UE Fracture part 2 Flashcards
forearm fracture of a single bone w/o disruption of the radioulnar joints is which type of fracture
stable
Radius and ulna along with proximal and distal radioulnar joints create a stable ring which can be injured in which fracture
forearm fracture
forearm fracture of both bones w/o disruption of the radioulnar joints is which type of fracture
unstable fracture
forearm fracture of single bone w/ disruption of one radioulnar joint is which type of fracture
unstable fracture
forearm fracture most common MOI
high impact injuries such as MVA or a fall for height, such as a ladder
another MOI for4 a forearm fracture is
a direct blow
describe a nightstick fracture
it is a stable forearm fracture that is in the mid to distant ulnar shaft region
the management is non surgical, using a functional forearm brace
what is a both bone former fracture
Radial shaft fracture and ulnar shaft fracture
this fracture is unusable
management is surgical
what is a Monteggia fracture
mid to proximal ulnar shaft fracture with an associated radial head dislocation
this fracture is unusable
management is surgical
what is a Galiazzi fracture
Mid to distal radial shaft fracture with an associated carpoulnar dislocation
this fracture is unusable
management is surgical
common name for a Flexor Tendon Avulsion Fracture
jersey finger
Flexor Tendon Avulsion Fracture MOI
Traumatic forced extension of actively flexed finger leads to an avulsion of flexor tendon at base of distal phalanx
Other mechanisms include spontaneous tendon rupture seen in patients with RA
Flexor Tendon Avulsion Fracture clinical presentation
the 4th finger (ring finger is most common)
there will be a visible deformity and the patient will be unable to flex the affected finger at DIP
which joint is affect in Flexor Tendon Avulsion Fracture
DIP
Flexor Tendon Avulsion Fracture management
need early surgical repair (7-10days leads to best recovery)
split the finger in whichever finger it presents and refer to hand surgeon
Distal Phalanx Fracture MOI
direct blow from like a hammer or root
many patients have subungal hematoma so be cautious
Distal Phalanx Fracture no surgical management
splitting– majority of all fx
Distal Phalanx Fracture surgical management
if the fracture is open, angulated more than 15 degrees and displaced more than 2 mm, if conservative management fails or if theres is non- union surgery is needed
Extensor Tendon Avulsion Fracture is also known as
Mallet finger
which joint are you unable to extend in an Extensor Tendon Avulsion Fracture
DIP joint
Extensor Tendon Avulsion Fracture MOI
Traumatic injury to the tip of a fully extended finger leading to avulsion of extensor tendon at base of distal phalanx
Other mechanisms include tendon rupture or tendon laceration
Extensor Tendon Avulsion Fracture clinical presentation
visible deformity and an inability to extend the affected DIP joint
Extensor Tendon Avulsion Fracture non surgical management
Continuous splinting for 6-8 weeks
but if extension is lost at any point, healing is disrupted and the clock starts again
Extensor Tendon Avulsion Fracture surgical management
if there is failure to heal with conservative care, or if the tendon is completely lacerated or is the the fracture involves more than 30% of the articular surface
Mallet fracture treatment
drill .035 k wire through distal phalanx into the middle phalanx and the avulsed fracture is reduced, loop by be needed
the finger is then splinted fir 6 weeks and then k wire is removed
Distal Radial Fracture MOI colle’s Fx
FOOSH w/ wrist in EXTENSION this is most common
Distal Radial Fracture MOI smith’s Fx
FOOSH w/ wrist in FLEXION
common fracture for postmenopausal women
Colle’s Fracture
Colle’s Fx clinical presentation
dinner fork deformity
localized swelling
potential for median nerve injury
Significant ROM limitation
Smith’s Fx clinical presentation
garden spade deformity
localized swelling
potential for median nerve injury
Significant ROM limitation
which Xray should you get for a colle’s fracture
AP and lateral and oblique view
which Xray should you get for a smith’s fracture
AP and lateral and oblique view
Colle’s Fracture Reduction
closed manipulation, wrist dorsiflexed
Distal Radial Fracture non surgical management
if it is not displaces give a short arm case
if it is displaces give a long arm cast to maintain reduction
Distal Radial Fracture surgical management
used when there is a Neurovascular injury, the fracture is open, there is and Intra-articular extension, theres is Severe comminution or if there is an Inability to maintain reduction
Pediatric Distal Radial Fracture
a pediatric distal radial fracture
it is most common in children under 10
Distal metaphysis
Buckling of cortex due to compression failure
Radial Torus “Buckle” Fracture MOI
FOOSH
Radial Torus “Buckle” Fractureclinical presentation
mild to moderate swelling, guarded limited ROM, no visible deformity
Radial Torus “Buckle” Fracture management
short arm was for 4 to 6 weeks
radial Greenstick fracture
a pediatric distal radial fracture
less common than buckle
Complete fracture of the TENSION side of the cortex with buckling of the compression side
radial Greenstick fracture MOI
FOOSH
radial Greenstick fracture clinical presentation
mild to moderate swelling, guarded limited ROM, a visible deformity may be present
radial Greenstick fracture management
Short arm cast for 6-8 weeks
Rarely require surgical management unless significant angulation, neurovascular injury, or Open Fx
Scaphoid Fracture
the most common fractured carpal bone
MOI is FOOSH
Clinical findings
Snuffbox pain / TTP
ROM limitations
Common for Fx to be occult on initial x-ray
Scaphoid Fracture limited blood supply
high incidence of nonunion and osteonecrosis
greenstick on x ray
complete disruption on one side with buckle on opposite side
when is 5th Metacarpal “Boxer’s” Fracture non surgical Management used
less than 15 degrees of angulation
Transverse, oblique, base & head Fx
when to get a surgical consult for a 5th Metacarpal “Boxer’s” Fracture
Open fracture, > 15 degrees angulation, Intra-articular, Comminuted fx, Spiral fx
5th Metacarpal “Boxer’s” Fracture
MC fracture of the hand
Distal metaphysis of 5th metacarpal
MOI is Closed fist striking an object
5th Metacarpal “Boxer’s” Fracture clinical presentation
Localized swelling
+/- malrotation deformity
+/- dropped knuckle deformity
malrotation
pinkie over ring finger
Scaphoid Fracture – Management
Long-arm thumb spica cast for 6-12 weeks
If clinical exam is indicative of fracture but x-rays are negative, splint and repeat x-rays in 10-14 days
If follow up x-rays still negative but clinical concern persists order MRI
Displaced transverse and oblique fractures tend to
angulate
Spiral fractures tend to
rotate
for Fractures of the Metacarpals and Phalanges, Ortho referral for surgical evaluation when?
Displaced (> 2mm), spiral, comminuted and intra-articular fractures
Uncorrected angulation and malrotation
