Handbook Review

Question 1

What muscles cause displacement in displaced clavicle fx?

Answer 1

Medial fragment usually posterosuperiorly from the SCM and trapezius. The lateral/distal fragment is usually inferomedial from the weight of arm and pec major

Question 2

What are the two most common mechanisms of injury for ac separation?

Answer 2

Both direct and indirect. Direct is a fall directly onto the adducted arm which drives acromion medial and inferior. Indirect is caused by fall on outstreched hand with force transmission through the humeral head into the ac articulation

Question 3

What is the definitin of flail chest?

Answer 3

3 or more consecutive ribs with segmental fxs

Question 4

What is paradoxical breathing?

Answer 4

When a part of the chest sinks in with inspiration and out with expiration

Question 5

How are 2 part fxs of the anatomic neck of the humerus handled?

Answer 5

In younger pt you do ORIF, hopefully just with screws. In older pts you probably would do a hemi or total arthroplasty. These fxs have high risk of osteonecrosis

Question 6

When a pt presents with a proximal humerus fx, what MUST you be checking on exam?

Answer 6

Axillary nerve function, usually just sensory over lateral deltoid bc strength will be weak when acute due to pain.

Question 7

What defines a part in Neer classification?

Answer 7

>1cm of displacement or >45 degree of angulation

Question 8

What is a West Point axillary view good for?

Answer 8

Good for identifying bony bankart lesion

Question 9

When you see a lesser tuberosity fx, you should automatically think what?

Answer 9

Post dislocation until proven otherwise

Question 10

What amount of displacement in a greater tuberosity fx would indicate surgery for a pt that requires overhead movement?

Answer 10

>5mm of displacement of greter tuberosity

Question 11

What are the tolerances for humeral shaft fx?

Answer 11

20 deg of ap, 30 deg of varus/valgus and <3cm of shortenting

Question 12

What must you evaluate before any manipulative reduction of a hip dislocation?

Answer 12

The femoral neck to rule out presence of a femoral neck fracture which you might displace with manual traction

Question 13

What are some radiographic evidences of hip dislocation on AP pelvis?

Answer 13

• Femoral heads normally appear similar in size. W/post dislocation it appears smaller than other. Ant dislocation it appears slightly large
• Shenton’s lineis normally smooth and continuous. Will not be with dislocation
• Appearance of greater and lesser trochanter may indicate pathology
• Pay attention to the adducted or abducted position of the femoral shaft to help also.