MSK-FX-UE Flashcards
What is req in a shoulder series X Ray?
- AP- ER exposed G. tuberosity.
- AP- IR G.tuberosity less exposed.
- Y- scapula view.
- DDX dislocations. Axillary- Dislocation, glenoid,
What is the special view of the glenoid?
AP oblique
WHat is showing In the Y trans scapular view?
- Top of Y is coracoid process and scapular spine.
- Bottom is scapula body
What is DX of humerus is ER and inferior to glenoid?
ANT dislocation. MC. Pt. fixed in ER, AB
Pt is in ER from MVA, holding arm in ADD, IR, cannot ER. Xray shows humeral head even lined up with glenoid?
- POST Dislocation.
- NO G. Tuberosity
- ***Hard to tell, consider CP of Pt..
What can be used to determine dislocation on Y view?
- ANT- humeral is MEDIAL to Y
- POST- humeral head is LATERAL to Y
What can be seen on Axillary view, rare for Dislocations?
- POST-Humeral head is far from coracoid, and inferior to glenoid.
- ANT- Humeral head overlaps coracoid
What is cond/XRay if pt is in a MVA with arm ABD fixed?
Luxatio Erecta- humerus severely inferior to glenoid fossa
What complication is from multiple dislocation, where the humeral head is impinged under ant glenoid rim leading to impaction FX on posterolateral humeral head?
Hill Sachs Fx
What can occur post reduction of dislocation on the glenoid rim?
BANKART FX. Labrum Tear
what are secondary injuries from mechanism of most dislocation?
- Avulsion of tuberosity RTC.
- Jt instability.
- Axillary nerve. ALWAYS check neurological
What is LC FX from direct impact, least problematic d/t 2/2 injuries in lungs where you must order a CXR, CT later, and Y view?
- Scapula FX- ALWAY GET CXR ASAP. Body MC.
- Risk Hemi, Pneumothorax, Failed Chest.
What is MC location of clavicle fX w/ what views?
- Middle 1/3.
- Distal 1/3 Elderly.
- AP and ANGled -15deg
What is used to determine 4 types of AC separation?
- SAND BAG wt bearing view-
- Type 1 partial tear,
- Type 2 Widening
- Type 3 AC and CC ligament.
- Type 4 impaction
What mm determine Type 2 vs Type 3?
>8mm vs >13mm
Describe caution of FX at humeral neck?
Surgical neck axillary blood supply AVN.
MC -impaction, comminuted, shortened
What views are reQ for elbow to the NORMAL Fig 8?
Lateral-90deg flexed handshake. Fig 8-capitelulm and trochlear bottom of 8, condyles superimposed
What views are reQ for elbow to seen the condyles?
Med. Oblique
What views are reQ for elbow to seen radiocapitellar?
Lateral Oblique
What views are reQ for elbow to radial head?
Capitellum view- Fig 8
Describe the fat pad sign and what it indicates?
- Hemarthrosis.
- Lucent -ANt. fat bad distal bicep-Normal
- FX= extended.
- ANY Posterior fat pad= FX
What is indicated if the Ant humeral and Radiocapitellar line don’t bisect the middle 1/3 capitellum?
FRACTURE
What is MC common sublet elbow FX in adults?
Radial head. USE approach
- AABC
- Fig 8
- Fat pad
- Ant humeral and Radiocapitellar Line bisect
- Humer, Olecranon, Ulna
What accounts for 60% of FX in kids in the elbow?
Supracondylar FX
For kids what is important not to confuse in bones FX?
Epiphyseal plate, ossicles, coronoid, medial condyles, olecranon etc. LOOK for alinement and fat pad
What are MC dislocations?
- fingers 2. shoulder 3. elbow- Kids #1. 90% posterior, HYPEREXT. Consider FX ALWAYS Check vascular and nerves
What is direct blow to ulna in defensive posture?
Nightstick FX
What is a Fracture of ulna and radial head dislocation?
- Monteggia
- FX-UNSTABLE surgery.
- Radial head ANT dislocation
What is distal 1/3 radial shaft FX w/ distal ulnar dislocation?
Galeazzi
Ulna-out at radioulnar and carpal ulnar jt. UNSTABLE
What is mnemonic for carpals?
Some lover try position- L-M. That they can’t handle
Trapezium- THUMB
For FOOSH FX what should been observed in carpals and radius?
Carpal row alignment. Intra Articular Radial FX
What view will you see in a FX on the radius during a FOOSH?
Oblique radial ulnar fX
Describe Distal Radius FX angulations?
LATERAL views-
Colles- Angle Dorsal/POST, dinner fork, humpback
Which nerve should be evaluated?
Median
What is MC FOOSH injury?
Colles FX, also check Ulnar styloid
What is a SMith’s FX?
Distal Ventral/ANT radius
FX- LATERal view DISTAL angulation*
What is volar/dorsal BUT with INtra-articular FX dislocstion?
Barton
What can be seen in an intraarticular radial styolid fx?
Chauffeur/Huttchens- lunate scaphoid widen. NO angulation
In a Lunate load fx, punch, what is seen?
Hyperdense at MEDIAL distal radius, with widening.Intraarticular
What is MCC carpal fx with risk of avasular necrosis?
- Scaphoid (NAav FX)- waist of bone HIGH proximal bone risk.
- view in ULNAR DEVIATION
What is the 2nd MC FX in hand best seen in which view?
Triquetrum- most dorsal bone FX- LATERAL view
What will a lunate dislocation look like on AP and LATERAL view?
- AP- Triangle, arches gone, Scaphoid shortened
- LATERAL- spilled teacup.
- UNSTABE- median nerve
What is seen on a LATERAL where the luncate is in postion but others are not?
Perilunate Dislocation- 3x MC. Capitate and MC Dislocated- check scaphoid and median nerve
What is seen on PA with perilunate?
crowded carpals
What is occurring in scapholunate Dissocation?
Extra widen space- Scaphoid rotates on AP view creating space
What is defined has Boxers fX?
4th or 5th metacarpal NECK FX. 5th digit may rotate medially
Are true Boxer fX shaft and intra articular?
NO!
What is a Bennetts FX?
- Intra Articular FX dislocation of 1st MCP jt.
- Abductor pollicis longus pulls MC downward avulsing off
What is a Rolando FX?
Comminuted MC intra articular base of thumb
What is easy to miss in hyperextension phalanx injury?
Volar plate avulsion PIP jt- UNSTABLE
What is a mallet finger?
- Avulsion FX of DIP at extensor tendon-untreated
- REFER ORTHO
What is Boutonniere finger?
HYPERFlex PIP d/t central slip and HYPEReXT d/t lateral bands. MC RA pts
What is swan’s neck finger?
Fixed EXT of PIP and FLEXED DIP- MC Autoimmune
what can occur at base of proximal 1st phalanx?
Gamekeeper thumb- UCL avulsion FX
What is important about distal phalanx fracture?
- Tuft- tip FX repair, ABX- NONURGENT.
- Distal NECK- OR URGENT
