Week 6 Flashcards
MOI for pelvic injuries
Younger - high energy
Older - osteoporosis, low energy
what is at risk with pelvic injuries
internal iliac arterial system
pre-sacral venous plexus
bladder and urethral injuries
open fracture initial management
reduce displacement
what is essential in pelvic injuries
PR exam
- presence of blood indicates rectal tear
what type of hip injuries do the elderly getting
pubic rami fractures
displaced lateral compression injuries w/ sacral fracture or SI joint disruption
common MOI for humeral neck fractures
low energy
osteoporotic bone
FOOSH
most common pattern for humeral neck fractures
fracture of surgical neck
medial displacement of the humeral shaft
Mx of humeral neck fracture
minimally displaced - conservatively w/ sling and rehab
displaced - internal fixation
complications of humeral neck fracture
stiffness
chronic pain
failure of fixation
what type of fractures usually require shoulder replacement
head splitting fractures
what is a Bankart lesion
detachment of the anterior glenoid labrum and capsule
what is a Hill-Sachs lesion
posterior humeral head impacts on the anterior glenoid causing an impaction fracture of the posterior head
what is the principal sign of axillary nerve injury
loss of sensation in the regimental badge area
what can be done to improve stability in people with ligamentous laxity
capsular shift
physio
MOI of posterior shoulder dislocation
posterior force on the adducted and internally rotated arm
Tx for posterior shoulder dislocation
closed reduction
period of immobilisation
physio
MOI of ACJ injuries
fall onto the point of the shoulder
can be sprain/subluxed/dislocated
Mx of ACJ injuries
conservative Mx - sling
physio for a few weeks
chronic pain - surgery
up to what degree of angulation can be tolerated in humeral shaft fractures
30 degrees
what is susceptible in humeral shaft fractures to damage and how would it manifest
radial nerve
wrist drop and loss of sensation in the first dorsal web space
Tx of humeral shaft fractures
humeral brace - most common
internal fixation w/ nail,plate,screws
non-union - plating and bone grafting
MOI for olecranon fractures
fall onto the point of the elbow with contraction of the triceps muscle
Mx for olecranon fractures
ORIF to restore triceps functio
what does a diaphysial fracture of both bones of the forearm require
ORIF with plates and screws
Anatomical reduction
clinical signs of scaphoid fracture
FOOSH
tenderness in the anatomic snuff box
pain on compressing the thumb metacarpal
Ix of suspected scaphoid fracture
X-ray:
AP
Lateral
2 oblique views
nothing seen on x-ray, but scaphoid fracture is still suspected
normal not to see anything
x-ray done two weeks later
Tx for scaphoid fracture
suspected but not seen on x-ray
- splinted and further assessed 2 weeks later
‘clinical scaphoid fracture’
otherwise
- 6-12 weeks plaster cast
complications of scaphoid fracture
non-union
AVN of PROXIMAL pole
penetrating hand injury on volar side risk injuring what
flexor tendons, digital nerves and digital arteries
penetrating hand injury on dorsal side risk injuring what
extensor tendons
complete or significant partial tendon injury Tx
surgical repair
what causes mallet finger
avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of the extended DIPJ
cannot extend at DIPJ
Tx of mallet finger
mallet splint holding the DIPJ extended worn continuously for a minimum of 4 weeks.
in stress fractures, what Ix is used after x-ray
Bone scan
Tx of toe fractures
stout boot
what type of toes fractures may benefit from reduction and fixation
Intra‐articular fractures of the base of the proximal phalanx of the hallux
open toe fractures require what
stabilisation with wires
how are toe dislocations treated
closed reduction
neighbour strapping or wiring
why are children’s bones more likely to bend than break like adults
have a thicker periosteum
children’s fractures heal slower than adults - true or false
false
healer quicker due to thicker periosteum with rich source of osteoblast
why is a greater degree of angulation tolerated in children
have a greater potential to remodel as they grow
bones form along lines of stress and can correct angulation
at what age do child fractures get treated as adult fractures
puberty
around 12-14
what type of fractures in children could disturb growth
around the physis (growth plate)
can result in shortened limb or angular deformity
how does the Salter-Harris progress
prognosis is poorer as the classification progresses
what is the Salter-Harris classification
classification of physeal fractures
what should be considered in femoral shaft fractures in children
NAI
Also, femur is a common site for benign and malignant bone tumors and the fracture may be pathological with osteolysis and cortical thinning.
