Orthopaedic Trauma Day 3 Flashcards
what metacarpal bone has the highest tolerance for fractures and which has the lowest tolerance?
highest tolerance = thumb
lowest tolerance = small finger
what is the most common metacarpal fracture?
5th metacarpal bone fracture (little finger)
defined as a small finger metacarpal neck fracture
boxer’s fracture
what should we evaluate if a patient has a possible boxer’s fracture?
rotation/scissoring
what is the non-op treatment for a 5th metacarpal fracture/boxer’s fracture? (2)
closed reduction
ulnar gutter splint
what is the operative treatment for a 5th metacarpal bone fracture/boxer’s fracture?
open reduction internal fixation (ORIF)
when would we want to operate on a 5th metacarpal bone fracture? (4)
open
intra-articular
rotational deformity
>60 deg of angulation
identify fracture
boxer’s fracture (neck)
identify
5th metacarpal bone fracture with volar angulation
identify
5th metacarpal shaft fracture with volar displacement
what are the most common phalanx fractures?
distal phalanx
what are the least common phalanx fractures?
proximal phalanx
a phalanx fracture most commonly occurs in which finger?
small finger
where do most distal phalanx fractures occur?
tuft of phalanx
distal phalanx fractures are most often associated with what?
nail bed/matrix laceration
very common injury in which nailbed can be either crushed, lacerated, or amputated
tuft fracture
identify
tuft fracture
identify
shaft fracture of distal phalanx
identify
volar base fracture
identify
dorsal base fracture
how should base fractures be treated?
by hand surgeon
which fractures of the phalanx often have dorsal or volar displacement d/t insertion of FDS and FDP tendons, as well as shortening and rotation of finger; typically requires surgical fixation?
middle and proximal phalanx fractures
what is the typical treatment for middle and proximal phalanx fractures?
surgery
what non-op management can be used for middle and proximal phalanx fractures? (2) when can we use this treatment? (2)
buddy tape or finger splint
no head or base involvement
no rotation or displacement
identify
proximal phalanx shaft fracture
identify
proximal phalanx fracture of ring finger
identify
tuft fracture to ring finger
what 2 locations do elderly patients most commonly have hip fractures?
femoral neck
intertrochanteric
what 2 locations do young patients most commonly have hip fractures?
acetabulum
proximal femur
which hip fracture is typically associated with hip dislocations?
femoral head fractures
which 2 hip fractures have a high risk of avascular necrosis (AVN)?
femoral head fracture
femoral neck fracture
what imaging is required for further evaluation of femoral head fracture?
CT
non-op vs operative treatment of femoral head fractures depends on what? (2)
location
fracture displacement
identify
femoral head fracture
hip fracture in which leg is shortened and externally rotated with abduction
femoral neck fracture
what should be ordered since femoral neck fractures are difficult to discern on plain film xray and CT?
MRI d/t possible occult fracture
what are femoral neck fractures highly associated with?
high morbidity and mortality
what are the treatment options for femoral neck fractures? (3)
surgery
ORIF
hip hemiarthroplasty
total hip arthroplasty
identify
femoral neck fracture
identify
impacted femoral neck fracture
proximal femur fracture at level of the greater and lesser trochanters in which the leg is shortened and externally rotated
intertrochanteric fractures
what is the treatment for intertrochanteric fractures?
cephalomedullary nail fixation
identify
intertrochanteric fracture
result in femoral head dislocations from the acetabulum socket
hip dislocations
which nerve is most commonly injured in hip dislocations?
sciatic nerve
are most hip dislocations anterior or posterior?
posterior
why is it important to reduce a hip dislocation as soon as possible (within 12 hours)?
prevent AVN of femoral head
what is the treatment for a hip dislocation?
reduction by flexing knee and hip and pulling superiorly with countertraction
a patient’s physical exam shows their leg is adducted with internal rotation. what injury is likely?
hip dislocation
identify
posterior hip dislocation
identify
anterior hip dislocation
in which patients is femur shaft fracture most common in?
young patient
what is likely to occur in a femur shaft fracture?
high blood loss
what are 4 complications of a femur shaft fracture?
fat emboli
internal soft tissue damage
frequent nonunion
leg length discrepancy
what is the treatment for a femur shaft fracture?
intermedullary nail within 24 hrs
identify
comminuted femur shaft fracture
identify
spiral femur shaft fracture
in which 2 fractures is skeletal traction used?
femur fractures
acetabulum fractures
what are the 2 most common locations for a skeletal traction?
distal femur
proximal tibia
why do we use skeletal traction? (4)
reduce pain
minimize blood loss
soft tissue rest
decrease muscle contraction
intra-articular fracture of the proximal tibia
tibial plateau fracture
what leads to joint impaction of a tibial plateau fracture?
axial load injury
what diagnostic should be used for a tibial plateau fracture?
CT
what nerve is most commonly injured in tibial plateau fractures?
common fibular nerve
what are 4 complications that a tibial plateau fracture can be associated with?
meniscal tear
ACL injury
compartment syndrome
neurovascular injury
what are 2 treatment options for a tibial plateau fracture?
acute ORIF
temporary external fixator + ORIF later
what are the post-op rules for a tibial plateau fracture?
weight bearing restricted for 12 weeks for healing
identify
tibial plateau fracture
+ fibular head fracture
identify
tibial plateau fracture
what imaging is best for patella fractures?
lateral knee xray
what does a patella fracture lead to?
loss of extensor mechanism
what part of the physical exam determines if a patient with a patella fracture needs surgery or not?
extensor mechanism
what are the 2 non-op treatments for a patellar fracture since extensor mechanism is intact?
knee immobilizer
hinged knee brace locked in extension
WBAT
what are the 2 op treatments for a patellar fracture since extensor mechanism is not intact?
ORIF with k-wires or screws + tension suture
plate/screws
what is the most common patellar fracture?
transverse
identify
transverse patellar fracture
what is the most common knee dislocation? anterior or posterior?
anterior
why will knee dislocation xrays look normal and are easily missed?
half of them spontaneously reduce
what nerve and artery are most at risk in knee dislocations?
common peroneal nerve
popliteal artery
what is the treatment for a knee dislocation? (3)
immediate reduction + stabilization
ankle-brachial index + CT angio
external fixator
identify
posterior knee dislocation
what type of knee dislocation has a higher risk for vascular injury? (popliteal artery)
posterior knee dislocation
identify
anterior knee dislocation
what type of knee dislocation has a higher risk for nerve injury? (common peroneal nerve)
anterior knee dislocation
