Upper Extremity Fractures Lecture Powerpoint

Question 1

Clavicle fractures

Answer 1

Often from direct blow to lateral aspect of shoulder, medial fragment goes posterosuperiorally, and lateral portion pulls inferomedially, potential to tent the skin,

Question 2

Clavicle fracture treatment options (2)

Answer 2

• sling immobilization followed by strengthening and ROM 6-10 weeks
• ORIF for open fractures, neurovascular injury to brachial plexus

Question 3

Advantages (3) and disadvantages (3) of ORIF for treatment of clavicle fractures

Answer 3

• improved time to union of bone
• improved functional outcome
• improved cosmetic and overall shoulder satisfaction
• risk of hardware failure
• increased risk for infection
• rubs against bra strap

Question 4

Proximal humerus fractures

Answer 4

3rd most common pattern seen in elderly patients, can see axillary nerve palsy associated and can be checked via deltoid sensation, must ensure axillary or velpeau xray to show humeral head is reduced in glenohumeral joints

Question 5

Proximal humerus fractures treatments (1)**

Answer 5

-**85% treated with sling immobilization followed by rehab with ROM 14 days, only emergent if open or vascular compromise

Question 6

Humeral shaft fractures

Answer 6

Important to remember radial nerve courses along spiral groove of the humerus therefore must assess radial n function with these fractures

Question 7

Humeral shaft fractures treatments (3)

Answer 7

• coaptation splint followed by functional brace
• radial nerve palsy NOT contraindication to non-op treatment as they generally get better on their own
• ORIF

Question 8

Radial head fractures

Answer 8

Mechanism often from FOOSH, must assess pain and ROM as well as varus/valgus stability as this fracture can produce mechanical block to motion, if pain is limiting factor then numb joint with injection of lidocaine and assess full range of motion to determine if need op or not

Question 9

Terrible triad of the elbow

Answer 9

• elbow dislocation
• radial head fracture
• coronoid fracture

Question 10

Treatment of radial head fractures (2)

Answer 10

• immobilization followed by early ROM

- ORIF or radial head resection (lose some range of motion)

Question 11

Olecranon fractures

Answer 11

Direct blow usually resulting in comminuted fracture, indirect blow from FOOSH usually results in transverse or oblique fracture, likely present with inability to extend triceps,

Question 12

Olecranon fractures treatment options (2)

Answer 12

• immobilization and splint even if lose motion as often low demand elderly individuals sees higher risk than benefit
• ORIF

Question 13

Radial and ulnar shaft fractures

Answer 13

When fractured together commonly referred to as “both bone”, high rate of open fracture, high risk of compartment syndrome, functional results depend on restoration of radial bow (radius moves relative to ulna for pronation and supination)

Question 14

Elbow x rays components to observe(2)

Answer 14

• measure anterior humeral line, should intersect the capitellum at the anterior to middle 3rd (that is proper alignment)
• radial capitellar line center of radius projecting outward no matter the angle should always bisect the anterior humeral line at the capitellum

Question 15

Treatment of radial/ulnar shaft fractures (2

Answer 15

• all radial shaft fractures should be fixed, isolated nondisplaced ulnar shaft fractures do not need to be
• ORIF

Question 16

Compartment syndrome

Answer 16

Increased osseofascial compartment pressure that leads to decreased perfusion most often in forearm or leg resulting in myoneural ischemia and irreversible muscle and nerve damage, outcomes may lead to loss of function, ischemic contracture, neurologic deficit, infection, and possible amputation, can be measured with needle placed in extremity fascial compartment, if above 30mmHg or 30mmHg above diastolic pressure take to operating room

Question 17

Compartment syndrome presentation (6 P’s)

Answer 17

• Pain out of proportion to clinical presentation
• Pain with passive stretch of fingers or toes
• Paresthesia and hyperthesia
• Paralysis
• Palpable swelling
• Peripheral pulse absent

Question 18

Distal radius fractures

Answer 18

Bimodal distribution between young and old patients, 50% are intraarticular, predictor of subsequent fractures in women with osteoporosis - always recommend DXA scan in these patients, have to assess for carpal tunnel syndrome symptoms

Question 19

Distal radius fractures treatment options (2)

Answer 19

• Closed reduction and splinting/cast (acutely splint, then cast in adults to allow for swelling expansion) immobilization
• ORIF

Question 20

Metacarpal fractures

Answer 20

Divided into fractures of metacarpal head, neck, shaft, and base, no degree of malrotation is acceptable, very common, goal is to immobilize fracture within acceptable tolerances, majority treated nonoperatively as there is very little functional deficit even if fractures are outside acceptable tolerances

Question 21

Boxers fracture and treatment (1)

Answer 21

Metacarpal neck fracture of 5th metacarpal, occurs from blow to clenched fist with 5th metacarpal absorbing large portion of impact

-Jahs maneuvers for closed reduction (flex MCP 90 degrees with dorsal pressure thru dorsal aspeect of proximal phalanx while stabilizing metacarpal shaft, place ulnar gutter splint with MCP joints in 70-90 degrees of flexion and PIP/DIP joint extension

Question 22

Phalangeal fractures

Answer 22

Most commonly distal phalanx affected and most common injury to skeletal system, must assess for nailbed injuries

Question 23

Phalangeal fractures treatments (5)

Answer 23

• buddy tape to adjacent finger
• ORIF
• closed reduction and percutaneous pinning
• if distal phalanx fracture with subungual hematoma >50% or if part of nail has come off must remove nail, repair nailbed, and replace nail into eponycheal fold (treat it as an open fracture)
• have to give tetanus, dose of IV antibiotics, and sent home with antibiotics

Question 24

Scapula fractures

Answer 24

Uncommon, associated with high energy trauma, must look for associated injury as up to 32% can see associated pneumothorax, can see shoulder completely free floating

Question 25

Scapula fracture treatment options (2)

Answer 25

• sling for 2 weeks followed by early motion

- surgical reserved for severe fractures

Question 26

Posterior shoulder dislocations are more common in this population

Answer 26

Seizure patients

Question 27

Radial bow

Answer 27

Refers to how ulna remains fixed and radius rotates at its head to then move its distal portion around allowing for pronation and supination, must be preserved in interventional orthopedics by maintaining the bend within the bone that is naturally occurring