UE Fracture

Question 1

where on the clavicle are you most likely to fracture?:

Answer 1

middle third (80%)

Question 2

common deformity from clavicular # involves the medial part moving ___ and the lateral part moving ___

Answer 2

up

down

Question 3

what is the most common way to treat a clavicular #?

Answer 3

sling and swathe for 4-6 weeks

Question 4

how are scapular #s usually treated?

Answer 4

sling and swathe for at least 2-3 weeks

Question 5

when are proximal humerus #s considered displaced?

Answer 5

if the fragment’s moved more than 1cm or angled farther than 45degrees

note 85% prox hum #s are undisplaced

Question 6

describe the three typical displacements of humeral shaft #s and which muscles pull them this way

Answer 6

surgical neck - proximal pulled into ABD and ER by rotator cuff, distal pulled into ADD by pecs

below pecs above delts - prox pulled into ADD by pecs, distal pulled ABD by delts

below delts - prox pulled ABD by delts, distal pulled ADD by biceps/triceps

Question 7

how are the vast majority of shaft #s treated? even ones 3cm off and 30 degrees rotated?

Answer 7

conservative with coaptation splint or hanging cast

Question 8

how are distal humerous #s usually managed?

Answer 8

splinting - posterior elbow for 90 degrees, posterior long arm for slight flexion

Question 9

what is standard management of a olecranon #? what about a radial head #?

Answer 9

olecranon - long arm cast at 45 or 90 flexion for 3 weeks if non-displaced, if displaced a posterior elbow splint following fixation
radial head - simple sling if non-displaced, surgery if displaced

Question 10

what is a nightstick #? how is it usually managed?

Answer 10

ulnar shaft # - sugar tong splint for 7-10d, then sling for 8wks

Question 11

what is a monteggia #?

Answer 11

prox 1/3 ulna # with dislocation of radial head

Question 12

what is a galeazzi #?

Answer 12

prox 1/3 radius # with dislocation of distal radioulnar jt

Question 13

how are most F/A #s managed?

Answer 13

long arm cast at 90 degrees

Question 14

what is the most common type of distal F/A #?

Answer 14

colles - distal radius # with dinner fork deformity (distal part of radius dorsal)

Question 15

what type of # gives a garden spade deformity?

Answer 15

Smith’s #

Question 16

how long are F/A #s usually immobilized?

if a stable fixation of radial head, how soon can one start AAROM?

Answer 16

4-6wks immobilized

if stable, no pron/sup for 3 weeks, AAROM everywhere else ok

Question 17

which part of the schaphoid is most prone to avascular necrosis?

Answer 17

the proximal part

Question 18

pain (in general or when resisting pronation/supination in handshake position), tenderness to palpation in which region of the wrist can indicate a scaphoid #?
what about axial compression of which metacarpal?

Answer 18

anatomical snuff box, first metacarpal

Question 19

how long will a proximal scaphoid # need to be immobilized for?

Answer 19

12-24 weeks!!

Question 20

what causes most metacarpal/phalangeal #s?

Answer 20

punching or hitting

Question 21

what is mallet finger?

Answer 21

cannot extend DIP

Question 22

what are the 5 diagnostic Ps?

Answer 22

pain
pallor
pulseless
paralysis
paresthesia

Question 23

for an undisplaced greater tuberosity #, what 3 things does one have to keep in mind and when can STR training start?

Answer 23

no ER or ABD AA-ROM for 6 weeks, PROM can start after about a week, and do not push EOR in IR

can start isometrics at 6-8wks, RT at 12wks

Question 24

are there any contraindications to humeral shaft # treatment once ok’d by MD?

Answer 24

no

Question 25

how soon can a stable metacarpal/finger # be doing AA-ROM?

Answer 25

within 72 hours to try and prevent contraction

Question 26

what is contraindicated with olecranon # for first 6-8 once out of cast?

Answer 26

can do PROM only except flexion up to 90 degrees but not beyond

Question 27

when can a supracondylar # patient be given AAROM?

Answer 27

after 1-2 wks (remove and replace splint)