Fractures/Dislocations

Question 1

how to classify fractures?

Answer 1

location, direction, alignment, open vs closed, and dislocation

Question 2

location?

Answer 2

proximal, middle, distal third

Question 3

transverse break

Answer 3

right angle to the axis of the bone

Question 4

spiral

Answer 4

bone has twised appearance, also called torsion

Question 5

obliue

Answer 5

fracture line bw horizontal and vertical direction

Question 6

comminuted

Answer 6

splintered or crushed

Question 7

segmental fracture

Answer 7

two plus fracture that isolate a segment of the bone

Question 8

Imaging studies for fractures

Answer 8

plain films (AP and lateral)

radionucleotide bone scanning= increased uptake at the side of an occult fracture or stress fraction (think athletes and disuse osteopenia)

CT- dx of pelvic, facial, or intra-articular fracture

**MRI sudy of chioce to dx an occulte hip fracture

Question 9

treatment of an open fracture

Answer 9

**any bleeding should be considered an open frx until proven otherwise

-debride and irrigate in OR w/in 4-8 hours of injur

Question 10

what abx for open fracture?

Answer 10

1/2 cd gen cephlosporin and aminoglycosids (48 hrs after frx and 48 hrs after surgery)

tetanus status!!!

Question 11

tx of intra-articular frx

Answer 11

frx line enters a joint cavity

-open tx may be indicated to restore and maintain articular congruity

Question 12

femur frx

Answer 12

percutaneous screws or hemiarthroplasty,

Question 13

femur shaft frx tx

Answer 13

intramedullary rods or plates

Question 14

intertrochanteric frx tx?

Answer 14

sliding hip screw fixation or long gamma nail

Question 15

complication of femur frx?

Answer 15

potential to hemorrhage

Question 16

tibia and fibula frx in adults

Answer 16

associated w./ ligamental, meniscal, and vascular injuries

Question 17

tibia and fibula simple frx

Answer 17

closed reduction w. cast placement

Question 18

complicated or unstable frx

Answer 18

open reduction internal fixation

Question 19

what part of children’s bones are most susceptible to frx than injury to attached ligments?

Answer 19

the physis

Question 20

what is a common finding ina ped fracture

Answer 20

swelling and tenderness over the physis

Question 21

what is helpful when evaluating a kids frx?

Answer 21

comparison filsm

Question 22

imcomplete frx

Answer 22

torus or greenstick

Question 23

torus fracture

Answer 23

• Occur when one side of the cortex buckles as a result of compression injury (e.g. FOOSH). Differs from a greenstick fracture by the mechanism of injury and sometimes buckles on both sides of the bone. Treatment is 4-6 weeks in a cast.

Question 24

greenstick

Answer 24

• Occur in long bones when bowing causes a break in one side of the cortex.
• When the angulation of the fracture is less than 15 degrees, a long arm or leg cast can be applied for 4-6 weeks.
• Fractures with angulation of >15 degrees needs referral to orthopedic surgeon.

Question 25

when to worry about pt safety

Answer 25

radiographs of a young child show multiple fractures at various stages of healing, abuse should be suspected and the child referred to a protective agency

Question 26

dislocation

Answer 26

total loss of congruity that occurs between the articular surfaces of the joint

Question 27

subluxation

Answer 27

any less serious loss of congruity, or a less than complete dislocation

Question 28

common sites of dislocation

Answer 28

anterior shoulder, posterior hip, posterior elbow

less common-navicular and subtalar joints, as a combo of Lisfranc frx and second metatarsal joint

Question 29

Lisfranc joint

Answer 29

is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus.[

Question 30

tx of dislocation or subluxation

Answer 30

• most able to be treated w/ a closed reduction
• some reduce spontaneously, but require immobilization for 2-4 wks, followed by ROM acivity and return to nrmal activity

Question 31

what is important to do when tx dislocation /subluxat?

Answer 31

to assess neurovascular status pre- and postreduction as well as get postreduction radiographs to assure adequate reduction.

Question 32

strain

Answer 32

an injury to the bone-tendon unit at the myotendinous junction or the muscle itself

Question 33

sprain

Answer 33

involves collagenous tissue, such as ligaments or tendons

Question 34

CF of a strain or sprain

Answer 34

-often follows a sudden stretch

Question 35

complication ofa strain or sprain

Answer 35

avulsion of tendon (e.g. mallet finger avulsion or stretch of the terminal extensor tendon, which is treated with extensor splinting for 6 weeks)

OR

ligamentous sprain (e.g. stretch of the anterior talofibular ligament, which causes the common ankle sprain)

Question 36

TX of strain or sprain

Answer 36

supportive, RICES