"Special" Fractures Flashcards
Mallet Finger
Disruption of extensor mechanism, often associated with avulsion fracture
Mallet Finger - MOI
Forced flexion of extended DIP
Mallet Finger - Rx
Splint in extension, then initiate AROM
Scaphoid Fracture - MOI
Fall on outstretched hand (FOOSH)
Scaphoid Fracture - Rx
Closed reduction and casting; ORIF and bone grafting if avascular
-AVN and non-union are frequent complications
Perilunate Fracture
Axial loading into hyperextension and ulnar deviation
Perilunate Fracture - MOI
High energy impact, typically young adults
Perilunate Fracture - Rx
Immediate ORIF
Boxer’s Fracture
Fracture of the 4th or 5th metacarpal
Boxer’s Fracture - MOI
Usually a blow with a clenched fist
Boxer’s Fracture - Rx
Closed reduction and casting; ORIF if significant displacement
Bennett’s Fracture
Fracture/dislocation of base of 1st metacarpal
Can be highly functionally limiting
Bennett’s Fracture - MOI
Axial loading of a partially flexed thumb
Bennett’s Fracture - Rx
Closed reduction with thumb spica or ORIF
Colles’ Fracture
- “dinner fork deformity”
- Transverse fracture of distal radius with dorsal/lateral displacement
- Common in post-menopausal women, associated with OP
Colles’ Fracture - MOI
FOOSH
Colles’ Fracture - Rx
Closed reduction and casting if not comminuted; ORIF if comminuted
Smith’s Fracture
- Fracture of the distal radius with palmar/medial displacement
- Common in young men, usually a fall or blow to the back of hand
Smith’s Fracture - MOI
Fall onto flexed or pronated wrist
Smith’s Fracture - Rx
Same as Colles’
Monteggia Fracture
- Fracture of proximal or mid 1/3 ulna with radial head dislocation
- Radial head dislocation may be overlooked
Monteggia Fracture - MOI
FOOSH or direct blow (MVA)
Monteggia Fracture - Rx
Usually ORIF and rigid immobilization
Galeazzi Fracture
Fracture of distal 1/3 of radius with distal radioulnar joint disruption
Galeazzi Fracture - MOI
Fall onto outstretched hand or direct blow (MVA)
Galeazzi Fracture - Rx
ORIF and rigid immobilization
Radial Head Fracture
Valgus force impaction of capitulum onto radial head
Radial Head Fracture - MOI
Axial loading on a pronated and partially flexed or outstretched arm
Radial Head Fracture - Rx
Usually ORIF, rarely closed reduction with casting or early ROM
Humeral Fractures
May be diaphyseal (younger), proximal (older), or distal (children)
Humeral Fractures - MOI
FOOSH/E, or direct blow
Humeral Fractures - Rx
Often closed reduction and immobilization, otherwise ORIF
Greenstick Fracture
Common in children, periosteal sleeve remains intact
Greenstick Fracture - MOI
Usually a bending force - fall or direct blow
Greenstick Fracture - Rx
Cast immobilization
Clavicle Fracture
Typically affects middle 1/3 of clavicle
Clavicle Fracture - MOI
Fall onto or direct blow to the shoulder
Clavicle Fracture - Rx
Figure-8 sling for nondisplaced fractures
Femoral Shaft Fracture
May be related to osteoporosis, metastatic disease, TKA
Femoral Shaft Fracture - MOI
Usually high-energy trauma (MVA), often accompanied by significant soft tissue trauma
Femoral Shaft Fracture - Rx
IM nailing, ORIF, or external fixation
Tibial Plateau Fracture
Critical lode bearing area, often associated with meniscal and/or ligamentous damage
Tibial Plateau Fracture - MOI
Valgus force with axial loading
Tibial Plateau Fracture - Rx
Functional bracing, ORIF if displaced > 5 mm
Tibial Shaft Fracture
Most commonly fractured long bone
Tibial Shaft Fracture - MOI
Usually high-energy trauma
Tibial Shaft Fracture - Rx
IM nailing, ORIF or external fixation
Talus Fracture
Considered intra-articular
Prone to avascular necrosis
Associated with lumbar spine burst or compression fractures
Talus Fracture - MOI
Fall from height or trauma
Talus Fracture - Rx
ORIF and immobilization
Calcaneal Fracture - MOI
Fall from height
Calcaneal Fracture - Rx
Strict immobilization and elevation, then protected weight-bearing - possible ORIF