ED, ortho, psych and randos Flashcards
Indications for a back slab
- Non-displaced #
- Minor injuries e.g. buckle or minor physeal #
- Swelling anticipated to be a problem - elbow or tibial #
- Crush injuries
- Open #
Clinical signs of scaphoid #
- Pain on dorsiflexion of wrist
- Tenderness over anatomical snuff box
- Pain on gripping
* Can have normal XR for first few days
Complications of scaphoid #
- Avascular necrosis (proximal portion)
2. Non-reunion
Distal humerus # can cause injury to… x nerve
Clinical signs would include…
- Radial nerve
- Wrist drop (supplies extensor muscle of forearm - extension of wrist and fingers + triceps to extend elbow) and loss of sensation over dorsal surface of thumb to middle of 2nd digit
Abnormal fat pads in supracondylar # of humerus…
- Visible posterior fat pad
- Usually tucked into olecranon fossa –> unable to visualise on XR
- Haemarthrosis/effusion assoc. w/ # lifts the posterior fat pad - Sail sign: an upward lifting of the anterior fat pad due to anterior haematoma
Hangman’s fracture
MOI: hyperextension of neck
- Bilateral fracture of C2 pedicle
- Horizontal tearing of disc C2-C3
- Anterior subluxation of C2 on C3
Salter-Harris Physeal Injury (growth plate #)
Type 1: separation through physis, usually through areas of hypertrophic and degenerating cartilage cell columns
Type 2: # through portion of physis extending into metaphysis
Type 3: # through portion of physis extending into epiphysis and into the joint
Type 4: # through epiphysis, physis and metaphysis
Type 5: crush injury to physis
Which Salter-Harris # is most likely to disrupt growth?
Type 4 and 5 are at high risk of growth disturbance
Jefferson’s #
Compression fracture of bony ring of C1
UNSTABLE #
MOI: axial blow to vertex of the head (e.g. diving injury)
Wedge fractures of C-spine
MOI: flexion injury to anterior column –> anterior compression #
- Most common at C4/5/6
- DDx: r/o burst # –> suspicious if >50% anterior vertebral body height loss
Perthe’s disease
Temporary interruption of the blood supply to the proximal femoral epiphysis -> osteonecrosis and femoral head deformity
Assoc with thrombophilia, FVL, protein C/S deficiency, lupus anticoagulant etc
MC boys than girls 4-8 years
Bilateral 10%
Supracondylar fractures
- Age group: 3-15yrs
- MOI: FOOSH with hyperextension at elbow
- Concerning signs: severe swelling, ischaemia of hand, absent radial pulse, skin puckering or anterior bruising, open injury, nerve injury
- -> Ulnar and radial nerve (7%) injuries are uncommon
- XR: posterior fat pad, sail sign, anterior humeral line passes through anterior 1/3 of capitellum or misses it completely
Supracondylar # classification and management
Gartland classification:
- Non-displaced #: immobilisation with above elbow back slab, 90 deg elbow flexion w/ sling for 3/52
- Displaced with intact posterior cortex: ortho referral, can trial gentle reduction in ED. If displacement in coronal plane, requires ortho review as it can cause malunion –> cubitus varus (cosmetically unacceptable)
- Displaced with no cortical contact: ortho referral - open reduction and percutaneous pin fixation
Volkmann’s ischaemic contracture
Highest risk with Gartland Type 3 Supracondylar #
- Also increased risk if full arm cast is used instead of backslab with hyperflexion of elbow
Monteggia’s fracture-dislocation
- Proximal ulna # causing radial head dislocation at proximal radioulnar joint
- Age group: 4-10yrs
- MOI: FOOSH with hyperpronation or hyperextension of forearm
- Clinical pres: diffuse swelling, pain to move elbow in any plane
- Other complications: radial nerve injury (most common), posterior interosseous nerve injury, delayed Dx = biggest concern
- XR: radiocapitellar line does not intersect centre of capitellum = radial head dislocation, ulnar # (can be subtle with plastic deformation)
- Mx: urgent ortho review
