Lecture 2: Fracutre And Dislocation Management

Question 1

What is included in a pelvic fracture?

Answer 1

pelvic fractures include breaks in pelvic ring
+
single bone fracture w/out pelvic ring break
+
acetabular fractures

Question 2

What is radiograph is more sensitive than plain radiographs? Standard for pelvic fractures?

Answer 2

CT is more sensitive than plain radiographs

Question 3

What do you look for or make sure to analyze on a pelvic xray?

Answer 3

look for:
-disruption of pelvic ring (should be smooth circle)
-obturator foramen
-pubic symphysis (should NOT be wide)
-SI joints
-acetabulum

Question 4

What is the etiology of a pelvic ring disruption? (MC)

What to look for on imaging for a Pelvic Ring Disruption?

What is the treatment of choice for pelvic ring disruption?

Answer 4

**Lateral Compression =MC **
side impact
8% mortality
-other types are open book (head-on collision) and vertical sheer (falls, least common)

ONLY ONE open book fracture with pubic symphysis affected too

Use pelvic binder to treat

Question 5

Non pelvic ring disruption:

Features?

Which is more common pelvic ring fx or non-pelvic ring fx?

How do you treat it?

Answer 5

non-pelvic ring are isolated, closed avulsion fractures and single-bone

non-pelvic fx are more common than pelvic ring

most just require pain control and non-weightbearing with Ortho follow up

Question 6

What type of fracture would an isolated rami fracture be?

Answer 6

an isolated rami fracture would be a non-pelvic ring disruption fracture

Question 7

When should we be weary of an isolated rami fracture happening?

Answer 7

isolated rami fractures can happen in high impact trauma! be weary!!

Question 8

What are some complications of fractures?

Answer 8

Urogynecologic injury:

Urethral - perineal hematoma, high-riding prostate, or blood at urethral meatus

Rectal injuries —— uncommon ! rectal exam to evaluate for gross blood tho

Question 9

To avoid causing further complications when entering a foley catheter in a pt with pelvic issues, what must be done prior?

Answer 9

do a retrograde urethrography before foley catheter!

Question 10

What is the most dislocated joint in the body?

what type is MC?

Answer 10

shoulder dislocation! smh

anterior are MC!!!

Question 11

What are some things that occur in accordance with a shoulder dislocation?

What position is the arm held in for reduction (traction)?

Answer 11

damage to the the axillary nerve which wraps around surgical neck of the humerus

 *axillary nerve responsible for lateral shoulder sensation*

arm held in external rotation + aBducted position for reduction

Question 12

Complications of shoulder disocations?

Answer 12

-humeral head bony defects (Hills-Sachs deformity)
-neurovascular injury ——— r a r e

Question 13

What type of fall will likely lead to elbow and forearm dislocations?

Answer 13

fall on outstretched hand or direct blow

Question 14

shoulder dislocation — -anterior MC
elbow dislocation ——- ________ MC ?

Answer 14

elbow dislocation —– posterolateral MC

Question 15

Which nerves/arteries can be damaged in an elbow dislocation and which is the MC?

treatment?

Answer 15

brachial artery, ulnar nerve and median nerve

brachial artery = MC

reduction using procedural sedation
splint w/ a long arm posterior splint w/ the forearm and wrist both in neutral position and the elbow at slightly less than 90 degrees of flexion

Question 16

How do you test for ulnar nerve damage in an elbow dislocation?

How do you test for median nerve damage ?

Answer 16

test for ulnar nerve damage by spreading fingers apart against resistance

test for median nerve damage if there is pain with thumbs up sign against resistance + sensory testing over tip of index finger

Question 17

Humerus fracture: how is it likely to occur and in what population is it most common?

Answer 17

caused by simple ground-level fall on outstretched arm
third common non-vertebral fracture pattern seen in the elderly

Question 18

What is a fat pad sail sign?

Answer 18

The sail sign on an elbow radiograph, also known as the anterior fat pad sign, describes the elevation of the anterior fat pad to create a silhouette similar to a billowing spinnaker sail from a boat. It indicates the presence of an elbow joint effusion.

Question 19

What is the most important part of treatment for a shoulder injury that is imperative in prevention of adhesive capsulitis?

Answer 19

to avoid capsulitis, get pt into doing mobilization EARLY

early or else more at risk

Question 20

What is the MC common fx of the elbow?

how does it occur?

how does it present?

how do you treat it?

Answer 20

MC elbow fracture is the radial head fracture

fall on outstretched hand –> radial head drives into the capitulum

pain in lateral elbow esp w pronation+supination of forearm

Sling immobilization

Question 21

What is the 3rd MC fracture in the elderly?

What is the MC nerve affected from this fx?

Answer 21

Humerus fracture. ground level fall on outstretched arm.

Axillary nerve injury.

Question 22

What is a Colle’s fracture? Mechanism?

What nerve injury is common with this fracture?

Answer 22

Colle’s = distal radial fx
fall on outstretched, extended hand

Medial nerve injury common –> unable to oppose/aBduct, sensory loss of palmar 1st, 2nd, 3rd radial half of 4th fingers

Question 23

What complication is commonly seen in a distal radial fracture?

Answer 23

Osteoarthritis at radiocarpal + radioulnar articulations !

Question 24

Scaphoid fractures

diagnosis?

complication?

tx?

Answer 24

MC carpal bone fracture

snuffbox tenderness

avascular necrosis –> disabling arthritis

thumb spica splint

Question 25

Boxers fracture
location?
mecahnism?
tx?

Answer 25

metacarpal neck of 5th digit. pinkie!
direct trauma to a clenched fist
ulnar gutter splint

Question 26

What is the MC mechanism of a hip dislocation?

common nerve injury?

Answer 26

MVC
posterior force to a flexed knee
extremity is shortened, aDducted and internally rotated

sciatic nerve injury MC!

Question 27

MC type of knee dislocation?

what nerve and artery are affected most commonly?

Answer 27

anterior knee dislocations are MC

popliteal artery and peroneal nerve MC affected

Question 28

What type of patellar dislocation is most common?
how to treat?

Answer 28

lateral patellar dislocation is MC

immobilize knee after reduction and provide crutches….
slight pressure to put back first

Question 29

What are the OTTAWA ANKLE RULES

Answer 29

x-ray only required if pain in malleolar zone w/
bone tenderness at posterior edge/tip of lateral malleolus OR medial malleolus OR inability to bear weight both immediately and in ED for 4 steps

Question 30

WHat is a LiscFranc fx?
signs and symptoms?
imaging?

Answer 30

a type of metatarsal fx, to the tarsometatarsal joint. rare but frequently missed. pain and swelling in midfoot.

CT or MRI

Question 31

What is a Jone’s fracture?

MC zone?

Answer 31

5th metatarsal (jone’s) fractures.
MC = zone 1
increased risk of nonunion

Question 32

MC compression fracture?

Answer 32

MC compression fx = Wedge/anterior

consider kyphoplasty if pt in pain 6 weeks after nonoperative tx

Question 33

MC cervical fracture in the elderly?

mechanism?

Answer 33

MC neck fx in old people is the odontoid fracture

forced flexion/extension of head in A-P orientation

Question 34

What fracture can occur in a MVC involving sudden deceleration resulting in forced neck flexion?

Answer 34

a spinous process fracture