Fractures 1 Flashcards Preview

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

Flashcards in Fractures 1 Deck (29):

What are the general characteristics for a humeral head fracture?

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


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


Where is the most common area for a humeral fx?

surgical neck fracture of humerus


What imaging studies are used for a humeral head frx?

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


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


What is the best true lateral view of the shoulder?

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


What is pendulum exercises?

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


What is the MOI of a humeral shaft fx?

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


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


What nerve does the thumbs up sign test?

Wrist extension also for
radial nerve function


What imaging is used for humeral shaft fx?

Xray: AP & Lateral views of shoulder & elbow


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


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)


What is the MOI for a supracondylar fx?

Fall on outstretched hand


What are the sxs of a supracondylar fx?

Gross swelling and tenderness proximal to elbow


What neurovascular injury may occur for a supracondylar fx?

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


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%


What does the OK sign test?

Median nerve integrity


How is ulnar nerve integrity tested?

Hold a piece of paper between fingers


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


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


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


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


What is the most common elbow fx in adults?

Radial head/neck fx?


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

Fall on outstretched hand


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


What imaging is used for radial head/neck fx?

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


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


What are complications of a radial head fx?

1. may not regain full flexion/extention of elbow