"Special" Fractures

Question 1

Mallet Finger

Answer 1

Disruption of extensor mechanism, often associated with avulsion fracture

Question 2

Mallet Finger - MOI

Answer 2

Forced flexion of extended DIP

Question 3

Mallet Finger - Rx

Answer 3

Splint in extension, then initiate AROM

Question 4

Scaphoid Fracture - MOI

Answer 4

Fall on outstretched hand (FOOSH)

Question 5

Scaphoid Fracture - Rx

Answer 5

Closed reduction and casting; ORIF and bone grafting if avascular
-AVN and non-union are frequent complications

Question 6

Perilunate Fracture

Answer 6

Axial loading into hyperextension and ulnar deviation

Question 7

Perilunate Fracture - MOI

Answer 7

High energy impact, typically young adults

Question 8

Perilunate Fracture - Rx

Answer 8

Immediate ORIF

Question 9

Boxer’s Fracture

Answer 9

Fracture of the 4th or 5th metacarpal

Question 10

Boxer’s Fracture - MOI

Answer 10

Usually a blow with a clenched fist

Question 11

Boxer’s Fracture - Rx

Answer 11

Closed reduction and casting; ORIF if significant displacement

Question 12

Bennett’s Fracture

Answer 12

Fracture/dislocation of base of 1st metacarpal

Can be highly functionally limiting

Question 13

Bennett’s Fracture - MOI

Answer 13

Axial loading of a partially flexed thumb

Question 14

Bennett’s Fracture - Rx

Answer 14

Closed reduction with thumb spica or ORIF

Question 15

Colles’ Fracture

Answer 15

• “dinner fork deformity”
• Transverse fracture of distal radius with dorsal/lateral displacement
• Common in post-menopausal women, associated with OP

Question 16

Colles’ Fracture - MOI

Answer 16

FOOSH

Question 17

Colles’ Fracture - Rx

Answer 17

Closed reduction and casting if not comminuted; ORIF if comminuted

Question 18

Smith’s Fracture

Answer 18

• Fracture of the distal radius with palmar/medial displacement
• Common in young men, usually a fall or blow to the back of hand

Question 19

Smith’s Fracture - MOI

Answer 19

Fall onto flexed or pronated wrist

Question 20

Smith’s Fracture - Rx

Answer 20

Same as Colles’

Question 21

Monteggia Fracture

Answer 21

• Fracture of proximal or mid 1/3 ulna with radial head dislocation
• Radial head dislocation may be overlooked

Question 22

Monteggia Fracture - MOI

Answer 22

FOOSH or direct blow (MVA)

Question 23

Monteggia Fracture - Rx

Answer 23

Usually ORIF and rigid immobilization

Question 24

Galeazzi Fracture

Answer 24

Fracture of distal 1/3 of radius with distal radioulnar joint disruption

Question 25

Galeazzi Fracture - MOI

Answer 25

Fall onto outstretched hand or direct blow (MVA)

Question 26

Galeazzi Fracture - Rx

Answer 26

ORIF and rigid immobilization

Question 27

Radial Head Fracture

Answer 27

Valgus force impaction of capitulum onto radial head

Question 28

Radial Head Fracture - MOI

Answer 28

Axial loading on a pronated and partially flexed or outstretched arm

Question 29

Radial Head Fracture - Rx

Answer 29

Usually ORIF, rarely closed reduction with casting or early ROM

Question 30

Humeral Fractures

Answer 30

May be diaphyseal (younger), proximal (older), or distal (children)

Question 31

Humeral Fractures - MOI

Answer 31

FOOSH/E, or direct blow

Question 32

Humeral Fractures - Rx

Answer 32

Often closed reduction and immobilization, otherwise ORIF

Question 33

Greenstick Fracture

Answer 33

Common in children, periosteal sleeve remains intact

Question 34

Greenstick Fracture - MOI

Answer 34

Usually a bending force - fall or direct blow

Question 35

Greenstick Fracture - Rx

Answer 35

Cast immobilization

Question 36

Clavicle Fracture

Answer 36

Typically affects middle 1/3 of clavicle

Question 37

Clavicle Fracture - MOI

Answer 37

Fall onto or direct blow to the shoulder

Question 38

Clavicle Fracture - Rx

Answer 38

Figure-8 sling for nondisplaced fractures

Question 39

Femoral Shaft Fracture

Answer 39

May be related to osteoporosis, metastatic disease, TKA

Question 40

Femoral Shaft Fracture - MOI

Answer 40

Usually high-energy trauma (MVA), often accompanied by significant soft tissue trauma

Question 41

Femoral Shaft Fracture - Rx

Answer 41

IM nailing, ORIF, or external fixation

Question 42

Tibial Plateau Fracture

Answer 42

Critical lode bearing area, often associated with meniscal and/or ligamentous damage

Question 43

Tibial Plateau Fracture - MOI

Answer 43

Valgus force with axial loading

Question 44

Tibial Plateau Fracture - Rx

Answer 44

Functional bracing, ORIF if displaced > 5 mm

Question 45

Tibial Shaft Fracture

Answer 45

Most commonly fractured long bone

Question 46

Tibial Shaft Fracture - MOI

Answer 46

Usually high-energy trauma

Question 47

Tibial Shaft Fracture - Rx

Answer 47

IM nailing, ORIF or external fixation

Question 48

Talus Fracture

Answer 48

Considered intra-articular Prone to avascular necrosis Associated with lumbar spine burst or compression fractures

Question 49

Talus Fracture - MOI

Answer 49

Fall from height or trauma

Question 50

Talus Fracture - Rx

Answer 50

ORIF and immobilization

Question 51

Calcaneal Fracture - MOI

Answer 51

Fall from height

Question 52

Calcaneal Fracture - Rx

Answer 52

Strict immobilization and elevation, then protected weight-bearing - possible ORIF