UE, Hip+Femur, General Flashcards
When is a fracture termed complete?
Interrupts both vortices of the bone on orthogonal radiographic views
How long does the humerus take to heal in an adult?
Femur?
What fracture heal fastest?
2 months
4 months
Oblique faster than transverse
What grading system is used to classify open fractures?
What ABx to use for class I? Dose? Class II and III?
Gustilo-Anderson
Cefazolin 1-2g IV
Add Gentamycin 1-1.7 mg/kg IV
What is a grade I vs grade II open fracture?
Grade I is less than 1 cm
Grade II is 5cm long with no contamination or crush, no excessive soft tissue loss, avulsion
What is Delta pressure?
What indicates Compartment syndrome?
Diastolic BP - Direct pressure of the compartment
< 30
What direct pressure measurement indicates compartment syndrome?
> 30-40 indicates ischemic necrosis
What structure runs with the median nerve in the middle of the elbow?
Brachial artery
What kind of splint for humeral shaft fractures?
Sugar-tong (start at outside deltoid, under elbow and into axilla)
Hanging cast
How to diagnose supracondylar fractures with xray?
Anterior humeral line - lateral film, should transects middle third of capitellum
Baumann’s angle - AP film measuring through mid shaft humerus and growth plate of capitellum should be 75
What is a supracondylar fracture?
Peak incidence?
MC type?
What nerve is MC injured?
Distal humerus fracture that occurs proximal to the epicondyles
5-10 y/o
Extension (98%)
Anterior interosseous
Fracture of the capitellum occurs with what else?
Usually d/t what?
Trochlea
Posterior dislocation of the elbow
What is an elbow dislocation?
Most serious complication?
What else can happen?
Disruption bw humerus and the olecranon (ulna)
Brachial a injury
Median n injury
How to reduce Posterior dislocation?
If that doesn’t work?
Cast how?
Apply traction at distal forearm w/elbow flexed 30 degrees and forearm supinate
Downward pressure at prox forearm and apply pressure behind olecranon while maintaining inline traction
Posterior splint w/elbow in flexion
What is the recommended method to reduce Nursemaid’s elbow?
Hyperpronation
Which middle third clavicular fractures should get more immediate ortho consultation?
Severely comminuted or displaced ( > 18mm of initial shortening)
What scapular injuries need ORIF?
Severely displaced coracoid fracture w/ruptured coracoclavicular ligaments
or
Glenoid involvement
What is the bimodal distribution of GH dislocations?
MC type?
20-30 y/o Men
Women in 60s
Anterior - 98%
What is a Hill Sachs deformity?
Compression fracture of the posterolateral aspect of humeral head
What does the FARES technique stand for?
How to do it?
FAst, REliable, Safe
Patient supine, head of bed elevated 20-30 degrees, hold their wrist and oscillate while abducting the arm, at 90 degrees externally rotate and abduct up to 120 while holding traction
What is the Cunningham method to reduce anterior shoulder dislocation?
Patient sitting up in a chair VERY straight. Adduct and fully flex elbow against your body. Provide traction on wrist while patient shrugs shoulders superior and posterior while massaging trap, deltoid, biceps
What is the special view to get for clavicle?
Zanca view —> AP w/15 degree cephalic tilt view
What type of clavicle fracture requires more urgent Ortho consult? Why?
Describe it
Type II lateral, 30% nonunion
Assoc w/torn coraclavicular ligament
When is reasonable to get X-rays in a pt with low back pain?
What are you looking for?
Pt has osteopenia or on chronic steroids
Occult spontaneous compression fracture
What is the ABx regimen for epidural abscess?
Vancomycin 30-60 mg/kg plus Metronidazole 500mg plus Ceftriaxone 2g
What are the stats on hip fracture?
20% die w/in first year after injury
33% require nursing home
< 33% regain pre-injury function
What kind of fracture does a leg w/external rotation w/shortening suggest?
Intertrochanteric fracture
What is a stress fracture of the lateral femoral neck called?
Medical?
Tensile
Compressive
How does a posterior hip dislocation present?
D/t what?
Adducted, flexed, Internally rotated
MVC
What is Shenton’s line?
Disruption indicates what?
Smooth curved line drawn along superior border of obturator foramen and medial aspect of the femoral metaphysis
Femoral neck fx or hip dislocation
What are the 3 ways to reduce hip dislocation?
All is
Stimson
Captain Morgan
