# management Flashcards
extracapsular hip fractures management =
internal fixation with DHS/ compression
if subtrochanteric = pre-op Thomas spling
management of intracapsular hip #
THR or hemiarthroplasty
management of extra articular non - distal femur #
IM nail
management of extra articular distal femur #
plating
management of intraarticular distal femur #
anatomical reduction, rigid fixation with plates and screws
management of femoral shaft #
femoral nerve block
Thomas splint
if unstable = IM nailing
management of prox tibia intraarticular #
temp spanning and ext fixation (if sig soft tissue damage)
anatomical reduction and rigid fix
often TKR
management of prox tibia extraarticular #
temp span and ext fixate if sig soft tissue injury
anatomical reduction rigid fixate
management of <50% displaced and <5degree angulation tibial shaft #
knee cast
management of comminuted and open tibial shaft #
sx stabilisation
IM nailing with plastic Sx assistance or ext fixate
management of extraarticular non distal # of distal tibia
IM nail
management of extraarticular distal tibial #
plate
management of non displaced stable distal tibial #
conservative Rx
management of Pilon #
Emergency
early int fix if soft tissue ok, if not = bridging ext fixate with delayed int fix
ORIF
CT for other injuries
management of isolated distal fibular ankle
walking cast / splint for 6 weeks
management of distal fibula # with deltoid lig rupture
ORIF with plates and screws
mortise AP xray to check for talar shift
management of bimalleolar distal fibula #
ORIF with plates and screws
mortise AP xray to check for talar shift
dont thomas splint distal femur supracondylar # because
leads to disimpaction of # due to pull of gastroc on distal fragment
management of minimally displaced medial malleolus # of tibia
conservative
walking cast / splint for 6wks
management of calcaneal # =
___ should be checked
ORIF debated
spinal injury
management of displaced talar fracture
closed or open reduction and screw fixation
management of Lisfranc (base of 2nd MT) #
CT scan if doubt because xray can be normal
closed/open reduction with fixation with screws
management of base of 5th MT #
walking cast/wearing stout boot for 4-6wks
management of proximal diaphysis of 5th MT (Jones #)
displaced in active =
non union =
stable =
displaced # in active = fixate with one screw
non union = bone grafting and fixation
stable = moon boot
1st MT # management
fixation
management of lesser MT #
minimal displacement = treated conservatively with cast
multiple displaced #s = stabilised with k wires
management of 2nd MT #
cast until pain subsides
management of extra art toe #
protect in stout boot
open = debride and stabilise with wires
management of toe dislocations
closed reduction and either neighbour strapping or wiring
management of intra art # of base of proximal phalanx of hallux
reduction and fixation
if open = debridement and stabilise with wires
management of minimally displaced prox humerus #
conservative with sling
management of persistently displaced prox humerus # =
internally fixate
management of head splitting # or 3/4 part fracture of proximal humerus
arthroplasty considered
most common pattern of fracture of proximal humerus
surgical neck # with medial displacement of humeral shaft due to pectoralis major pull
s dancers get :
MT avulsion #
`wrist drop and loss of sensation in 1st dorsal web space is due to
radial nerve damage
management of humeral shaft #
functional humeral brace to compress and stabilise
polytrauma = int fix wit hIM nail, plate or screw
non union = plating and bone graft
management of intra art distal humerus #
ORIF with anatomical reduction and rigid fixation
elbow replacement considered in highly comminuted
management of olecranon #
ORIF
simple transverse avulsion # = fixed with tension band wiring
management of radial head and neck #s
min displaced marginal # = conservative
Sx if displaced fragment blocks extension
comminuted = excise +/- replacement
management of epicondyle #
fixed screw
management of coronoid #
if large = ORIF with screw
management of nightstick #
conservative
management of ulna and radius together #
ORIF with plates and screws
kids w minimal angulation = plaster
very angulated with intact periosteum after reduction and unstable in 1 direction = MUA and plaster
management of Monteggia # dislocation (ulnar # with radial head dislocation)
ORIF of ulnar #
and once reduced radial head will reduce
management of Galeazzi # dislocation (radial # with dislocation of ulna at distal radio ulnar J)
ORIF of radial #
and once reduced ulna head will reduce
management of Colles # (extra - art distal radius # with dorsal displacement of distal radius)
stable min displaced/angulated = plaster
displaced simple = MUA
displaced, comminution = MUA k wiring and ORIF
complications of Colles #
median nerve compression
EPL rupture
CRPS
loss of grip strength
dinner fork deformity =
Colles #
management of Smith # ( extra art of distal radius # with volar disp)
ORIF with plate and screws
Smith # = __ failure of radius
Colles = ___ failure of radius
smith = flexion colles = extension
management of intra art radial # with dorsal or volar rim # (Bartons #)
ORIF
management of comminuted intra art distal radial #
externally fixate +/- k wires
management of scaphoid #
splint wrist undisplaced # = plaster cast for 6-12wks displaced # = special compression screw non-union = screw fixate and bone graft 4 xrays
management of 3rd/4/5th MC #
conservative
management of 5th MC neck #
up to 45 degree angulation tolerated
manipulation with neighbour strapping or k wire stabilisation
management of phalangeal #
sig displaced/angulated = MUA / digital nerve block
unstable # = k wire / fixate with small screws
interarticular # = k wire or small screws
