Upper Extremity Flashcards
Most sensitive examination finding for wrist fractures
Pain with wrist extension (95.7% sensitivity)
A common fracture in children after FOOSH injury is _____ fracture of the distal radius (+/- ulna), a type of incomplete compression fracture characterized by bulging of one side
Buckle or Torus fracture
Treatment of buckle fracture of distal radius +/- ulna
3 weeks of immobilization (commonly volar wrist splint vs soft cast) followed by gradual return to activity. May not even need a clinic visit to assess healing given low rate of complications, but reasonable to have them come back for evaluation to determine further need for X-ray
How does a greenstick fracture differ from a buckle fracture?
Greenstick fracture: cortical disruption on tension side + cortical bulging on compression side
Buckle fracture: incomplete fracture just showing cortical bulging, no disruption
Management of greenstick fractures (<10 years old)
If angulation <20-30 degrees in sagittal alignment and <50% displacement, management similar to buckle fractures
Management of NON-DISPLACED (or minimally displaced) distal radius fracture (adults)
[if applicable] closed reduction followed by X-ray to confirm alignment
Sugar-tong splint x3 days –> X-ray to determine continued non-displacement –> short arm cast x4-6 weeks (until fracture site is nontender and X-ray shows healing)
Displaced distal radial fractures: ortho referral indicated if:
- radial step-off is >____ mm
- involvement of articular surface of distal radial-ulnar joint
- > ____ degrees of _____ (dorsal/volar) angulation
- > ____ mm radial shortening after reduction
- radial step-off is >2 mm
- involvement of articular surface of distal radial-ulnar joint
- > 10 degrees of dorsal angulation
- > 2 mm radial shortening after reduction
A ______ fracture is a distal radius fracture with dorsal displacement of the distal radius fragment
Colles
A Colles fracture is a distal ______ fracture with _____ displacement of the distal fragment
Radius, Dorsal
A Smith fracture is a distal ______ fracture with _____ displacement of the distal fragment
Radius, Volar
A _____ fracture is a distal radius fracture with volar displacement of the distal fragment
Smith
Management of isolated NON-DISPLACED distal ulnar fracture (“Nightstick fracture”)
Ulnar gutter (posterior) splint x10 days –> plaster sleeve or functional brace x4-6 weeks
If an isolated ulna fracture is identified via X-ray, it is important to rule out dislocation of _____
radial head (ulna fracture + dislocation of radial head = Monteggia fracture)
Isolated ulnar fractures are stable if <_____ degrees angulation and >_____% apposition
<10 degrees, >50% apposition
Combined fractures of the radius and ulna requires orthopedic evaluation. Immobilize with sugar-tong splint and then refer to ortho, to be seen within 48 hours
Combined fractures of the radius and ulna requires orthopedic evaluation. Immobilize with sugar-tong splint and then refer to ortho, to be seen within 48 hours
Radial head fractures are associated with limitations of range of motion, notably elbow ____ and ____
extension, supination
Injury with limited elbow extension and supination should make you suspicious for _______
Radial head fracture
Radial head fracture presents with limitation of ROM of elbow __________ and __________
Elbow extension and supination
Management of nondisplaced radial head fracture
Posterior arm splint (holds elbow in 90 degrees flexion) x3 days –> sling x2 weeks
Longer immobilization results in stiffness without improvements in healing, but extend restrictions of use to 4 weeks generally
Ulnar fracture + dislocation of radial head = ________ fracture
Monteggia
Place in sugar-tong splint and URGENT ortho referral - needs operative management
Radial fracture + distal radioulnar joint dislocation = ________ fracture
Galleazzi
Requires operative management
Distal radius fractures: The _____ nerve is commonly affected, with injury to the nerve present in up to ________ of patients
Median, 25%
What finding on physical exam would make a radial head fracture need to go to ortho?
Instability of MCL or LCL of elbow
Management of mallet fracture
Strict immobilization x8 weeks in extension (to slightly hyperextension)
Splints: Aluminum splint with dorsal padding, Volar splint, or Thermoplastic stack splint
Mallet finger is avulsion of the ________ tendon at the DIP
Extensor tendon
Indications to refer a mallet finger to ortho (2)
- Fracture involving >1/3 of the joint surface
- Inability to passively extend DIP
Indications for ortho referral for distal phalanx fractures (3)
- Inability to flex/extend DIP
- Loss of distal sensation
- Complex fractures
Management of distal phalanx fractures (if no indications for ortho referral)
Splint DIP in full extension x4-6 weeks
Jersey finger is an avulsion fracture of the ____________ muscle
Flexor digitorum profundus (avulses at the site where the FDP tendon attaches to the volar base of the distal phalanx)
Jersey finger most commonly occurs in the ___th finger
4th
Examination findings of Jersey finger
Volar-sided pain, inability to actively flex DIP joint
Management of Jersey finger
ORTHO (in the meantime, splint DIP and PIP in slight flexion)
Classic physical examination finding of middle or proximal phalanx fractures
Malrotation (when flexed, all fingers should point to the scaphoid)
Indications for ortho referral for middle/proximal phalanx fractures (a lot of indications)
- Malrotation on exam
- X-ray showing oblique, spiral, displaced, or rotational fractures
- Intra-articular fractures
- > 10 degrees angulation
Management of NON-DISPLACED, EXTRA-ARTCIULAR proximal/middle phalanx fractures
Buddy taping x3-4 weeks (apply the tape/wrap in the proximal phalanx and the middle phalanx)
I did not create cards about finger dislocations
Clavicle fractures:
_____% in the middle
_____% distal
_____% proximal
80% in the middle
15% distal
5% proximal
When is ortho needed for midshaft clavicle fracture?
Neurovascular compromise
Open fracture
Skin tenting
Otherwise generally not needed, even if fairly significantly displaced. Though if “completely displaced” (e.g. more than 1 bone width or shortening >14-18mm)
Most common mechanism for clavicle fractures
Direct blow to the shoulder
Management of midshaft clavicle fractures (assuming ortho referral is not needed)
Figure-of-eight OR arm sling for 4-8 weeks (until crepitus resolves and tenderness is minimal or absent)
Sling is preferred if non-displaced or minimally displaced, as it is more comfortable and healing is comparable
3 types of distal clavicle fractures and their management
Type 1: Nondisplaced and ligaments are not affected –> sling x3-6 weeks
Type 2: Displaced and coracoacromial ligaments are ruptured –> Sling/Swath and ortho referral (needs surgery)
Type 3: Intra-articular fracture (into AC joint) –> sling x3-6 weeks (has high rate of AC joint pain in the future)
Proximal clavicle fracture management
Sling x3-6 weeks followed by X-ray (unless significantly displaced, SC joint dislocation, or NV injury)
