Flashcards in Fractures 2 Deck (38):
What are the hand fxs?
1. Boxer’s Fracture
2. Colles’ Fracture
3. Smith Fracture
4. Gamekeeper’s Thumb
5. Scaphoid Fracture
Define boxer's fx?
Fx of metacarpal neck of 5th finger
what is the moi for a boxer's fx?
What are the sxs of a boxer's fx?
1. Examination reveals loss of prominence of 5th knuckle w/ tenderness
2. Inspect for puncture wound over MCP joint
A. If fx caused by punch to mouth, need to prescribe abx
What is the tx for fx with >30degree angulation?
Frxs with >30deg angulation should be reduced and placed in ulnar gutter cast for minimum 4 weeks
Define Colles' Fx
1. Distal radial fx w/ dorsal angulation
A. Most common wrist injury
B. Mechanism of injury
forced wrist dorsiflexion
C. Described as “silver fork” deformity
How is a Colles' fx managed?
Cast immobilization after reduction(if needed) 10-12 wks
What is a Smith's fx?
Fall on a flexed wrist
Reverse Colles' fx: much less common
Compare Smith's and Colles' Fx
1. Smith’s fx: Distal radial fracture. Volar displacement of the distal fragment
2. Colles’ fx: Distal radial fracture. Dorsal displacement of the distal fragment; MORE COMMON
What imaging do you want for a Colles' fx?
AP, Lateral, +/- oblique
Define gamekeeper's thumb
1. Sprain or tear of ulnar collateral ligament (UCL) of thumb
A. Usually hx of sprained thumb or fall on hand
B. Skiers injury
What are the sxs of a gamekeeper's thumb?
1. Examination reveals ligamentous laxity of ulnar collateral ligament
2. Instability & weakness of pinch
What is the tx for a skier's/gamekeeper's thumb?
1. Refer to Hand Surgeon -> Surgical repair indicated for complete rupture
2. Partial rupture -> immobilization w/ thumb spica cast
What is the most commonly fx carpal bone?
What imaging is used for a gamekeeper's thumb?
MRI to determine if ligament is entirely ruptured
Why is detection of a scaphoid fx critical?
1. Blood supply is from Radial artery
2. Proximal pole of scaphoid has poor blood supply that is further compromised w/ fxs thru bone can lead to avascular necrosis (AVN) of scaphoid
What are the sxs of a scaphoid fx?
1. Pain over anatomic snuffbox
2. Swelling & eccymosis radial wrist
3. Often confused w/ wrist sprain
A. Scaphoid fx may not show initially on x-ray*
What imaging is used for a suspected scaphoid fx?
1. AP , Lat and Scaphoid views
2. If neg. initially, repeat films in 10 days - 2 wks
3. MRI can be used to avoid delay in diagnosis
4. Bone scan: often ordered by orthopedist
What tendons are involved in the anatomic snuffbox?
1. Extensor pollicis longus
2. Extensor pollicis brevis
3. Abductor pollicis longus
What is the treatment for scaphoid fx?
1. Treatment- Always Refer to Ortho
A. Long arm thumb spica cast x 2 weeks -> short arm thumb spica cast
B. Displacement of >1 mm requires ORIF
2. Bone stimulation unit in extreme cases
What are the complications of scaphoid fx?
1. Non-union of fracture
2. Avascular necrosis (AVN)
A. chronic wrist pain, can lead to collapse of bone & wrist jt dysfunction
Define nursemaid's elbow
1. Most common in children < 5 yo
2. Subluxation of radial head caused by longitudinal traction; displacement of the annular ligament
What is the MOI of nursemaid's elbow?
Forearm is pulled or jerked upward
What is the presentation of a child with nursemaid's elbow?
Hold affected arm close to the body with the elbow slightly flexed or extended and the forearm pronated
What imaging is used for nursemaid;s elbow?
AP & Lateral films done to r/o fracture, especially if hx of fall
How is nursemaid's elbow reduced?
1. Reduce subluxation
A. Hold affected arm just above wrist and just below elbow
B. Practitioner places their thumb over radial head while fully supinating forearm & applying posteriorly directed pressure
-Radial head slides back into place
What is ganglion cyst?
1. Ganglion cystic structure -> synovial sheath or joint cavity
2. Viscous, gel-like fluid
What is the pathophys of a ganglionic cyst?
Arises from herniation of synovial tissue from a joint capsule or tendon sheath
What are the sxs of a ganglionic cyst?
1. Dorsal or volar radial aspect of wrist, +/–
pain (mostly unsightly reasons)
2. Wrist swelling/lump
3. +/- aching worse w/ extreme flex/ext.
A. Differentiates cystic lesion from solid tumor
What is the treatment of a ganglionic cyst?
1. May spontaneously regress / recur
A. Reassurance to patient
2. If cyst painful:
A. Aspiration & cortisone injection (Recurrence is rate high)
B. Surgical excision of cyst
(Recurrence rate 5-10%)
What is a mallet finger?
Injury to DIP extensor, so finger is stuck in flexion
How is a mallet finger treated?
Stack splint 24/7 for 6-8 wks
What is a dupuytren's Contracture?
Fibrosis of flexor tendon in volar aspect of hand
What are the risk factors for Dupuytren's fx?
5. > 40 yo
What is the tx for dupuytren's contracture?
1. No cure
2. Finger splints not indicated
3. Refer to Hand Specialist
A. +/- cortisone inj for painful nodules
B. Xiaflex injection(indicated for dupuytren’s w/cord)
What is stage 1 D contracture?
small lump in the plam of the hand, usually just under the digit on the palmar crease
What is stage 2 D contracture?
The cord is present as the disease spreads uo the fascia and into the fingers