Fractures 1 Flashcards Preview

Phys: Bone & Gen Med: Ortho > Fractures 1 > Flashcards

Flashcards in Fractures 1 Deck (29):
1

What are the general characteristics for a humeral head fracture?

Most occur in older pts w/ osteoporosis
F:M = 2:1

2

What are the sxs of humeral head fracture?

1. Pain, swelling, tenderness esp. in region of greater tuberosity
2. Pt holds affected extremity against chest wall
3. Look for injuries to brachial plexus and/or axillary nerve/artery

3

Where is the most common area for a humeral fx?

surgical neck fracture of humerus

4

What imaging studies are used for a humeral head frx?

AP, lateral and “Y” view (outlet view), axillary

5

What is the tx for a humeral head fx?

1. Sling for most nondisplaced fxs (check axillary nerve)
A. Early mobilization w/ pendulum exercises to prevent frozen shoulder
2. Refer to Ortho for ORIF -> displaced fxs

6

What is the best true lateral view of the shoulder?

1. Axillary view
A. Superior to inferior or inferior to superior

7

What is pendulum exercises?

The arm is hung downward and rotated in large circles in order to regain shoulder range of motion

8

What is the MOI of a humeral shaft fx?

1. MVA
2. Fall on outstretched hand
3. Penetrating injuries, i.e. gunshot wound

9

What are the sxs of a humeral shaft fx?

1. Pain, swelling, deformity and arm shortening
2. Radial nerve must be assessed for possible injury, as well as ulnar nerve and median nerve

10

What nerve does the thumbs up sign test?

Wrist extension also for
radial nerve function

11

What imaging is used for humeral shaft fx?

Xray: AP & Lateral views of shoulder & elbow

12

What is the tx for humeral shaft fx?

1. Specialized splints: long arm splint/proximal sugar tong splint/coaptation splint/clamshell brace
2. Operative repair: ORIF
A. Displaced fracture
B. Neurovascular compromise

13

What are the complications of humeral shaft fx?

1. Radial nerve injury: 18% of cases
A. Occurs @ time of frx
B. May also develop after reduction
C. Delayed complication as a result of incorporation of nerve by callus formation (healing bone)

14

What is the MOI for a supracondylar fx?

Fall on outstretched hand

15

What are the sxs of a supracondylar fx?

Gross swelling and tenderness proximal to elbow

16

What neurovascular injury may occur for a supracondylar fx?

1. Radial artery, Brachial artery
2. Median, Radial & Ulnar nerves

17

When and where does vascular injury occur in a supracondylar fx?

*vascular injury occurs in 5-20% of children w/ supracondylar frx (brachial artery injured)
Most nerve palsies from supracondylar frx are neuropraxias, and will resolve spontaneously
Median nerve can be up to 50%
Radial nerve can be up to 25%

18

What does the OK sign test?

Median nerve integrity

19

How is ulnar nerve integrity tested?

Hold a piece of paper between fingers

20

What imaging is used for supracondylar fx?

1. AP & lateral views (include elbow and wrist)
A . 5-6% can have distal radius frx too
2. In children, always bilateral views to compare

21

What is the tx for a supracondylar fx?

1. Long arm cast for children w/ nondisplaced fx
2. Closed reduction in OR w/ post. splint application for displaced fxs (post reduction x-rays and neurovascular checks)
3. Adults should always have ORIF

22

What are potential complications of supracondylar fx?

1. Compartment syndrome (< 1%) and the resulting sequelae of Volkmann’s contractures
A. Injuries to Brachial artery and Median nerve (and radial nerve)
2. Varus or valgus deformities of elbow

23

What is volkmann's contracture?

1. Type of forearm ischemic contracture from injury to brachial artery asst w/ supracondylar fx
What happens?
2. Fixed flexion of the elbow, pronation of the forearm, flexion at the wrist, and joint extension of the metacarpal-phalangeal joint

24

What is the most common elbow fx in adults?

Radial head/neck fx?

25

What is the MOI of a radial head/neck fx?

Fall on outstretched hand

26

What are the sxs of a radial head fx?

1. Pain over lateral aspect elbow
A. Worsens w/ forearm rotation (pronation / supination)
2. Tenderness on palpation over radial head

27

What imaging is used for radial head/neck fx?

1. AP & lateral views
2. Displacement of anterior fat pad +/- posterior fat pad -> hemarthrosis, fracture

28

What treatment is used for radial head/neck fx?

1. Sling for non-displaced fxs -> conservative tx & Ortho referral
2. Operative repair for complex fractures
3. Early ROM

29

What are complications of a radial head fx?

1. may not regain full flexion/extention of elbow