Orthopedics Flashcards
Why do humeral fractures usually occur at the distal portion?
The humerus is thinnest at the olecranon fossa. Adolescents are particularly vulnerable to this because they have growth spurts that cause the long bones to be thinner.
In children, ______________ humeral fractures can usually be treated nonoperatively (even ones that are quite angulated).
proximal
What is neuropraxia?
A temporary loss of peripheral nerve function
Example: Radial nerve injuries with humeral shaft fractures are most commonly neuropraxia that resolves in 6-8 weeks.
Supracondylar fractures peak at which ages?
The highest incidence from 3 to 10 with peak years of 5-7. It’s thought that the bone is weaker from growth during this period.
In examining a child suspected of having a supracondylar fracture, what do you need to do?
- First look for signs of compartment syndrome. A grossly swollen elbow with hematomas raises the concern, as does pain with movement of the fingers.
- Next, do a neurovascular exam:
- Motor: radial (wrist extension), ulnar (wrist flexion and adduction, finger spread), median (wrist flexion and adduction, PIP flexion, opponens [thumb to pinky]), and anterior interosseous (flexion of the thumb DIP)
- Sensory: radial (dorsal web space), ulnar (ulnar aspect of palm/dorsum), and median (radial aspect of palm)
- Vascular: cap refill, radial pulse
In suspected supracondylar fractures, you need to also get __________ x-rays.
forearm
Concurrent forearm fractures are positive in 10-15% of supracondylar fractures.
In an elbow radiograph, the ___________ fat pad is always abnormal.
posterior
It is normally hidden in the olecranon fossa.
Review the types of supracondylar fractures.
- I: non-displaced fracture, can sometimes see the fracture but more commonly the fat pads or abnormal elbow lines
- II: displaced fracture with intact posterior cortex
- III: displaced fracture with both anterior and posterior cortices fractured
The three most common elbow fractures in children are _______________________.
lateral condylar fracture, medial epicondylar fracture, and radial neck fracture
Review the basic principles of splinting.
- The goal of splinting is to stabilize both above and below the fracture. If either is free, then movement can stress the fracture and cause displacement.
- Obtain the following supplies: stocking or cotton wrap, splinting material (either orthoglass, fiberglass, or plaster), ace wrap, tape, scissors, water, basin, chucks
- Wrap initially with stocking or cotton padding, then splint, then wrap cotton or stocking around splint edges, and finally wrap splint in ace wrap
- Check neurovascular status afterward
What are red flag symptoms/signs of lower back pain?
- Neurologic dysfunction: saddle anesthesia, incontinence, weakness
- Infectious signs: fever, leukocytosis, chills
- Malignant features: known malignancy, weight loss, night sweats, fever, point tenderness on spinous process
- Hematoma risk factors: trauma, bleed risk
- Ask about PMH of cancer, osteoporosis, IVDU, and bleeding risk factors
Nursemaid’s elbow is technically _________________.
radial head subluxation
Radial head subluxation does not need to be evaluated with ______________.
x-rays
In practice, though, young children may need x-rays because they can’t tell you what hurts.
Radial head subluxation usually presents in children younger than ________.
5 years
The two methods to reduce nursemaid’s elbow are _____________.
hyperpronation and elbow flexion and supination
Hyperpronation: Hold the child’s extended elbow with one hand and put gentle pressure on the radial head. With your other hand, hyperpronate the forearm.
Flexion and supination: With the same hand positioning as earlier, apply gentle longitudinal traction then supinate the child’s forearm and flex the elbow.
Success is judged by the child moving the affected arm.
When shoulder pain improves with abduction, you should be concerned for what type of pain?
Cervicogenic
Shoulder pain that worsens with flexion of the elbow is typical of what kind of shoulder pain?
Bicipital tendinitis
Adhesive capsulitis is suggested by what physical exam features?
Limited passive and active ROM that is not due to pain
This is associated with immobilization of the shoulder (such as from a surgery), diabetes, autoimmune disorders, and hypothyroidism.
The empty can tests the _________ muscle.
supraspinatus
(Think of someone drinking a can in a Toyota Supra.)
Difficulty with internal rotation of the shoulder is indicative of what rotator cuff injury?
Subscapularis
Inability to supinate and probate the hand along with shoulder injury is suggestive of what two rotator cuff injuries?
Teresminor and infraspinatus
True or false: Neer’s test (placing one hand on the scapula and raising the patient’s arm passively) tests for cuff tear.
False
It tests for impingement of the rotator cuffs.
What test evaluated the labrum of the shoulder?
O’Brien’s
Arm brought up to eye level, 10 degrees in, thumb down
The Thessaly test looks for _______ injury.
Meniscus
Have them stand on the leg in question, flex to 20 degrees, and rotate both directions.