luis disciplines test 3 Flashcards
What fracture occurs commonly at the middle area (75%)
Clavicle
Whats the MOI of a clavicular fracture
a fall with the arm to the side
who is most at risk of a clavicular fx?
women, over 60s, and udner 30s
What fx has Crepitus and tenting of the skin?
Clavicular Fx
What are the images needed for a Clavicular Fx?
AP, Lateral and 45 degree tilt
Can a patient externally/internally rotate their arms with a clavicular fx?
Yes, Not with a humoral head fx
How can you tx a clavicular fx
Non-operative: Sling or figure 8 (better posture)
Surgical: Open, Neurovascular (N,O) Tenting
When do you surgically repair a clavicular fracture?
Dominant arm of an athlete, Wide displacement, displacement is >1/3 fx
MOI of a humorus head?
Fall on oustreched hand (FOOSH) more common in over 60 yo and female
How can you classify a humoral head fx?
Neers
1) fx w/ <1 cm of displacement
2) fx w/ >1 cm of displacement
3) Many fractures w/ >1 cm displacement
4) Surgical neck + lesser tuberosity + Greater tuberosity
What images do you order for a humoral head fx?
Lateral, AP, Y view (LAY)
How can you tx a humorus head fracture?
Non surgical: Neers 1
Surgical: Neers 2, Bicipital groove alteration, N, O
MOI of Mid humorus Fx
FOOSH, bending force on humerus
What do you suspect if a Peds pt presents with a mid humorus fx?
Child abuse
What nerves are can be damaged in a mid humorus fx?
MC = Radius (sensory: dorsum of hand. Motor: Wrist flexion)
Median (sensory: palm, thumb, 1st 3 fingers. Motor: thumb opposition)
Ulnar (sensory: little finger. Motor: finger abduction)
How do you do a vascular scrn for a mid humorus fx?
Distal Pulses: Brisk 2+ bilateral, Capillary refill 2 seconds
How can you treat mid humorus fx?
Most are non-surgical: Brace (need early mobility to prevent adhesion capsulitis
Surgery: > 3 cm shortening, >30 angulation
What should you not see on an xray of the elbow? if you see it you always assume a fracture?
Posterior fat pad
What are the ossification centers?
CRITOE: capitullem, radial head, internal epicondyle, trochlea, olecrenon, external epicondyle
MOI of a supracondylar Fx?
FOOSH with hyperextension (bike) Peds
What is a complication to Supracondylar Fx?
Volksman ischemia = blood into compartment leading to ischemia of new blood.
What can a Supracondylar Fx mimic?
A posterior elbow fracture
How can you classify a Supracondylar Fx?
Garland classification
1- no displacement
2-posterior displacement = fat pad
3- significant displacement = fat pad
Tx for a Supracondylar Fx?
garland 1 = non-surgical
garland 3, N, O = surgical
MOI of a Radial head Fx?
FOOSH w/ flexed arm (MC) or posterior elbow dislocation
What can a patient not do with a Radial head fracture?
supinate or extend hand
How can you classify a Radial head Fx?
Mason Classification (mason jar, twish the radial head)
1- fx w/ no displacement
2- fx w/ displacement
3-Many fx w/ displacement
Is a radial head fracture 1 of 2 occult fracures?
Yes, do a AP, Lateral, Oblique xray
How can you tx a mason (radial head) fx
Non-surgical: type 1 gets a splint for 5-7 days and supination at day 7 OR type 2 gets a splint for 10-14 days and aggressive ROM and mod displacement with ORIF
Surgery = Type 3
What structures form a stabilizing ring?
radius, ulna, prox and distal radioulnar joint. single bone fx w/o radioulnar distruption = stable fx
MOI of forearm fracture?
High impact, MVA, high fall
What is a night stick fracture?
Mid ulna (protect yourself from a cop) TX: brace, non-surgical
What is an unstable ulnar fx?
Both radius and ulna fx, Monteggia fx (mid to proximal ulna w/ radial dislocation), Galiazza fx (mid to distal radius w/ carpoulnar dislocation)
MOI of a distal radial fx?
FOOSH with wrist extension = collies (dinner fork)
FOOSH w/ wrist flexion = smith (garden spade)
what is the major nerve at risk with a distal radial fx?
Median nerve damage
what can you do to see if a patient has a colles fx without imaging?
ask the patient to push their palm on your hand
How can you tx a distal radial fx?
Non-surgical: short cast - no displacement, long cast w/ displacement
Surgical: N, O, intra-articular extension, severe comminuted, cant maintain reduction
MOI of pediatric distal radial fx?
MC <10 yo distal metaphysis, compressed cortex FOOSH
Clinical presentation of a peds distal radial fx (buckle)
No visible deformation, swelling, guarding
Tx for a buckle fracture?
short arm cast 4-6 weeks
MOI of a green stick fx?
Compression and bending FOOSH
Clincial presentation?
Visible deformity
Tx for a green stick fx?
Rarely needs surgery, cast for 6-8 weeks
Scaphoid fracture MIO?
Most common carpal bone fx, FOOSH
Scaphoid fracture clinical presentation?
snuff box pain, limited ROM
Is a scaphoid fx the 2/2 occult fx?
yes
What is the major complication with a scaphoid fx?
Nonunion and osteonecrosis
What images do you roder for a scaphoid fx?
PA lateral and Scaphoid
what is the scaphoid tx?
Long are cast with thumb spica for 6-12 weeks and repeat xray 10-14 days
if both xrays for a scaphoid fx are negative, what do you do next?
MRI, or bone graft from radius
What does a traverse or oblique fracture of the metacarpals or phalanges result in?
Angulation. A spiral fx = rotation
do you do an ortho consult with a fracture of the metacarpals or phalanges?
yes, if the displacement is > 2 mm, spiral, communited, or intra-articulation fx
What is malrotation?
patient makes a fist but his fingers dont all point to his scaphoid.
How is the MOI of a boxer’s fracture?
punching a wall (men 20s)
presentation with boxer’s fist
swelling, malrotation, deformity, drop knuckle
What is the hand contusion quandary and when would you do it?
have the patient push on yout hand with their palm to elicit pain
Boxer fracture tx?
Non-surgical = Ulnar gutter splint surgical = >15 degrees of angulation, spiral, angulation
What is mallet finger and what is its MOI
extensor avulation, direct blow to the distal pit of finger = tendon rupture or laceration. Patient cant extend distal tip
mallet finger tx?
Continous splint 6-8 wk - clock starts again if you extension is lost
Surgical: uses K wire, failure to heal, complete tendon rupture, >30% articulation surface
What is jersey finger and what is its MOI
Forced extension under forced flexion at base of DF. Usually the ring finger (cant flex it)
how do you treat the jersey finger?
all require surgry. finger splint with hand surgery (best if done within 7-10 days of injury)
What is the MOI of a distal phalanx fracture
a direct blow (hammer or mallot)
What is a complication of the phalanx fracture?
subungual hematoma.always assume a fracture.
How can you tx the distal phalanx fracture?
take xrays first, if no fx then drill to relieve the pressure.
