Upper/Lower Extremity Lecture Flashcards
90% of elbow dislocations are…
posterolateral
MOI usually FOOSH
pt holds elbow in 45 degrees of flexion, signifcant swelling obscures olecranon (which is displaced posteriorly)
Elbow dislocations
Ulnar Nerve
Brachial artery
..most frequently injured structres in?
Elbow dislocations
Reduction
Long arm posterior splint to immobilize elbow in slightly less than 90 degrees flexion
Elbow dislocation tx
95% of supracondylar fractures are extra articular and commonly seen in…
kids
Lateral elbow pain and tenderness
inability to fully extend elbow
(RADIAL HEAD, SUPRACONDYLAR OR OLECRANON FX?)
Radial head
Significant swelling, tenderness and limited ROM
(RADIAL HEAD, SUPRACONDYLAR OR OLECRANON FX?)
Inter and supracondylar fractures
(supracondylar fractures may resemble a posterior elbow dislocation)
Presence of abnormal fat pads on XRay
(any posterior effusion or a very prominent anterior fat pad called a “sail sign”
Elbow fracture!
What type of splint do you use for a elbow fracture
Long arm posterior splint
True or False..
Middle third of clavicle is involved in 80% of fractures
True
Most common injury associated with scapula fractures?
Rib fractures
MOI= direct trauma to shoulder with arm adducted
Type I-III: treat with sling immobilization, ice, analgesics, early ROM at 7-14 days
Type IV-VI: ortho for surg repair
AC joint injuries
Glenohumeral joint dislocations are most commonly ________ dislocations
Anterior
MC nerve injured with glenohumeral dislocations
(can be tested by testing sensation over lateral deltoid)
Axillary N
MC population of ppl who have prximal humerus (humeral head) fractures?
and MC MOI?
Elderly pts with osteoporosis, FOOSH
Pain, swelling, ecchymosis, tenderness, abnormal mobility
MC injury= axillary N
Tx= sling immobilization
Proximal humerus fracture
Fracture of the proximal ulna shaft with radial head dislocation
Presents with significant pain and swelling over elbow
*VERY obvious XRay
Monteggia Fracture-Dislocation
Fracture of the distal radius with an associated distal radioulnar joint dislocation
presents with localized swelling and tenderness over distal radius and wrist
*very obvious xray
Galeazzi Fracture-dislocation
Thumb ulnar collateral ligament rupture, AKA
Gamekeeper’s thumb
Forced radial abduction at MCP joint
tx= splint in thumb spica and refer
Gamekeeper’s thumb (thumb ulnar collateral ligament rupture)
increased pressure in a confined muscle compartment that results in functional and circulatory impairment of a limb
MC sites= legs and forearm
Compartment syndrome
normal tissue perfusion is <10 mmHg
comparment pressures of _______mmHg are detrimental to nerves and muscles
30-50 mmHg
Severe, out of proportion pain
pain with passive stretch
swollen, firm and tender to palpation
(color and temp are normal. pulses are felt until late in dz process)
Compartment syndrome
A delta pressure of ______mmHg is used to diagnosed acute compartment syndrome
30 mmHg
Tx=
surgical fasciotomy!!
elevate affeected limb to level of heart
remove any restrictive casts, dressings, etc
Comparment syndrome
For compartment syndrome, the best outcomes happen if treatment occurs within…
6 hours
Sulcus sign is seen with…
Glenohumeral dislocation
MC shoulder dislocations are anterior
..what are the 2 causes of posterior dislocations?
Seizure
Lightening
a dent in the back of the humeral head which occurs during the dislocation as the humeral head impacts against the front of the glenoid.
Hill-Sachs lesion
Key exam finding for rotator cuff injury?
Limited ROM
Which type of pelvic fracture is “stable” and pts can walk in
Ramus fracture
What should you do before putting a foley in a pelvic fx patient
Check urethral opening for blood
2 best images for pelvic fx pts
XRay
CT
If pt has a negative xray but cannot walk, what image should you get next?
CT
(acetabular fractures do not always show up on xrays)
Shortened and externally rotated
classic hip fracture
Shortened and internally rotated
hip dislocation
90% of hip dislocations are _______
posterior
(may have associated acetabular or femoral head fracture)
If a hip fracture is not seen on XRAY, this image has a near 100% sensitivity for occult fractures
MRI
Hallmark ED management for a femur fracture
Traction splint (Hare)
If a pt has an open femur fracture, what do they need
Broad spectrum abx
MC knee dislocations are _______
anterior
(spontaneous reduction occurs in ~50%)
______ dislocations are more common in women and result from a twisting injury on an extended knee
patellar
A high incidence of associated injuries to the popliteal artery and peroneal nerve, as well as ligaments and meniscus exists with…
knee dislocations
(aka why only ortho should deal with them)
In a knee dislocation,
do normal distal pulses rule out popliteal artery injury?
NO
What is the management of a knee dislocation?
Contact ortho ASAP!!!
Need immediate reduction
Admission is mandatory for obsevation of neurovascular status
ACL tears account for ~___% of all hemarthroses
75%
ACL..positive Lachman, Anterior drawer
Posterior drawer tests for…
PCL
what is the most common, medial or lateral mensical injury?
medial!
bc it is connected to the MCL, whereas the lateral side is not connected to anything and can move more freely
painful locking of knee
popping, clicking or snaping
sense of instability
+McMurrarys test (but not sensitive)
Meniscal injury
What movement should you always ask your knee injury pts to do? and why?
Knee extension (to rule out quad rupture)
MOI: valgus or varus forces combined with axial load that drives the femoral condyle into the tibia
Tx= non-displaced, unilateral fx: knee immobilizer with non weightbearing. refer to ortho 2-7 days
Tibial plateau fractures
THESE ARE VERY HARD TO SEE ON XRAY!!
Bi and trimalleolar fractures required…
open reduction internal fixation (ORIF)
Wet sterile dressing coverage
Splinting
Tetatnus
1st generation cephalosporin
…treatment for what kind of ankle fractures
Open fractures
How should you splint an Achilles rupture?
Splint in full plantar flexion
True or False…
calcaneal fractures usually happen bilaterally
True
combination of spiral fracture of the proximal fibula and ankle injury which could manifest by widening of the ankle joint due to distal tibiofibular syndesmosis and/or deltoid ligament disruption, or fracture of the medial malleolus. It is caused by pronation external-rotation mechanism
Maisonneuve fracture
(always check the proximal fibula for tenderness with an ankle injury)
