UE Fractures part 1 Flashcards
what is the most common MOI for a clavicular fracture
Direct fall on the shoulder with arm at side
what is the another MOI for a clavicular fracture
a direct blow
risk factors for clavicular factors
contact sports and being a male until age 75 then
what age do females become more likely to experience clavicular fractures
over 75 years old
how does a clavicular present
deformity at fracture site usually midline
defect may be palatable
crepitus with AROM
Clavicular Fracture neuromuscular exam
subclavian vessels
brachial plexus
Clavicular Fracture locations
middle
distal
medial
is a Clavicular Fracture a non operative treatment?
yes
how do manage Clavicular Fracture
sling or figure 8 brace
when do you need surgical management for a Clavicular Fracture (definitive indications)
it is an open fracture
there is a neruovascular injury
tenting of the skin is present
when do you need surgical management for a Clavicular Fracture (relative indications)
widely displace fractures multiple fracture segments displaced lateral 1./3 fractures dominant extremity in overhead athlete cosmetic concerns
most common Proximal Humerus Fracture MOI
fall onto an outstretched hand
Proximal Humerus Fracture other MOI age groups
simple fall in older people
high energy trauma in young patients
Proximal Humerus Fracture clinical presentation
swelling, ecchymosis, pain, guarding, limited ROM
1 part Proximal Humerus Fracture
Surgical neck, anatomic neck, lesser tuberosity or greater tuberosity
Any fracture pattern with less than 1 cm displacement
2 part Proximal Humerus Fracture
Surgical neck, anatomic neck, lesser tuberosity or greater tuberosity
Fragments must be displaced by 1 cm
3 part Proximal Humerus Fracture
Surgical neck and greater tuberosity or surgical neck and lesser tuberosity
Fragments must be displaced by 1 cm
4 part Proximal Humerus Fracture
Surgical neck, lesser and greater tuberosities
Fragments must be displaced by 1 cm
non surgical Proximal Humerus Fracture management need for
neer type 1
surgical Proximal Humerus Fracture management need for
associated neurovascular injury Open Fx Neer types 2, 3, and 4 Significant distortion of the bicipital groove Fracture dislocation
Midshaft Humerus Fracture MOI
there is a direct blow to humerus
or a bending force applied to the humerus
falling on an out starched hand can also cause this type of fracture
is a pediatric patient presents with Midshaft Humerus Fracture suspect what?
child abuse
Midshaft Humerus Fracture clinical presentation
swelling, ecchymosis
viable shortening may be present
radial nerve neurological screen sensory
dorsum of hand
radial nerve neurological screen motor
wrist dorsiflex
medial nerve neurological screen sensory
palmar aspect of thumb
index finer middle fingers
ulnar nerve neurological screen sensory
palmar aspect of pinkie
ulnar nerve neurological screen motor
dinger abduction
medial nerve neurological screen motor
thumb opposition
Midshaft Humerus Fracture vascular screen
distal pulses radial and ulnar
cap refill
the majority of the time Midshaft Humerus Fracture is managed how?
non surgical with a functional humerus brace
Early shoulder range of motion in mid shaft humerus should be done to
reduce the risk of adhesive capsulitis
what is and adhesive capsulitis also known as
frozen shoulder
when are surgical interventions used for a mid shaft humerus fracture?
Neurovascular injury Open Fx Pathologic Fx > 3 cm shortening > 30° angulation
Pediatric ossification centers (CRITOE)
Capitellum Radial head Internal (medial) epicondyle Trochlea Olecranon External (lateral) epicondyle
Supracondylar Fracture most common MOI
hyperextension injury associated with falling on outstretched hands, resulting in a extension Supracondylar Fracture
other Supracondylar Fracture MOI
a direct blow that will cause a extension or flexion type Supracondylar Fracture
Supracondylar Fractures are seen more commonly in which patient population
pediatrics
Supracondylar Fracture clinical presentation
possible palatable displaced fragment
swelling ecchymosis
Potential for neurovascular injury
Forearm compartment syndrome
Forearm compartment syndrome results in what and presents as what
Volkmann’s ischemia / contracture
Marked swelling of the forearm
Palpable tenseness
Pain with passive extension of the finger
Supracondylar Fracture can mimic which dislocation
posterior elbow dislocation
when do we use a non surgical approach to Supracondylar
type I and type II with reduction
when do we use a surgical approach to Supracondylar
theres a neuromuscular injury
open fracture
type III
Radial Head fracture Most common MOI
FOOSH w/ partially flexed elbow
Radial Head fracture additional MOI
Posterior elbow dislocation
Radial Head fracture clinical presentation
swelling over lateral elbow
limited ROM
which ROMs are especially difficult for patients with Radial Head fracture
Extension, supination
which type of x ray should you get for a suspected Radial Head Fracture
and what sign are you looking for
AP, lateral views AND oblique view
look for fat pad sign
*Type I Fx may be occult on initial x-rays
Radial Head Fracture type I Non surgical
Splint or sling for 5-7 days
allow patients to use the sling for comfort after this time period
Early ROM
Radial Head Fracture type II Non surgical – Minimal displacement
Minimal displacement
Splint for 10-14 days
allow patients to use the sling for comfort after this time period
Aggressive ROM after splint removal
Radial Head Fracture type II Moderate displacement management
open reduction and internal fixation (ORIF)– surgical intervention
Radial Head Fracture type III management
surgery