Orthopedic Xray Presentation Flashcards
Introduction
Name DOB
Date
Part of body
View
History key questions
Age, Sex, Handedness, Occupation and hobbies
MOI and date
Smoking - affects bone healing
PMHs, AC/AP use - fitness for GA, LA
Examination
Closed
Open - is there a pathway between environment and bone
Neurovascularly intact before and after every intervention
-UL - median, radial, ulnar
Specific tests
-Scaphoid # - press on AS
Management
Analgesia - pain relief
Reduce
Hold - cover half of arm with plaster
Distal radius fracture in adults
High energy, comminuted
Colles - FOOSH, dinnerfork, EA DA
Smiths - inverse FOOSH, EA, VA
Bartons - V or D
Chauffeurs - IA, radial styloid fracture, scaphoid-lunate ligament diastasis
Radial inclination - 22deg
Radial height - 11mm
Ulnar variance +-2mm
Volar tilt - 11-15deg
ORIF needed if
- unstable
- dorsal comminution
- dorsal angulation 20deg+
- IA
- age
- ulnar fracture
- radial height
- prereduction position
Distal radius fractures in children
INCOMPLETE
Often incomplete => buckle, torus
-periosteum is thicker in children so they buckle instead of break
Very rarely need plaster
Splints may be enough
Salter Harris classification - break in relation to growth break
1S - separation
2A - above MOST COMMON
3L - lower
Scaphoid fractures
High index of suspicion - often not visible on initial xray
MOI - high energy, sports
Clinical examination
- press on AS
- scaphoid tubercle tenderness
- deep flexion, extension painful, ulnar deviation
Imaging
-scaphoid series or MRI
IMPORTANT TO DOCUMENT SPECIFICALLY
Proximal pole - poorest blood supply
Greenstick
Could this be non accidental injury - Hx is key
Galeazzi vs Monteggia
GR
Distal 1/3 radius fracture
Ulnar dislocation
UM
Proximal 1/3 ulnar fracture
Radial dislocation
Olecranon
extensor mechanism may be disrupted
Consider age
Elbow radiographic lines
Elbow fat pads - occult bony injury
Supracondylar humerus fracture in paeds
Gartland 1 - UD => plaster 2 - disrupted ant humeral line 3 - displaced 4 - displaced, rotational unstable
Puncture wound, pucker sign Check AIN - ok sign Ulnar nerve Brachial artery Pulse Check colour
Clavicle
SLing
Humeral
Holstein Lewis spiral fracture - radial nerve palsy
Collar and cuff
Hand examination
CRT - injured and non injured comparison
Sensation of both sides of finger
Passive, active movement of fingers
Joint stability comparisons
Passive lateral MCPJ and PIPJ stress
AP - test volar plate
Hand imaging
ASK FOR SPECIFIC IMAGES OF AREA OF CONCERN Xray CT MRI US - dynamic concerns, tendons Bone scan
Sensory innervation of hand
Ulnar - little finger
Radial - dorsal between 1st and 2nd finger
Median - palmar index
Motor function of hand
Ulnar - key pinch’
-Froments sign - thumb flexion = median compensating for ulnar issue
Median -
Radial - wrist drop
Sharp injuries
Concerns over FDS FDP
Tendon lacerations
Must test specifically unless you can see the damage
-FDS, FDP
Wound exploration
zig zag incisions
-prevent contractures forming over joints
Mallet finger
Drooping distal phalanx - unable to ext
-ext tendon ruptured or avulsed bone
Tendinous - finger splints
-keeps finger straight
Bony - Kwire
Digital nerve laceration
Microsurgical nerve repair
Hand infections
-common organisms
Most common - trauma, post op, foreign bodies
S aureus
Mixed - staph, streph
Anaerobes - dog/cat/human bites, IV, DM, dental scrapings
Occupational
-works with water, fish tanks
Dangers of cat bites
Dangers of dog bites
Bacteria needle like teeth => very deep but small skin breaks
Dogs have strong teeth => crush injuries, fractures
Assessment
Hx - predisposing factors
- DM
- IVDU, alcohol, HIV, chronic CS, AI, malnutrition
Symptoms - -local, systemic Signs - -local, systemic -superficial, deep -hand posturing
Trends are useful
FBC, cultures, ESR, CRP
MC&S
Imaging
XRay - FB fragments, fractures
Management
Incision - extension of small/penetrating wounds
Debridement - leave open => let them drain
Irrigation/drains
Splinting to keep it open
ABx - culture before start
Pyogenic flexor tenosynovitis
Kanavel’s cardinal signs
-sausage fingers, pain passive extention
Urgent treatment
-exploration, cont irrigation
Bites, contaminated wounds
DON’T CLOSE THEM IMMEDIATELY
Fight bite
Tooth fragments may be there
Goal of fracture treatment
Restore function
Prevent complications
Get fracture to heal in position that will produce optimal functional recovery
Non operative fracture treatment
Manipulation for reduction if displaced
Hematoma block
LA
IV morphine
Skiers thumb
Collateral thumb ligament torn
