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UL Ox > UL Fracture Ox > Flashcards

UL Fracture Ox Flashcards

1
Q

Common Fx locations for Long Bones Ox Management

Anatomy Review

A

Diaphysis (middle of bone)

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2
Q
  • Normal
  • Transverse
  • Oblique

Types of Fx

A
  • No Fx
  • perpendicular to long axis
  • angled fx
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3
Q
  • Spiral
  • Comminuted
  • Segmental
  • Avulsion

Types of Fx

A
  • Fx in a twisting pattern
  • bunch of fractures
  • chunk out of the bone
  • yanked by tendon
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4
Q
  • Impacted
  • Torus
  • Greenstick

Types of Fx

A
  • bone smushes itself
  • pediatric; buckle fracture
  • bone partially fractures
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5
Q

Spatial Relationships

Fracture Terminology

A
  • Distracted - seperation in long axis
  • Displaced - seperation along the short axis
  • Angulated - angle of fracture
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6
Q

Fracture Heal General Process

A
  • Inflammation/hematoma
  • Blood floods the fracture, bruising occurs
  • new blood vessels form (callus grows)
  • outer surface of callus hardens
  • osteoblasts develop
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7
Q

X-Rays needed to evaluate healing

A

AP - varus
Lateral - Ext. (AKA anterior angulation)

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8
Q

What does “cloudiness” indicate on a radiograph of a fracture healing?

A

Osteoblasts formation

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9
Q

Remodeling

Fx healing

A

tries to make bone the original shape and size

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10
Q

What can you measure to evaluate a fx after it heals?

A

Varus angle

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11
Q

Surgical Cons

Fracture Management

A
  • bone fragments are rigidly fixed (no motion)
  • frequent pain and Sx complications
  • delayed healing
  • bone is relatively weaker after Sx
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12
Q

Orthotic Pros

Fracture Management

A
  • micromotion at fx site
  • movement of adjacent joints
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13
Q

Sarmiento Treatment Principles

A
  • micromotion at fracture site (osteogenesis)
  • soft tissue compression
  • minor shortening, angulation, and rotation are NOT complications
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14
Q

Humeral Fx

MOI

A
  • Adults - low energy injury (fall from height; rotation)
  • Pediatrics - high energy injury (MVA)
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15
Q

Ulnar Fx

MOI

A
  • Adult - Direct Blow
  • Pediatrics - Indirect injury; typically a fall an outstretched hand or child abuse
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16
Q

Colles Fx (distal radius)

MOI

A
  • Fall on outstretched hand
  • wrist ext. and radial deviation

usually older patients

17
Q

Humeral Fx - Sx indications

Clinical Descision Making

A
  • unaccepted position after reduction
  • radial nerve palsy
  • open fx
  • comminuted fx
  • pathologic fx (cancer)
  • both forearm bones
  • poly-trauma
  • compartment syndrome
18
Q

Humeral Fx

Acceptable Outcomes

A
  • anterior angualtion < 20 degrees
  • varus angulation < 30 degrees (loss of carrying angle)
  • no more that 1” of shortening
19
Q

Humeral Fx - Ox indications

Clinical Decision Making

A
  • capable of performing ROM exercises (crucial for osteogenesis)
  • normal sensation
  • no open wounds
  • can follow/adhere to protocol
20
Q

Ox typical wear schedule

A

usually full time; removed for hygiene if cleared by physician

21
Q

Pre-Ox Management

Humeral Fx

A

Coaptation (“Sugar Tong”) Splint

controls pain and edema

22
Q

Initial Application

Humeral Fx

A

7-14 days

23
Q

Fitting Parameters

Humeral Fx Ox

A
  • 1” distal to axilla
  • 1” proximal to humeral epicondyles

Does not need to extend past the fracture

Key Mechanism - Compression of Soft Tissue

24
Q

Treatment Protocol

Humeral Fx Ox

A

Orthosis is worn full time
* Codman’s “home” exercises
* avoid active shoulder abduction

25
Q

Discontinuation of Ox

Humeral Fx Ox

A
  • abscence of pain
  • observation of osseous bony bridge between fragments
26
Q

Compications

Humeral Fx Ox

A
  • Nerve Palsy - radial nerve; entrapment of nerve in callous
  • Malalignment - deformities are usually well tolerated; cosmesis
  • Delayed Union - frank motion is present at fx site
  • Re-fracture - very rare; new fx will occur above or below old fx site
27
Q

Ulnar Fx - Sx indications

Clinical Decision Making

A
  • unacceptable position post reduction
  • unstable
  • more than 50% displaced
  • open fx
  • more than 15 degrees angulation
  • disruption of interosseous membrane
28
Q

Ulnar Fx - Sx

Acceptable Outcomes

A
  • less than 15 degrees angulation
  • shortening is not a concern (other bone)
29
Q

What level is Ox management effect for?

Ulnar Fx

A

distal 2/3 of forearm

proximal 1/3 will need Sx (i.e. Monteggia)

30
Q

Ulnar Fx Ox

Treatment Protocol

A
  • distal 2/3 only
  • start w/ long arm cast for 1 week (elbow at 90 and in supination)
  • transition to sleeve orthosis
31
Q

Ulnar Fx Ox

Fitting Parameters

A
  • free motion of wrist and elbow
  • no explicit guidelines (except bicepital mark)
32
Q

Ulnar Fx Ox

Treatment Protocol

A
  • full time except for bathing and exercises
  • discontinued after resolution of symptoms (regardless of healing phase)
33
Q

Ulnar Fx Ox

Complications

A
  • Malalignment - rare; interosseous membrane usually prevents this
  • Delayed Union- failure to achieve will require sx
  • Re-fracture - very rare with ox, common with plating
34
Q

Colle’s Fx

Clinical Decision Making

A
  • Limited evidence that Ox is beneficial
  • Moderate evidence that rigid immobilization is better than Ox
  • Sx usually indicated
35
Q

Surgical Indications

Colle’s Fx

A
  • Higher incidence instability vs. more proximal fx
  • displacement more common and difficult to reduce with cast or Ox
  • Percutaneous pinning techniques usually advocated
36
Q

Colle’s Fx Orthoses

Design and Indication

A

Originally used to address re-dislocation following closed reduction

  • Long arm cast for one week (90 degrees flexed and in supination)
  • Replaced with a Muenster style cast or Ox

Cast designed to eliminate pronation/supination

37
Q

Colle’s Fx Ox

Treatment Protocol

A
  • Full time except for bathing and exercises
38
Q

Colle’s Fx

Complications

A
  • Malalignment - rare; interosseous membrane usually prevents this
  • Delayed Union- failure to achieve will require sx
  • Re-fracture - very rare with ox, common with plating

UL Ox (11 decks)

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