ORTH SCP Flashcards
Top 3 injuries associated with scapula fracture
injury of
head
ribs
lungs
pulmonary injuries occur in how much of patients with scapulrar fracture
1/3
most scapular fracture is treated with
sling
surgery for scapular fracture is indicated when
there is involvement of glenoid with a major particular step off or if there is a glenoid rim fracture or subluxation of the joint
most commobly dislocated large joint
shoulder specifically glenohumeral joint
most dislocations of the glenohumeral joint are
a. anterior
b. posterior
c. lateral
d. medial
A
injuries(avulsion) of the anterior inferior glenoid laBrum is called
Bankart lesion
impaction fractures of the Humeral Head
Hill-Sachs lesion
3 lesions associated with shoulder dislocations
Bankart lesion
Hill Sachs
Rotator cuff
nerve most at risk with shoulder dislocations
axillary nerve
if elderly patient with shoulder dislocation is unable to raise the arm after reduction of shoulder, the reason is probably
rotator cuff tear
if young patient with shoulder dislocation is unable to raise the arm after reduction of shoulder, the reason is probably
axillary nerve injury
dislocation rate of shoulder dislocations if the patient is younger than 20 years
90%
these type of shoulder dislocations are associated with seizure or electric shock
Posterior dislocations
what is the most important plain radiography view for shoulder dislocations
axillary view
what should be done for a patien lt with shoulder dislocation when axillary view cannot be obtained?
computed tomography
treatment of shoulder dislocations
closed reduction followed by a short period of sling immobilization
historical system of classification of proximal humeral fractures
Neer’s classification
4 parts of the humerus according to Neer’s classification
He let go of her
humeral head
greater tuberosities
lesser tuberosities
humeral shaft
3 factors that determine treatment of proximal humeral fracture
displacement of the fracture fragments
amount of angulation of the fracture
amount of comminution
indication of ct scan in humeral fracture
suspicion of intra articular fracture
tx of majority of proximal humerus fractures
sling immobilization
early shoulder motion
pendulum exercises
How long after proximal humers fracture should physiotherapy be done to prevent stiffness? (esp in the elderly)
2 weeks
what is the treatment of choice for proximal humerus fracture if therr is adequate bone stock and fracture can be successfully reduced
Open reduction internal fixation with plate and screw fixation
older patients w/osteoporosis, comminuted fractures, head-splitting fractures and 4-part fracturrs or fracture dislocations are typically treated with
prosthetic replacemenr of the humeral head or hemiarthroplasty
True about humeral shaft fractures
a. majority of humeral shaft fracturrs can heal with nonsurgucal mgt
b. radial nerve spirals around the humeral shaft and at risk of injury
c. radial nerve palsy is manifeste as wrist drop
d. most radial nerve injuries are neuropraxias
AOTA
most radial nerve injuries after humeral shaft fractures are neuropraxias and function will return within
3-4 mos
A spiral fracture of the distal one third of the humeral shaft is commonly associated with neuropraxia of the radial nerve and this is called
Holstein Lewis Fracture
Criteria for acceptable alignment of Humeral.shaft fractures
less than 20deg anterior angulation
less than 30deg varus/valgus angulation
leas than 3cm shortening
T/F radial nerve palsy is a contraindication to conservative treatment
F. not a contraindication
Neer’s classification: Surgical Neck
III
Neer’s classification: Greater tuberosity
IV
Neer’s classification: Anatomical Neck
I
Neer’s classification: Lesser tuberosity
V
Neer’s classification: Minimal Displacement
I
Neer Classification humeral head fracture
No fragments meet the criteria for displacement ( any fracture pattern less than 1cm displacement)
1 part
Neer classification: one tuberosity is displaced and the surgical neck fracture is displaced, the remaining tuberosity is attached which produces rotational deformity (at least 1cm displacement)
three part
Neer classification
one segment is displaced which may be the greater tuberosity, lesser tuberosity, or articular segment at the level of anatomic neck or surgical neck
two part
Neer classification
both tuberosities, articular surface and shaft meet the criteria for displacement
four part
diagnostic done to monitor recovery of radial nerve after humeral shaft fracture and ORIF
EMG
mechanism of fractures of the distal humerus
fall onto the elbow or onto outstretched arm
What’s the most common fracture of the distal humerus?
Supracondylar fractures
minimally displaced distal humerus fractures can be treated with
posterior long arm splint wirh the elbow typically flexed to 90deg
severely comminuted distal humerus fractures can be treated with
elbow replacement
common mechanism of elbow dislocations
typically occur with fall on outstretched hand
Terrible triad of elbow dislocations
- injury to the joint capsule and rupture of the lateral collateral ligament/ possible involvement of the medial collateral ligament
- possible fractures of the radial head and 3.coronoid
REC
radil head elbow coronoid
recommendations to avoid stiffness of the elbow for simple elbow dislocations
short term immobilization of about 7-10 days follwed by early range of motion
characterized by a fracture of the radial head, dislocation of the distal radioulnar joint and rupture of the antebrachial interosseous membran
Essex-Lopresti fracture
surgery is recommended for radial fractures when (4)
D DBW displaced fracture dislocation of the elbow blocks supination or pronation wrist pain
radial head comminuted fracture management of choice
radial head replacement with metallic head implant
mechanism of olecranon fractures
fall on flexed elbow
tx of olecranon fractures, nondisplaced,
splint 45-90deg of flexion
muscle that inserts into the olecranon
triceps
tx of olecranon fracture
surgical fixation
common mechanism of forearm fractures
fall on outstretched arm
what is a nightstick fracture
isolatrd fracture of the ulna shaft
mechanism of nightstick fracture
direct blow to the side of the forearm
fracture of the proximal third of the ulna associated with radial head dislocation
Monteggia fracture
fracture of distal third radial shaft associated wirh distal radioulnar joint injury at the wrist
Galeazzi fracture
distal radius fracture causing dorsal displacement of the distal radius. Presents as dinner fork deformity
Colles fracture
distal radius fracture causing volar displacement of the distal radius. a.k.a reverse colles smith
Smith’s fracture
areintra-articular fracturesof theradial styloidprocess. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size.
Chauffer’s fracture
Hutchinson fracture
Backfire fracture
Intr articular volar or dorsal fracture with associated dorsal subluxation/dislocation of the radiocarpal joint.
Barton’s fracture
the ff are true with forearm fractures
a. every attempt should be made to rule out feactures that extend intra articularly into the wrist joint or involve the DRUJ
b. Osteoporosis should be ruled out
c. median nerve injury is possible
d. loss of thumb extension from extensor pollicis longus tendon rupture can occur especially in nondisplaced distal radiua fractures
AOTA
usual tx for forearm fractures
closed reduction
WHAT IS THE MOST COMMON FRACTURE OF THE CARPAL BONE
scaphoid
sequelae of missed scaphoid fracture
nonunion and avascular necrosis
most common site of scaphoid fracture and higher incidence of avascular necrosis
proximal
this clinical.finding suggesrs scaphoid fracture and should be considered as such until proven otherwise
pain in the anatomical snuff box
the ff diagnostic test is helpful if no fracture is seen on xray
a. MRI
b. CT scan
c. Utz
A
true about pelvic fractures EXCEPT
a. pelvic fractures are indicative of high energy trauma
b. hemorrhage from pelvic trauma can be life threatening
c. hemodynamic instability would require immediate open reduction and internal fixation
d. ratio of blood ffp and platelets to be given in hemodynamically unstable px is 1:1:1
C. resucitation with fluids and blood
Describe an open book.mechanism of pelvic injury
anteroposterior compression mechanism. pelvis springs open, hinged on the intact posterior ligaments with widening of the pubic symphysis
initial.management for open book fracture of the pelvis
pelvic binder
fractures of the sacrum may be difficult to see on xray. what could be done to visualize ?
CT scan
compression of the nerve roots below the level of the spinal cord causing paralysis, impaired bladder and/or bowel control, loss of sexual sensation, and other problems. Even with immediate treatment, some patient may not recover complete function.
cauda equina syndrome
indications for anterior plate and posterior fixation for pelvic fracture
pubic symphysis is widened 2.5 cm
posterior pelvic ligaments are also injured
function of this nerve should be examined after acetabular fracture
sciatic nerve
sequelae of hip dislocation not reduced immediately
avascular necrosis of femoral head
45 degree views used to evaluate acetabular fracture
Judet views
true about hip dislocations
a. hip dislocations usually result from low impact trauma
b. most commonly occur posteriorly
c. acetabular fracture is rare
d. closed reduction is usually unsuccessful
B
a. high energy trauma
c. common
d. usually succwaaful
What is a Pipkin fracture
femoral head fracture associated with hip dislocation
true about hip fractures EXCEPT
a. more common in women
b. more common in of with osteoporosis
c. Three most common fractures in the elderly are those of shoulder, spine and hip
d. patients who suffer from hip fractures are at increased risk of DVT
e. early ambulation diminishes risk for many of these adverse events
C. wrist, hip, spine (WHS)
what is the treatment of choice for hip fractures
surgery within 24-48 hrs
goals of surgery for hip fracture
minimize pain
restore hip function
allow early mobilization
main blood supply for femoral neck
deep branches of the medial femoral circumflex arteries
true about intertrochanteric hip fractures
a. occur between the greater and lesser trochanter of the distal femur
b. osteonecrosis is common
c. reverse oblique intertrochanteric fracture exits on the medial cortex
d. reverse oblique intertrochanteric fracture is best treated with a cephalomedullary nail
e. dynamic hip screw is the right device to be used in reverse oblique fractures
D
a. proximal femur
b. uncommon
c. lateral cortex
e. wrong device
true about subtrochanteric hip fractures EXCEPT
a. usually at proximal shaft just distal to the lesser trochanter in an area of high biomechanical stresses
b. tend to be significantly displaced
c. most often treated with long cephalomedullary nail
d. it could to bisphosphonate use
AOTA
True of femoral shaft fractures EXCEPT
a. associated with risk for complications such as thromboembolic events
b. most commonly fixed with intermedullary nail
c. Trauma patients who are hemodynamically unstable are treated immediately with open reduction
d. NOTA
C. initially, they should have external fixation until the time they can undergo surgery. this is called damage control orthopedics
coronal fractures thay usually involve the lateral femoral condyle
Hoffa fractures
