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NMSKI > elbow/forearm and wrist fractures > Flashcards

elbow/forearm and wrist fractures Flashcards

1
Q

different fractures in the distal humerus

A

Supracondylar
Lateral Epicondyle
Medial Epicondyle
Y-shaped

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2
Q

what is an elbow supracondylar fracture and how is it caused?

A

Fall on hand with elbow bent
Fracture in line of condyles
Distal fragment displaced posteriorly

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3
Q

complications that arise from supracondylar fracture

A 
Vascular problems
Volkmann’s ischaemic contracture
Compartment syndrome
Median nerve damage
Myositis ossificans
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4
Q

types of supracondylar fracture

A

undisplaced and unstable

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5
Q

management of undisplaced supracondylar fracture

A

Reduction - elbow flexed > right angle
Cast with elbow flexed
Collar + cuff x3/52

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6
Q

management of unstable supracondylar fracture

A

Difficult realignment
Monitor blood supply
ORIF (wires)
Cast with elbow flexed 3-4/52

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7
Q

cause intercondylar fracture

A

Fall

Blow to elbow

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8
Q

types of intercondylar fractures

A 
Unicondylar
Bicondylar 
 - Coronoid driven between two halve of trochlea 
   -Y-Shaped 
   -T Shaped  
Undisplaced 
Displaced 
Comminuted
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9
Q

management of undisplaced intercondylar fractures

A

Unicondylar

Cast in elbow flexion position x 4-6 weeks (+C+C)

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10
Q

management of displaced/comminuted intercondylar fracture

A

ORIF
Wires
Plate and Screws
Cast in elbow flexion position x 4-6 /52 (+C+C)

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11
Q

complications of post intercondylar fracture

A

elbow stiffness - loss of full extension
long term risk of OA
ulnar nerve palsy - clae hand - flexion of last 2 digits
weak / unable to abduct/adduct fingers

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12
Q

cause of fracture of olecranon

A

Direct -Fall on point of elbow

Indirect (Avulsion)- strong triceps contraction

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13
Q

management of hairline/undisplaced olecranon fracture

A

Hairline / undisplaced

Long arm POP 6-8 /52 in elbow flexion

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14
Q

management of displaced olecranon fracture

A

ORIF e.g. tension band wiring

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15
Q

management of comminuted olecranon fracture

A

excision

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16
Q

causes of dislocated elbow

A

Fall outstretched arm in extension (adults and children)

Displaced distal fragment over coronoid process

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17
Q

complications of dislocated elbow

A

Joint stiffness
Ectopic ossification
Recurrent dislocation
Nerve damage: median/ulnar- uncommon

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18
Q

management of dislocated elbow

A

Reduce
Collar+cuff 2-3 wk
Early mobilisation

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19
Q

fractures radial head causes

A

Fall on outstretched arm

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20
Q

undisplaced radial head fracture management

A

Aspirate blood from joint.

Supportive bandage collar + cuff early mobilisation

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21
Q

management of displaced radial head fracture and angulation

A

ORIF

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22
Q

management of comminuted radial head fracture and angulation

A

Radial head excision with early mobilisation

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23
Q

monteggia fracture

A

proximal fracture of ulna and radial head dislocation

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24
Q

cause monteggia fracture

A

fall on outstretched fully pronated arm

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25
Q

management of monteggia fracture

A

ORIF –plate fixation of ulna
Cast above elbow in 90º flexion to below wrist and in supination x 4-6 weeks
NB Physio post cast

26
Q

galeazzi cause

A

by fall on outstretched hand

27
Q

galeazzi fracture

A

distal 1/3 radius shaft #

associated distal radioulnar joint (DRUJ) injury

28
Q

complication of galeazzi

A

Mal-union

Unstable distal fragment

29
Q

management of galeazzi

A

ORIF-plate and screws

Cast as for Monteggia

30
Q

fracture of radius and ulna

A

Twisting injury / rotational deformity

31
Q

complications of radius and ulna fracture

A

Mal-union
Non-union
Compartment syndrome

32
Q

conservative management of radius and ulna fracture

A

Seldom successful - difficult due to unopposed supination  rotational deformity / slippage
or
ORIF - for both

33
Q

acute compartment syndrome affects what compartment

A

volar compartment

34
Q

acute compartment syndrome affects what muscles and why

A

flexor pollicis longus
flexor digitorum profundus
most vulnerable due to proximity to bone

35
Q

acute compartment syndrome affects what nerves and arteries

A

Median nerve

Brachial Artery

36
Q

if acute compartment syndrome is untreated it can result in

A

Volkmann’s Ischaemic Contracture.

37
Q

how does the pressure change in acute compartment syndrome

A

Normal resting pressure= 0- 8mmHg
Abnormal= 30mmHg –requires immediate decompression fasciotomy
can cause irreversible damage to nerves

38
Q

symptoms of compartment syndrome

A 
Pain++
Swelling+
Numbness
Paraesthesia (P+Ns)
Painful ROM
39
Q

complications of compartment syndrome

A

Muscle necrosis

Excision or debridement of necrotic muscle tissue

40
Q

management of acute compartment syndrome

A

Immediate decompression fasciotomy - until pressure is released is prescribed antibiotics to prevent infections

41
Q

3 types of fracture distal radius

A

colles fracture
smiths fracture
bartons fracture

42
Q

colles fracture location

A

low energy, dorsally displaced, extra-articular
Most common
within 1 inch wrist joint

43
Q

smiths fracture location

A

low energy, volarly displaced of distal segment, extra-articular

44
Q

bartons fracture location

A

Intra-articular fracture

45
Q

cause of colles fracture

A

fall on outstretched hand

Common in middle-aged and elderly women

46
Q

5 elements of colles fracture

A 
Backward angulation
Backward displacement
Radial deviation
Supination
Proximal impaction
47
Q

complications of colles fracture

A 
Complex regional pain syndrome (CPRS)- Sympathetic Nervous system dysfunction 
 - Severe Pain 
 - Swelling 
 - Stiffness 
 - Skin discolouration 
carpal tunnel syndrome
rupture EPL tendon
Mal-union deformity
48
Q

conservative management of colles fracture

A

Manipulation under anaesthetic (MUA)
disimpact fracture, flex wrist, pull hand into ulnar deviation
POP short-arm cast (below elbow) for 4 – 6/52 and C+C
Removal POP + refer to physiotherapy

49
Q

ORIF management of colles fracture

A

K-wires (removed when fracture healed)
POP as above for up to 6/52
Physio post removal of cast

50
Q

smiths fracture cause

A

Patient lands with wrist in flexion

51
Q

smiths fracture has risk of

A

deformity

52
Q

management of smiths fracture

A 
Reduction of fracture
Long arm plaster
Above elbow, Arm in supination + wrist ext + elbow flex
Remove POP 6 weeks
Refer to physiotherapy
53
Q

bartons fracture cause

A

fall on extended and rotated wrist

54
Q

fracture line in bartons fracture

A

Fracture line runs into joint-
intra-articular fracture
Distal fragment can displace anteriorly or posteriorly

55
Q

how does bartons fracture differ from smith and colles

A

of carpal displacement

56
Q

management of bartons fracture

A

Generally requires ORIF to ensure stabilisation.
Important to restore the radiocarpal joint integrity
+ Below Elbow cast

57
Q

short arm cast fixation is for

A

forearm or wrist fracture

58
Q

long arm cast fixation is for

A

upper arm, elbow or forearm fracture

59
Q

physio treatment for distal fracture

A 
Swelling management- POLICE
Strengthening & ROM exercises Wrist 
HEP - self assisted
Check other joints for ROM especially fingers, thumb and elbow. 
Elbow may be stiff if long arm cast was used. 
Manual therapy once fracture well healed
Hand function 
Gross grip 
Fine grip activities
60
Q

exercises for ROM wrist fracture

A

wrist flexion/extension
wrist radial ulnar deviation
pronation /supination

61
Q

exercises following wrist fracture

A

grip strength

NMSKI (38 decks)

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