Upper extremity classifications and surgical HY

Question 1

Clavicle Fx

Answer 1

Allman
1. Middle 3rd fx (80%).
2. Distal 3rd fx (15%).
Type I: interligamentous fx.
Type II: medial to coracoclavicular ligament.
Type IIa: conoid and trapezoid attached to distal frag.
Type IIb: conoid torn, trapezoid attached to distal frag.
Type III: intraarticular fx of AC joint.
3. Prox 3rd fx (5%).
type I: minimally, Type II: displaced, Type III: intraarticular, type IV: epiphyseal, Type V: comminuted.

Question 2

Prox humerus fx

Answer 2

Neer
# of parts-greater tub, lesser tub, shaft, hum head.
Parts displaced >1cm or 45 degree angulation

Question 3

Supracondylar humerus fx

Answer 3

Gartland:
Extension Type: 
1. nondisplaced.
2. displaced w/ intact posterior cortex.
3. complete displacement.
Flexion type:
1. Nondisplaced.
2. Displaced w/ intact anterior cortex. 
3. complete displacement, anterolateral.

Question 4

olecranon fx

Answer 4

Mayo:

1. nondisplaced - 1a. non-comminuted, 1b. comminuted.
2. diplaced - 2a. non-comminuted, 2b. comminuted.
3. unstable - 3a. non-comminuted, 3b. comminuted.

Question 5

radial head fx

Answer 5

Mason:

1. nondisplaced.
2. marginal fx (impaction, angulation).
3. comminuted fx.
4. associated w/ dislocation (johnston)

Question 6

radial head dislocation/prox ulna fx:

Answer 6

Bado:
Monteggia:
1. anterior dislocation/anterior angulation (70%).
2. posterior dislocation/posterior angulation (5%).
3. lateral dislocation/ greenstick ulna (25%).
4. Anterior dislocation/ both bone forearm fx (7%).

Question 7

distal 3rd radius fx/ DRUJ disruption

Answer 7

Galeazzi fx

Question 8

Scapular glenoid fx

Answer 8

Idenberg:

1. Avulsion of anterior rim.
   2a. transverse glenoid fx, exit fossa inferior.
   2b. oblique glenoid fx, exit fossa inferior.
2. oblique glenoid fx, exit fossa superior.
3. Transverse fx, exit medial border of fossa.
4. Type 2 + 4

Question 9

periprosthetic Total shoulder arthroplasty fx

Answer 9

University of Texas san antonia class:

1. Humerus fx proximal to tip of stem prosthesis.
2. huerus fx extends beyond tip of stem prosthesis.
3. fx entirely distal to tip of prosthesis.
4. fx occurs adjacent to glenoid prosthesis.

Question 10

AC joint separation

Answer 10

1. AC ligament sprain.
2. AC ligament Tear.
3. AC + coracoclavicular ligaments torn
4. Distal clavical displaced into trapezius
5. Distal clavicle >100% displaced
6. clavicle displaced inferior to coracoid

Question 11

intercondylar humerus fx

Answer 11

Riseborough & Radin:

1. Non-displaced.
2. Slight displaced, no rotation b/t fragments.
3. Displaced w/ rotation.
4. Comminution of articular surface.

Question 12

Coronoid process fx

Answer 12

Regan & Morrey:

1. Avulsion of tip of process.
2. 50% of coronoid process fx.

Question 13

capitellum fx

Answer 13

Large component of capitellum: Hahn-Steinthal.

Articular cartilage cap: Kocher-Lorenz

Question 14

Distal radius fx

Answer 14

Frykman:
I, II - extraarticular, w/ ulna styloid fx.
III, IV - radiocarpal joint, w/ styloid.
V, VI - radioulnar joint, w/ styloid.
VII, VIII - radiocarpal + radioulnar joint, w/ styloid.

Question 15

Thumb fx:

Answer 15

• 1st MC base fx, avulsion of APL: Bennett.

- Bennet + Y or T type Fx: Rolando.

Question 16

Scaphoid fx blood supply

Answer 16

main blood supply: dorsal scaphoid branch of radial artery entering dorsal ridge 80%.

Question 17

scaphoid fx test

Answer 17

Watson test: wrist ulnar & radial deviation w/ palmar pressure over scaphoid.

Question 18

Scaphoid fx locations

Answer 18

Tuberosity 15%, distal pole 10%, waist 70%, proximal pole 5%.

Question 19

Scaphoid fx time to union

Answer 19

distal 3rd: 8 weeks. Middle 3rd: 10-12 weeks. Proximal 3rd: 12-24 weeks.

Question 20

Scaphoid surgical indications:

Answer 20

> 1mm displacement, >15 angulation (humback deformity), proximal pole fx

Question 21

Scaphoid surgical approach

Answer 21

volar: b/t flexor carpi radialis and radial artery.

Question 22

Healing rate of scaphoid fx with nonoperative tx

Answer 22

Tuberosity & distal 3rd: 100%, waist: 80-90%, proximal pole: 60-70%.

Question 23

distal radius fx acceptable alignment

Answer 23

volar tilt: neutral.

radial inclination:

Question 24

Distal radius operative indication:

Answer 24

Loss of reduction, open fx, loss of volar buttress, articular comminution or step off, DRUJ incongruity.

Question 25

distal humerus single column condyle fx classification

Answer 25

Milch:
Type 1 - lateral trochlear ridge left intact.
Type 2 - Lateral trochlear ridge part of the condylar fragment (medial or lateral)