
  • Sternum
  • Chance fx
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38
Q

What is a Bankart lesion?

A

an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.

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39
Q

How do you determine if a lateral view of the shoulder is adequate?

A

If the body of the scapula is narrow

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40
Q

What is a Hill-sachs fracture?

A

a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.

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41
Q

What movement of the shoulder can patients with a posterior dislocation not do?

A

External rotation

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42
Q

What are the three Es that posterior shoulder dislocations are associated with?

A
  • EtOH
  • Epilepsy
  • Electricity
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43
Q

What is the “light bulb” sign associated with shoulder injuries?

A

Loss of the greater tuberosity of the shoulder on AP view with a posterior dislocation

44
Q

What is the primary movement of the each of the SITS muscles?

A
  • Supraspinatus = abduction
  • Infraspinatus = external rotation
  • Subscapularis = internal rotation
  • Teres Minor = Lateral rotation
45
Q

How far must a patient be able to abduct the shoulder in order to say the supraspinatus is intact?

A

Past 60 degrees

46
Q

What is the treatment for a complete rotator cuff tear?

A

MRI, and surgical referral

47
Q

What sign on x-ray may be seen with acute onset of adhesive capsulitis?

A

Calcification of the supraspinatus tendon-responds well to cortisone shots

48
Q

What causes thoracic outlet syndrome?

A

Compression of the neurovascular bundle beneath the 1st rib and clavicle

49
Q

What movement worsens s/sx of thoracic outlet syndrome?

A

Overhead activity

50
Q

What is the Adson’s test for thoracic outlet syndrome?

A
  • Hold shoulder in slight abduction and flexion, extend and rotate neck toward arm, and take a deep breath
  • If s/sx are reproduced or pulse lost, confirms
51
Q

What joints must be involved in the splint for a midshaft fractures?

A

Joints above and below

52
Q

What is the treatment for a humeral head fx (that is not extremely displaced)?

A

Sling and close f/u

53
Q

What is the treatment for a proximal vs distal biceps tears?

A
  • Proximal tears = close f/u with ortho

- Distal = surgical

54
Q

Speed’s tests diagnoses what?

A

Bicep tendonitis

55
Q

What is the classic mechanism for an ACL tear? Meniscal tear? LCL/MCL?

A
  • ACL = planting, change direction
  • Meniscal = twisting
  • LCL/MCL = varus/valgus
56
Q

What movement tests should be performed in patients with a patellar injury?

A

Straight leg raise to assess for extensor mechanism disruption

57
Q

What is the treatment for a patellar fx?

A

Knee immobilizer

58
Q

Why should you be hesitant to diagnose an LCL injury?

A

May have a posterolateral corner injury, and mean something more significant

59
Q

What are the four pieces of an ACL history?

A
  • Sudden deceleration
  • Felt/heard a pop
  • Swelling within an hour
  • Did not continue playing
60
Q

What is a Segond fracture?

A

Vertically oriented avulsion fx over the lateral knee, specific for LCL tear

61
Q

What is a “locked knee”? What pathology is it seen in, and what does it indicate?

A
  • Knee lacks full extension
  • Seen in ACL tears
  • Indicates may get contracture
62
Q

If you suspect a tibial plateau fracture, what testing is indicated?

A

CT of the knee

63
Q

What are proximal tibia fractures prone to compartment syndrome?

A

Very good blood supply to this area

64
Q

Tenderness and swelling over the joint lines of the knee indicated what possible pathology?

A

LCL/MCL sprain/tear, or tibial plateau fx

65
Q

What is the difference between a subluxation and a dislocation?

A

Subluxation = still contact between articular surfaces

66
Q

Why are patients with patellar dislocations sore on the medial side of the patella?

A

Medial patellofemoral ligament inserts there

67
Q

What is the significance of a loose bone fragment on a knee x-ray? (2)

A
  • May get in joint and cause knee locking

- If cartilage attached is from weight bearing surface, can cause OA on that joint later

68
Q

Lipohemarthrosis on x-ray (knee)= ?

A

Fx somewhere

69
Q

Why are popliteal injuries such a concern with knee dislocations?

A

It is tethered proximally and distally, without and “slack in the line”

70
Q

Why do all patients with a knee dislocation need to be admitted to a hospital?

A

-If there is an intimal tear in the popliteal artery, can form a thrombus and embolize

71
Q

What defines a knee dislocation in terms of number of ligaments with laxity?

A

2+

72
Q

Foot drop after knee injury =?

A

Peroneal nerve injury, and likely dislocation of the knee

73
Q

What is the Insall-Salvati index to determine if a patella is high riding or not?

A

Length of the patella on lateral x-ray should be about the same -ish compared to the length from the inferior pole of the patella to the tibial tuberosity

74
Q

How can US be used to differentiate between bursitis vs septic arthritis?

A

joint effusion = concern for septic arthritis

75
Q

What is the management for septic bursitis?

A

Admission with ortho consult and IV Abx

76
Q

What is the major clinical difference between prepatellar and infrapatellar bursitis?

A

Suprapatellar bursa connects with the knee joint itself, whereas the inferior bursa does not

77
Q

What are the three (four) major compartments of the lower leg?

A
  • Anterior
  • Lateral
  • Posterior (deep and superficial)
78
Q

If you see a fibular fracture, what other area needs to be assessed?

A

Medial malleolus

79
Q

What direction of fracture is concerning for a fibula fx?

A

Oblique–may indicate spiral fx

80
Q

What is a pilon fracture?

A

a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents.

81
Q

What is a tongue fracture, and what is the significance of it?

A

Break of the calcaneus where the achilles tendon inserts (rips off)
-Sharp end may erode through the skin and convert it to an open fx–call ortho

82
Q

What are the three ligaments that comprise the lateral ankle?

A

ATFL
PTFL
Calcaneofibular

83
Q

What are the two ligaments that are involved in a high ankle sprain?

A

Anterior and posterior inferior tibiofibular ligaments

84
Q

What is the purpose of the mortise view of the ankle?

A

To ensure that the space between the distal tibia and the talus is equal (1 mm of change or more is significant)

85
Q

What is the posterior malleolus?

A

Posterior aspect of the tibia

86
Q

Is the navicular bone on the medial or lateral aspect of the foot? What imaging should you get if there is tenderness here?

A
  • Medial

- Foot series

87
Q

How many steps must a person weight bear to pass the ottawa ankle rules? Does it matter if it is an antalgic gait?

A
  • two on each foot

- does not matter if antalgic

88
Q

What is the treatment for a syndesmosis injury to the tib/fib?

A

Foam walker, WBAT

89
Q

What is a Telo fracture? Why does this occur?

A

Fracture of the distal tibial growth plate at the lateral aspect.
-Growth place begins fusion medially, and extends laterally

90
Q

What is a Weber A fracture of the ankle? Stable or unstable?

A
  • fx of the fibula below the level of the joint

- Stable if not tender over deltoid

91
Q

What is a Weber B fracture of the ankle? Stable or unstable? Treatment?

A
  • fx is at the level of the joint

- unstable especially if tender on the medial side. Posterior slab, NWB

92
Q

What is a Weber C fracture of the ankle? Stable or unstable? Treatment?

A
  • Above the level of the syndesmosis
  • unstable
  • Surgical treatment
93
Q

Leaving a talus subluxed relative to the distal tibia may cause what concerning issue?

A

Ischemic necrosis of the talus

94
Q

What is a Maisonneuve fracture?

A

a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament.

95
Q

What is the mechanism by which a LisFranc fracture occurs?

A

Plantarflex and external rotation (falling off a horse)

96
Q

What is a Lisfranc fx?

A

Where one or more of the metatarsals are displaced from the tarsus due to ligamentous disruption

97
Q

What additional x-ray view can be obtained for a Lisfranc fracture?

A

Weight bearing compared to non-weight bearing

98
Q

Where are patient’s tender with a lisfranc injury? How do you determine on x-ray if there is a ligamentous disruption?

A
  • Medial Midfoot

- Metatarsals should line up with the cuneiforms

99
Q

What is the treatment for a lisfranc injury?

A
  • Mild/suspected = NWB and close f/u
  • Mildly displace = call
  • Dislocated = reduce and call
100
Q

What is a Dancer’s fracture?

A

Fx at the base of the fifth metatarsal

101
Q

What is a Jone’s fracture?

A

Fracture of the 5th metatarsal, distal to the metatarsal ligaments

102
Q

What is the treatment for a dancer’s fracture?

A

Stable and can WB so need foam walker or still soled shoe

103
Q

What is the treatment for a Jones fracture?

A

NWB

104
Q

What is the treatment for a 5th metatarsal fracture that goes through the the whole metatarsal?

A

Boot and f/u if have intact sensation

105
Q

What is Bohler’s angle found in calcaneal fractures?

A

-Line connecting the anterior and posterior processes of the calcaneus, should be 20-40 degrees

106
Q

How do you examine the calcaneus for fractures?

A

Lift foot off of bed with patient in supine position, and squeeze the calcaneus. If painful, or bruising present, then concerning

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