Orthopedic/Fractures/Sprains/Musculoskeletel

Question 1

what percentage of bone fragment is required for a P3 avulsion to be treated like an articular fracture vs a soft tissue mallet?

Answer 1

if bone fragment is greater than 30%, it is treated like an articular fracture

Question 2

in conservative mgmt of distal tuft fractures, when can AROM be started?

Answer 2

immediately for PIP and MCP joints and as indicated/tolerated for DIPJ

Question 3

The thumb IP joint is primarily stabilized by:

Answer 3

collateral ligaments and the volar plate

Question 4

What is a Stener’s lesion?

Answer 4

acute injury where distal portion of UCL displaces proximally and is trapped superficially at the proximal edge of the intact adductor aponeurosis. Due to this interposition, healing of the UCL isn’t possible as the aponeurosis lies between the UCL and the bone

Stener’s lesion is a Grade III UCL injury. Grades I and II don’t require surgery

Question 5

what is “climber’s finger”?

Answer 5

A2 pulley injury in a rock climber

Question 6

What are the 3 phases of healing?

Answer 6

1. Inflammatory Phase: focus is on protection, maintaining stability, controlling pain, reducing edema, light ROM
2. Fibroplastic phase: focus on gentle PROM/AROM, heat modalities, light ADLs and static progressive splinting. High level strengthening and joint mobs are not appropriate
3. Remodeling: focus on heat modalities, AROM/PROM, progressive strengthening, low grade joint mobs, static progressive splinting, endurance training, and work hardening

Question 7

What injury is associated with an MCP dorsal dislocation and what is the appropriate splint position for the MCP joint?

Answer 7

dorsal dislocation of MCP leads to a volar plate tear, which needs to be splinted in at lest 30deg of flexion to allow volar plate to re-approximate to its proximal attachment point located on the volar surface of the metacarpal neck and allows it to scar down

Question 8

what is a Colles’ fracture?

Answer 8

distal radius fracture from a FOOSH, resulting in DORSAL displacement/angulation of the distal bone fragment

Question 9

what is a Smith’s fracture?

Answer 9

the result of a fall onto a flexed wrist, causing palmar/volar angulation of the distal bone fragment. This is more dangerous due to neurovascular structures in this direction