Ortho Forearm, wrist, hand Flashcards
Incomplete fracture with cortical disruption and periosteal tearing on the convex side of the fracture (intact periosteum on the concave side) “bowing”
Greenstick fx
Incomplete fracture with wrinkling or bump on the metaphyseal-diaphyseal junction (where the dense bone meets the more porous bone) due to axial loading.
Torus (buckle fx)
Most common site of radial nerve injury
humerus Fx
Tx for humerus fx
sugar tong splint
What fx can potentially cause a median nerve, brachial artery and radial nerve injury?
Supracondylar Fracture
Tx for nondisplaced Supracondylar Fx
splint
Tx for radial head Fx
sling + long arm splint 90 degrees
Tx for nursemaids elbow
supination-flextion technique
How does a nightstick Fx happen?
direct blow
Isolated fractures of the ulna, typically transverse and located in the mid-diaphysis and usually resulting from a direct blow.
Nightstick (ulnar shaft) Fx
Proximal Ulnar shaft Fx with radial head dislocation
Monteggia Fx
“GRUM”: Galeazzi, Radius and Ulnar, Monteggia
What nerve may be injured in a Monteggia Fx?
Radial Nerve (wrist drop)
Tx for Monteggia Fx
ORIF
Distal radial shaft fracture with dislocation of the ulnar-radial joint
Galeazzi Fx
Cubital Tunnel Syndrome effects which nerve?
Ulnar Nerve: tingling and numbness in 1/2 of 3rd, 4th and 5th digits
PE will show what for cubital tunnel syndrome
+tinels sign
+ Fromen’t sign
What is a + froments sign
seen in cubital tunnel syndrome
pt grasps paper between pointer finger and thumb and pt not able to hold paper when paper pulled away by provider
T for cubital tunnel syndrome
wrist immobilization w/sleep, NSAIDS
inflammation of tendon insertion of extensor carpi radialis brevis
Tenis Elbow (Lateral epicondylitis)
inflammation of pronator teres-flexor carpi radialis
Medial Epicondylitis (Golfers elbow)
Lateral epicondylitis Presentation
pain w/gripping, pronating forearm & wrist extension
Medial epicondylitis Px
pain w/ wrist flexion against resistance & worse with pulling activities
MC type of elbow dislocation (opposite of MC shoulder D/L)
Posterior
Pt presents with flexed elbow & marked olecranon prominence
Elbow dislocation
Tx for elbow dislocation
Emergent reduction!! Posterior splint
What nerve injuries must you rule out with an elbow dislocation?
brachial artery & median/ulnar/radial nerve injury
Complication with scaphoid Fx
avascular necrosis
anatomical snuffbox tenderness w/ what Fx?
scaphoid Fx
Scaphoid Fx Tx
thumb spica
Scapholunate dissociation tx
radial gutter splint
dinner fork deformity
colles fracture
dorsal posterior angulation in wrist fracture
colles fracture (dinner fork Deformity)
Diagnosis for Colles and Smith FX
Lateral X ray so you can differentiate between Colles and Smith
garden spade deformity
smith fx
ventral anterior angulation of this wrist fracture
smith fracture (garden spade deformity)
complication of colles Fx
extensor pollicus longus tendon rupture
complication of smith fracture
Median nerve injury: can develop into carpal tunnel syndrome
Tx for colles and smith fx
sugar tong splint/cast
ORIF if unstable or communited
piece of pie sign
lunate dislocation
lunate D/L
lunate doesn’t articulate with capitate or radius
tx for lunate dislocation
unstable: ORIF
what is the most serious carpal fracture
lunate fracture
kienbocks disease
avascular necrosis of lunate bone
sudden blow to tip of an extended finger with forced flexion
mallet (baseball) finger
entensor tendon avulsion
mallet (baseball) finger
inability to straighten the distal finger (flexed at DIP joint)
mallet (baseball) finger
Tx for mallet finger
splint the DIP in uninterrupted extension x 6 weeks
finger flexed @ PIP joint & hyperextended @ DIP joint
Boutonneire deformity
finger hyperextended @PIP joint & flexed @ DIP joint
Swan neck deformity
sprain or tear of ulnar collateral ligament of the thumb–> instability of MCP joint
Gamekeepers (skiers) thumb
difff between skiers thumb and gatekeepers thumb
skiers thumb: acute
gamekeepers: chronic hyperabduction injury
thumb far away from other digits especially with valgus stress
gamekeepers thumb
tx for gamekeepers thumb
thumb spica
Fracture of the neck of 5th metacarpal
boxer’s Fx
Tx for boxer’s Fx
ulnar gutter splint
intraarticular fracture through the base of the 1st metacarpal (MCP) bone
bennet’s fracture
comminuted Bennett’s fracture
Rolando’s fracture
SALTR Harris classification
S: Same
A: Above
L: Lower
T: Through
R: Rammed
SALTR HARRIS classification is used for which fractures?
growth (epiphyseal) plate fractures
MC SALTR HARRIS Fx
Type II: growth plate fx + fx of metaphysis (good prognosis)
de quervain tenosynovitis
stenosing tenosynovitis of the abductor pollicus longus (APL) and extensor pollicus brevus (EPB)
pain along radial aspect of wrist radiating to forearm
de quervain tenosynovitis
+ finkelstein test
pain w/ulnar deviation or thumb extension
Tx for de quervain tenosynovitis
thumb spica splint
Obtain repeat radiographs in 2 weeks for what fracture?
scaphoid fx