Section 19 - injuries to bones, joints, soft tissue Flashcards
What radiographs are required for diagnosis of an injury to a long bone?
- Joint proximal and distal xray
Common diagnoses missed by xray?
- Scaphoid, radial head, metatarsal shaft fx
Salter-harris type 1?
- Through the epiphysis
Salter-harris type 2?
- Above the physis (metaphysis)
Salter-harris type 3?
- Below the physis (epiphysis)
Salter-harris type 4?
- Through the epi/meta/physis
Salter-harris type 5?
- Compression of the physis
5 signs of compartment syndrome?
- Pain, pallor, paresthesias, pulselessness, paralysis
Tx of fracture/sprain/strain? Open fx?
- Control swelling, pain control, remove objects such as rings/watches, reduction of fx/dislocation
- Open fx need abx, irrigation, debridement
Test for median nerve motor function on hand?
- Flex thumb against resistance
Test for ulnar nerve motor function on hand?
- Spread fingers against resistance
Test for radial nerve motor function on hand?
- Maintaining extension of wrist and fingers against resistance
What is the best way to test tendon function?
- Test tendon function against resistance, 90% can be torn and still move without resistance
What is mallet finger?
- Rupture of extensor tendon at DIP, flexed at 40 degrees, splint in hyperextension
What is boutonniere deformity?
- Flexor at PIP and hyperextensor of DIP joint, splint PIP in extension
Tx of DIP and PIP joint dislocations?
- Digital block, reduce by distraction, hyperextension, then reposition, splint in full extension
- Be concerned about irreducible joint
Tx of MCP joint dislocations?
- Most likely need surgery, attempt closed reduction and splint with MCP joint flexed 70-90 degrees
Thumb IP joint dislocations tx?
- Closed reduction, thumb in spica splint
Tx of thumb MCP dislocations?
- Reduce by flexing and abducting metacarpal with pressure, place in thumb spica
Tx of thumb MCP ulnar collateral ligament rupture?
- Place in thumb spica splint (gamekeeper or skier thumb)
Tx of MC fractures of fourth or fifth? Tx of MC fractures of second or third? Tx of MC fractures of thumb?
- Ulnar gutter splint, radial gutter splint, thumb spica splint
Which wrist bones can cause avascular necrosis of bone?
- Scaphoid, lunate, capitate
What is a colles fracture?
- Distal radius displaced proximally and dorsally, ulnar styloid may be fractured
What is a smith fracture?
- Distal radius displaced proximally and volarly
What is a barton fracture?
- Volar and proximal displacement of radial articular surface, volar displacement of carpus, radial styloid may be fractured
Difference between proximal long head biceps tendon rupture vs distal tendon rupture?
- Elbow flexion maintained with proximal, weak with distal tendon rupture
How do you test for distal biceps tendon rupture?
- Examiner squeezes muscle belly of bicep with elbow flexed and forearm resting on patient’s lap
Tx of biceps/triceps tendon ruptures?
- Sling, ice, analgesics and referral to ortho surgeon for definitive management, repair in young active patients
Majority of elbow dislocations?
- Posterolateral
What should you be concerned about in elbow dislocation?
- Neurovasc compromise: absence of radial pulse before reduction, systemic injuries suggestive of arterial injury
Which elbow fracture is concerning for NV compromise? What is one feared complication?
- Supracondylar fracture, Volkmann ischemic contracture: refusal to open hand, pain with passive extension of fingers, forearm tenderness, also all nerve problems
Tx of elbow fx nondisplaced?
- Sling immobilization and ortho referral
Tx of elbow fx displaced, open, or NV compromise?
- Admit with immediate ortho
What is monteggia fx?
- Proximal third of ulna with radial head dislocation
What is galeazzi fx?
- Fracture of distal radius with associated distal radioulnar dislocation
Tx of forearm fx?
- Nondisplaced with long-arm splint and referral
- Displaced need ortho consult
Feared complications of sternoclavicular sprains and dislocations?
- Hoarseness, dysphagia, dyspnea, upper extremity paresthesias or weakness = PTX, great vessel problem, trachea problem, esophagus problem
Tx of sternoclavicular sprains/disloactions?
- Ice, analgesics, sling immobilization, if posterior call ortho for ORIF
What should one look for with scapula fx?
- Associated intrathoracic injuries
Views for glenohumeral joint dislocation?
- Ap and scapular Y view
What nerve is injured with proximal humeral fractures?
- Axillary nerve and artery
What nerve is injured with humeral shaft fractures?
- Radial nerve
Tx of pelvic fx?
- Bind, look for other source of bleeding, send to angio with embolization and external fixation, ORIF