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y2 msk > Week 5 > Flashcards

Week 5 Flashcards

1
Q

How many views do we need for a cervical spine and a scaphoid x ray

A

3

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2
Q

What are the views we need for a cervical spine xray

A

lateral
antero posterior
odontoid/open mouth view

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3
Q

What are the views we need for a scaphoid xray

A

lateral
anteroposterior
two obliques

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4
Q

Symptoms of scaphoid fracture

A

Tenderness at anatomic snuff box
Pain on compressing the thumb metatarsal

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5
Q

Where is the anatomic snuff box

A

Between the Abductor pollicis brevis + extensor pollicis brevis and extensor pollicis longus tendons
(when fingers abducted, it is below the thumb)

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6
Q

What is the cortical layer of the bone

A

dense outer surface of bone

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7
Q

What fracture appearances are there

A

Cortical extension (extends to the cortical layer of bone)
Spiral
Transverse
Comminuted
Angulation
Displacement
Impaction
Avulsion

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8
Q

What is an angulation fracture

A

The fracture displaces the bone; the normal axis of the bone is altered so that the distal portion of the bone is pointed into another direction

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9
Q

What is an impaction fraction

A

when two pieces of a fractured bone are driven into each other

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10
Q

What is an avulsion fracture

A

When a small piece of bone attached to a ligament or tendon gets pulled away from the main part

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11
Q

What causes avulsion fracture

A

due to bone is moving one way, and a tendon or ligament is suddenly pulled the opposite way

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12
Q

What can mimic avulsion fractures

A

Old injuries and normal anatomy

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13
Q

What is the difference between an actual avulsion fracture and an avulsion fracture mimic

A

An avulsion fracture mimic will be completely corticated whereas an avulsion fracture is not

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14
Q

How to tell if a bone fragment is corticated

A

Dense outer layer - grey colour on all sides

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15
Q

What bones can mimic avulsion fractures

A

sesamoid bones
accessory ossification centers

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16
Q

What is the posterior fat pad sign

A

When an elbow effusion is present, the posterior fat pad at distal humerus will be displaced and become visible (posterior fat pads should not be visible)

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17
Q

What does the fat pad at the elbow look like on xray

A

Black-ish appearance, black appearance will be next to distal humerus

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18
Q

What do children’s bones do instead of snap and splinter like adult ones when they sustain an injury

A

Bend or bow

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19
Q

Why don’t children’s bones snap when they sustain an injury

A

Because their bones are soft

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20
Q

What fractures do children usually get

A

Buckle fracture
Plastic bowing
Greenstick fracture

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21
Q

What is a buckle fracture and what does it look like

A

Incomplete fracture that happens when the bone is pressed to the point it bulges out

looks like a bump on the bone

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22
Q

What is a greenstick fracture

A

Incomplete fracture that happens when the bone is bent to the point it breaks but it doesn’t break all the way through (cracks without breaking completely)

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23
Q

Is avulsion fracture more common in adults or children

A

Children

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24
Q

Which part of the developing bone is the weakest

A

growth plate

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25
Q

What can result from a growth plate fracture

A

Growth deformity such as shorter limb / crooked limb

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26
Q

Where is the growth plate normally located at

A

It is a lucency between the epiphysis and metaphysis

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27
Q

Fractures in which bone is often associated with injuries in other areas too

A

femoral fractures

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28
Q

Why should you suspect injuries in other areas too if there is a femoral fracture

A

Because femoral fractures are high energy injuries

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29
Q

2 Steps management for femoral shaft fractures

A
  1. Analgesia + Thomas splint
  2. Closed reduction + IM nail
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30
Q

How can fat embolism occur in displaced femoral shaft fracture

A

Fat enters the damaged venous system

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31
Q

What can happen as a result of fat embolism caused by displaced femoral fracture

A

Hypoxia
Confusion
Acute respiratory distress syndrome

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32
Q

What should you expect if you see a bony ring (such as spinal canal) is injured

A

there should be 2 or more injuries of the bony ring because it is difficult to disrupt the ring in only one place

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33
Q

Why can wood and plastic splinters be invisible on xrays

A

Not dense enough; to be shown on the xray, the object needs to be in different density

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34
Q

Which type of shoulder dislocation may not be seen properly on xray AP view

A

When the humerus dislocates posteriorly

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35
Q

What should you do if you can’t see the posterior shoulder dislocation on AP view

A

Do oblique view

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36
Q

Which artery can be damaged by supracondylar fracture

A

brachial artery

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37
Q

What should you do if you still can’t spot scaphoid fracture after 3 different views

A

Repeat xray 10 days after
MRI

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38
Q

What can scaphoid fracture cause

A

Damage to scaphoid blood supply, causing necrosis and leads to early osteoarthritis

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39
Q

Necrosis of which pole can be caused by scaphoid fracture

A

Proximal pole

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40
Q

Management of undisplaced scaphoid fracture

A

Cast

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41
Q

Where does the blood supply for scaphoid come from

A

Distally from a branch of radial artery

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42
Q

Which devices can show soft tissue injuries

A

Ultrasound
MRI

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43
Q

Which ring-like bones usually have more than 1 site of injury when damaged

A

Pelvic ring
Spinal ring
Tibia and fibula
Radius and ulna

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44
Q

Pelvic ring fractures usually occur in

A

Elderly people with osteoporosis after a minor fall

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45
Q

Which structures are usually affected by pelvic fractures

A

pubic rami
sacrum

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46
Q

What are the soft tissues of the knee that you must examine as well and why

A

Patellar tendon
Quadricep tendon
Suprapatellar fat space

avulsion fracture can indicate soft tissue injury

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47
Q

What other clinical finding is usually accompanied with soft tissue injury of the knee

A

effusion filling suprapatellar space

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48
Q

Which artery can be disrupted by knee dislocation

A

Popliteal artery

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49
Q

Which structure of the tibial plateau is usually affected

A

lateral condyle

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50
Q

What injury mechanism causes tibial plateau fracture

A

valgus force (force coming into contact with outer side of knee) with foot planted

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51
Q

Extensor mechanism (quadriceps and patellar tendon) injuries of the knee can be seen by which device

A

Ultrasound

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52
Q

Which knee injuries can be shown in MRI

A

Meniscal tears
ACL/PCL/LCL/MCL
hyaline cartilage damage

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53
Q

What clinical presentation can be shown by displaced, torn meniscus

A

Locked knee

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54
Q

Which device can show complex ankle fractures

A

CT

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55
Q

What is a talar dome lesion

A

Injury at the upper part of talus - could be cartilage injury / the underlying talus bone

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56
Q

What do calcaneal compression fractures look like

A

Loss of central peak and increased bone density

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57
Q

What injury mechanism causes calcaneal compression fracture

A

Axial compression e.g. falling from height onto the heel

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58
Q

What is a common fracture mimic in the foot

A

Longitudinal accessory ossification center of the 5th metatarsal

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59
Q

What is a common fracture mimic in the leg

A

Fabella ; sesamoid bone posterior to distal femur

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60
Q

What conditions can predispose to tendon rupture

A

Diabetes
Rheumatoid Arthritis
Steroid use

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61
Q

Which nerve is at risk of damage due to anterior dislocation of glenohumeral joint and why

A

Axillary or Radial nerve because the posterior cord is behind the glenohumeral joint

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62
Q

Which cord of the brachial plexus is behind the glenohumeral joint

A

Posterior cord which branches to axillary and radial nerve

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63
Q

Which neck of the humerus is most prone to fractures

A

Surgical neck

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64
Q

Where is the anatomical neck of the humerus located at

A

The groove between the humerus head and the greater tuberosity

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65
Q

Which nerve is at risk of damage due to fracture of the surgical neck of humerus and why

A

Axillary nerve because it is a circumflex nerve around the surgical neck of the humerus

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66
Q

Which muscles are supplied by the axillary nerve

A

Deltoid
Teres minor

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67
Q

Function of the teres minor muscle

A

It is a rotator cuff muscle
It helps with external rotation

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68
Q

Function of the deltoid muscle

A

Abduction of the arm

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69
Q

What happens when the axillary nerve is damaged

A

Difficulty / Inability to lift your arm
Muscle weakness
Muscle wasting
Paraesthesia
Numbness
Pain

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70
Q

What is the classical sign of radial nerve damage

A

Wrist drop
Loss of sensation at dorsal web space

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71
Q

Fracture in which location can cause damage to the radial nerve

A

Fracture of humerus around its shaft

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72
Q

What artery is at risk of damage if there is a humeral shaft fracture and why

A

Deep brachial artery because it lies near the radial groove

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73
Q

Management of undisplaced proximal humeral fracture

A

Non-operatively with collar and cuff

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74
Q

How may the triceps brachii be involved in fracture of the humerus

A

Proximal fracture at the shaft of the humerus can damage the branch of radial nerve that innervates the triceps brachii, causing loss of function of the triceps

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75
Q

Wasting of which muscles can be caused by ulnar nerve injury

A

Adductor Pollicis
Hypothenar eminence

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76
Q

What are mucous cysts of the hand

A

a type of ganglion (outpouchings of synovial fluid) that occurs at DIP

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77
Q

Where do mucous cysts usually occur on hands

A

DIP

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78
Q

Which condition is associated with mucous cysts

A

Osteoarthritis

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79
Q

What possible symptoms can mucous cysts cause

A

Nails can grow irregularly due to the cyst growing near nail beds
May be painful
May rupture and release discharge

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80
Q

Management of mucous cysts

A

Nothing
Excision only indicated if it causes pain / at risk of rupturing

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81
Q

What are ganglions

A

Outpouchings of synovial fluid

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82
Q

Where do ganglions occur

A

DIP (mucous cyst)
Wrist
knee
foot and ankle

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83
Q

What is the ganglion present at the knee called

A

Baker’s cyst

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84
Q

Management of ganglions

A

Nothing
needle aspiration or surgery if causing localised discomfort

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85
Q

What is the problem of needle aspiration for ganglions

A

High recurrence rate

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86
Q

What should you beware of when performing needle aspiration of volar ganglion cyst

A

Radial artery is nearby

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87
Q

What is a pulley

A

ligamentous strap that keeps tendons close to the bone to create an optimal line of pulling

Tendons glide smoothly through the pulleys during flexion and extension

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88
Q

What causes trigger finger

A

1) Tendonitis of a flexor tendon to a digit, causing nodular enlargement of the tendon usually distal to A1 pulley
2) The nodule passes under the pulley when you flex your finger but cannot pass back under the pulley when you want to extend your finger
3) causes pain and discomfort when forcefully try to regain extension

89
Q

Which fingers are usually affected by trigger finger

A

Middle and ring fingers

90
Q

Management of trigger fingers

A

Nothing - often resolves itself
Steroid Injection
Splints
Surgery

91
Q

When is surgery indicated in trigger finger

A

In recurrent cases

92
Q

Borders of the carpal tunnel

A

Base - carpal bones forming an arch
Roof - flexor retinaculum

93
Q

Contents of the carpal tunnel

A

Median nerve
9 tendons

94
Q

What are the tendons in carpal tunnel

A

1 x flexor pollicis longus
4x flexor digitorum profundus
4x flexor digitorum superficialis

95
Q

Branches of the median nerve

A

Recurrent
Palmar digital

96
Q

Innervation of palmar digital branch of median nerve

A

Sensory innervation to palmar skin and dorsal nail beds of the lateral 3 1/2 digits
Motor innervation to the 2 lateral lumbricals

97
Q

Innervation of recurrent branch of median nerve

A

Motor innervation to the thenar eminence

98
Q

What sign can be presented on the hand due to median nerve damage

A

Hand of benediction

99
Q

Describe the presentation of hand of benediction and how does it occur

A

Hand of benediction - ask the patient the make a fist but they can’t flex their first 3 fingers

This is because the palmar digital branch of median nerve supplies the 2 lateral lumbricals which are involved in flexion of index and middle fingers. The recurrent branch supplies the thenar eminence which is involved in flexion of the thumb.

100
Q

Carpal tunnel syndrome mainly affects ____ and how?

A

Median nerve; neuropathy due to compression

101
Q

What causes carpal tunnel syndrome

A

Fibrosis of the flexor tendons
Anatomically small carpal tunnel
Lesions
Inflammation
RA
Fluid retention
Fractures of the wrist

102
Q

Which group of people is often affected by carpal tunnel syndrome and why

A

Pregnant women due to fluid retention

103
Q

Symptoms of carpal tunnel syndrome

A

Pain
Paraesthesia
Weakness of the thumb
Clumsiness of thenar area
Muscle wasting at thenar area
Sensory loss

104
Q

What exacerbates the symptoms of carpal tunnel syndrome

A

Flexion and extension of the wrist

105
Q

At which point of the day does the symptoms of carpal tunnel syndrome get worse

A

Night

106
Q

What are the examinations testing for carpal tunnel syndrome

A

Phalen’s test
Tinel’s test

107
Q

Describe Phalen’s test

A

ask patient ti hyperflex their hands and hold the dorsal surfaces together

Pain = positive

108
Q

Describe Tinel’s test

A

Percussion over the median nerve

Tingling sensation / pain = positive

109
Q

Management of carpal tunnel syndrome

A

Wrist splints at night
Steroid injections
Carpal tunnel decompression surgery

110
Q

What tendons are affected in DeQuervain’s tendinopathy

A

Abductor pollicis longus
Extensor pollicis brevis

111
Q

Which group of people are most commonly affected by DeQuervain’s tendinopathy and what may be the reason

A

Pregnant women
Due to repeatedly picking up their babies

112
Q

Symptoms of DeQuervain’s tendinopathy

A

Wrist pain on the radial side
Swelling or tenderness at the radial styloid

113
Q

Pain in DeQuervain’s tendinopathy is aggravated by

A

Gripping / holding objects

114
Q

Which examination can be used to test for DeQuervain’s tendinopathy

A

Finkelstein’s test

Pain = positive

115
Q

Management of DeQuervain’s tendinopathy

A

Splints
Analgesia
Avoid holding or gripping objects

116
Q

What is Dupuytren’s contracture

A

Hyperplasia of palmar fascia, forming nodules then progresses into contracture at MCP and PIP

117
Q

How does hyperplasia of Dupuytren’s contracture occur

A

Proliferation of myofibroblast cells and production of abnormal collagen

118
Q

Which fingers do Dupuytren’s contracture usually affect

A

Ring and Little fingers

119
Q

Risk factors of Dupuytren’s contracture

A

Male
Genetics
Northern European or Scandinavian descent
Alcoholic cirrhosis
Diabetics
Peyronie’s disease and Ledderhose disease

120
Q

Symptoms of Dupuytren’s contracture

A

Painless progression
Palpable nodules
Puckered skin

121
Q

Management of Dupuytren’s contracture

A

Stretch
Surgery

122
Q

When is surgery indicated in Dupuytren’s contracture

A

Stiffening of PIP or more than 30 degress at MCP

123
Q

What is Paronychia

A

infection within nail fold

124
Q

Which group of people are commonly affected by paronychia

A

Children, especially those that like to bite nails

125
Q

Management of paronychia

A

Elevate the affected finger
Antibiotics
Drain / incise

126
Q

What are the rotator cuff muscles

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

127
Q

Where is the attachment point of supraspinatus, infraspinatus and teres minor

A

Greater tuberosity of the humerus

128
Q

Where is the attachment point of subscapularis

A

Lesser tuberosity of the humerus

129
Q

What is the collective function of the rotator cuff muscles

A

To provide stability to the glenohumeral joint during movement

Compression of the humeral head into glenoid fossa to create a stable point for the deltoid muscle to perform abduction

130
Q

What is the collective function of the rotator cuff muscles

A

To provide stability to the glenohumeral joint during movement

Compression of the humeral head into glenoid fossa to create a stable point for the deltoid muscle to perform abduction

131
Q

Function of supraspinatus

A

Abduction
Compression of humeral head for abduction

132
Q

Function of infraspinatus

A

External rotation
Compression of humeral head for abduction

133
Q

Function of teres minor

A

External rotation

134
Q

Function of subscapularis

A

Internal rotation
Compression of humeral head for abduction

135
Q

Which nerve innervates the supraspinatus muscle

A

Suprascapular nerve

136
Q

Which nerve innervates the infraspinatus muscle

A

Suprascapular nerve

137
Q

Which nerve innervates the teres minor

A

Axillary nerve

138
Q

Which nerve innervates the subscapularis

A

Subscapular nerve

139
Q

What are the most common shoulder problems in middle aged patients

A

Rotator cuff tears
Frozen shoulder

140
Q

What is impingement syndrome

A

When the tendons of rotator cuff muscles are compressed under the subacromial space during movement

141
Q

Symptom of impingement syndrome

A

Pain when lifting arm

142
Q

Which rotator cuff’s tendon is the most commonly affected in impingement syndrome

A

Supraspinatus

143
Q

What are the conditions that can cause impingement syndrome

A

Tendonitis
Subacromial bursitis
Acromioclavicular OA with inferior osteophyte

144
Q

What is subacromial bursitis and how does it lead to impingement syndrome

A

Subacromial bursitis is the inflammation of bursa present underneath the acromion

It can cause the impingement syndrome because the bursa becomes inflamed and thickened, narrowing the subacromial space hence the tendons can get compressed and inflamed

145
Q

What test can be done to test for impingement syndrome

A

Hawkins Kennedy test

146
Q

Describe the Hawkins Kennedy test

A
  1. Ask the patient to elevate their arm to 90 degrees and perform forward flexion (like forming L shape)
  2. Let their arm rest on your arm
  3. Use your other hand to perform passive internal rotation

Pain = positive test

147
Q

Management of impingement syndrome

A

Analgesics - NSAID, Steroid injections into subacromial space
Physiotherapy
Subacromial decompression surgery

148
Q

How many times can steroid be injected into subacromial space

A

3

149
Q

What extent of trauma can cause rotator cuff tears in young/middle aged people

A

Young - significant trauma
Middle aged - minimal / no trauma, due to degenerate changes

150
Q

Which rotator cuff’s tendon is the most commonly torn

A

Supraspinatus

151
Q

If the rotator cuff tear is large, which other rotator cuff muscles can be torn

A

Infraspinatus and Subscapularis

152
Q

Symptoms of rotator cuff muscle tear

A

Difficulty in abduction / external rotation / internal rotation of the arm (depends on which tendon torn)
Muscle wasting

153
Q

What tests can be done to test for subscapularis muscle tendon tear

A

Gerber’s test
Belly press test

154
Q

What test can be done to test for supraspinatus / infraspinatus muscle tendon tear

A

Drop arm test

155
Q

Describe the Drop arm test

A
  1. Passively abduct the patient’s arm
  2. Ask the patient to hold at that position, stop supporting the arm
  3. Ask the patient to lower their arm slowly

Positive = cannot lower their arm slowly hence their arm drops

156
Q

Describe the Gerber’s test

A
  1. Stand behind the patient
  2. Ask the patient to place the back of their hand to mid lumbar spine area
  3. Ask the patient to lift their hand
  4. If the patient can perform this, ask the patient to lift their hand again but this time with resistance (press against patient’s hand)

Positive = cannot lift hand with or without resistance / pain while lifting

157
Q

When is the belly press test used to test for subscapularis tear

A

An alternative to Gerber’s test when the patient has limited internal rotation ROM

158
Q

Describe the belly press test

A
  1. ask the patient to flex their elbow and place their palm against their upper abdomen area (below xiphoid process)
  2. Move the patient’s elbow forwards a bit
  3. Ask the patient to press their palm against their abdomen

Positive = patient needs to compensate by moving their elbow backwards

159
Q

What imaging tests can be done to assess rotator cuff muscle tears

A

Ultrasound
MRI

160
Q

Management of rotator cuff muscle tears

A

Physiotherapy to strengthen the unaffected rotator cuff muscles
Analgesics
Surgery

161
Q

What is the problem with rotator cuff repair surgeries

A

Failure occurs in 1/3 of patients

162
Q

What is frozen shoulder

A

Progressive pain and stiffness of the shoulder due to thickening of the shoulder capsule but resolves after 18-24 months

163
Q

What age group is most commonly affected by frozen shoulder

A

40-60 years old

164
Q

What are the phases of frozen shoulder

A
  1. Pain
  2. Pain subsides, Stiffness begins
  3. Stiffness reduces, start to regain normal ROM
165
Q

Risk factors for frozen shoulder

A

Diabetics
Women
Hypercholesterolaemia
Dupuytren’s disease
Previous shoulder surgery causing shoulder to be immobilized for a period of time

166
Q

What is a key symptom of frozen shoulder

A

Limited external rotation

167
Q

Apart from frozen shoulder, which other condition also causes pain, stiffness and limited external rotation of the shoulder and how can you differentiate

A

Osteoarthritis

OA occurs in older patients

168
Q

Management of frozen shoulder

A

Physiotherapy
Analgesics - NSAID / steroid injections / co codamol
Manipulation under anaesthetic / surgical capsular release

169
Q

What type of steroid injection is given for frozen shoulder

A

Glenohumeral injection

170
Q

What causes traumatic shoulder instability

A

Bankart lesion
Hill Sach lesion

This can lead to recurrent dislocations caused by minimal force/injury

171
Q

What is the term for tear of labrum

A

Bankart lesion

172
Q

What is the likelihood of recurrent dislocations in patients under 20 with previous dislocation and Bankart lesion

A

80%

173
Q

Management of traumatic shoulder instability

A

Bankart’s surgery to repair labrum tear

174
Q

What causes atraumatic shoulder instability

A

Hyperlaxity of shoulder ligaments

175
Q

What causes hyperlaxity of shoulder ligaments

A

Some people just have it
Repetitive overhead motion
Marfan’s ; Ehlers-Danlos

176
Q

Which sports requires repetitive overhead motion and causes hyperlaxity

A

Swimming
Tennis
Volleyball

177
Q

What type of dislocation can hyperlaxity cause

A

Multidirectional dislocation

178
Q

Management of atraumatic shoulder instability

A

Analgesia
Physiotherapy

179
Q

What is cellulitis

A

Infection and inflammation of the dermis and subcutaneous tissue

180
Q

What are the pathogens causing cellulitis

A

Beta haemolytic strep
Staphylococci

181
Q

What type of conditions poses as a risk for cellulitis

A

Conditions that impairs venous drainage / integrity of the skin barrier

182
Q

Risk factors for cellulitis

A

Diabetics
Pregnancy
Obesity
Venous insufficiency
Ulcers / open wounds

183
Q

What classification is used to describe the severity of cellulitis

A

Eron classification

184
Q

Management of cellulitis

A

Rest
Elevation
Analgesia
Antibiotics - oral or IV

185
Q

What antibiotics are used to treat cellulitis

A

Oral Penicillin +/- flucloxacillin
IV flucloxacilin / clindamycin / vancomycin

186
Q

What antibiotics are used to treat cellulitis if the patient is allergic to penicillin

A

Erythromycin
Clarithromycin

187
Q

Management of abscess

A

Drain - if there’s pus, let it out
Antibiotics
Rest, elevation, analgesia

188
Q

Types of septic arthritis

A

Native joint infection
Prosthetic joint infection

189
Q

How do pathogens enter and cause septic arthritis

A

Haematogenous spread
Direct inoculation - during surgery / open wound / animal bites
From neighbouring infection

190
Q

Which heart infection can lead to septic arthritis

A

Infective endocarditis

191
Q

Mechanism of septic arthritis

A

Infection -> joint effusion -> increase in intraarticular pressure damaging vascular supply -> spread through blood -> systemic infection

192
Q

Symptoms of septic arthritis

A

Acute monoarthropathy
Decreased ROM
Swelling
Systemic upset
Raised WCC and inflammatory markers

193
Q

Arthroplasty of which joint is more susceptible to septic arthritis

A

Knee

194
Q

Why is prosthetic septic arthritis more difficult to treat with antibiotics

A

Because the presence of foreign substance enhances bacteria’s ability to form biofilm

195
Q

Prosthetic septic arthritis that occurred less than 3 months after surgery indicates

A

that the infection was acquired during surgery

196
Q

What is the likely causative pathogen for a prosthetic septic arthritis that occurred <3 months after surgery

A

S aureus
E coli

197
Q

What is the likely causative pathogen for a prosthetic septic arthritis that occurred 3 - 12/24 months after surgery

A

Coagulase negative staph

198
Q

Prosthetic septic arthritis that occurred more than 12 or 24 months after surgery indicates

A

That the infection was not related to surgery, most likely from haematogenous spread

199
Q

What is the likely causative pathogen for a prosthetic septic arthritis that occurred 12/24 months after surgery

A

S aureus
Strep
E coli

200
Q

Which pathogen is most common in IVDU causing septic arthritis

A

Pseudomonas aeruginosa

201
Q

Which pathogen is most common in young sexually active patients causing septic arthritis

A

Neisseria gonorrhoeae

202
Q

Investigation for septic arthritis

A

Joint aspiration ideally before antibiotics but do not let this delay prescribing antibiotics to patients if there is already a highly indicative pathogen and the patient is deteriorating

203
Q

Management for septic arthritis

A

Sepsis 6 bundle
3 in - antibiotics ; IV fluids; oxygen
3 out - blood cultures ; urine output ; lactate

Surgery: arthroscopic drainage

204
Q

What is the most common pattern of proximal humeral fracture

A

Fracture at surgical neck + medial displacement of the humeral shaft

205
Q

Why may there be displacement of humeral shaft in proximal humeral fracture

A

Due to pull of pectoralis major muscle

206
Q

Should you be worried about a displaced humeral shaft due to proximal humeral fracture

A

If it is minimally displaced, no need to worry as the position of displaced bone improves after muscle spasm ends

207
Q

Management of undisplaced proximal humerus fractures

A

Sling
Internal fixation (surgery)

208
Q

When is proximal humeral shaft treated surgically

A

If persistently displaced fractures

209
Q

Proximal humerus fractures are common in what type of injuries and in which group of people

A

Low energy injuries in patients with osteoporotic bones

210
Q

What can occur if the humeral head undergoes AVN after proximal humeral fracture

A

Cause chronic pain

211
Q

Which type of proximal humeral fractures may require shoulder replacement

A

Comminuted fracture
Head splitting fracture

212
Q

What ligaments are ruptured in subluxation of acromioclavicular joint

A

Acromioclavicular ligaments

213
Q

What ligaments are ruptured in dislocation of acromioclavicular joint

A

Acromioclavicular ligaments + coracoclavicular ligaments

214
Q

What are the coracoclavicular ligaments

A

Conoid
Trapezoid

215
Q

Up to what degrees of humeral shaft displacement can be accepted

A

Up to 30 degrees of angulation

216
Q

Management of humeral shaft fractures

A

Humeral brace
Internal fixation + IM nail

217
Q

Management of most intraarticular fractures

A

ORIF

218
Q

Which direction of elbow dislocation is the most common

A

Posterior direction

219
Q

Management of uncomplicated elbow dislocations

A

Closed reduction
Sling after surgery

y2 msk (19 decks)

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