Radial Head Fx _Nonsurg tx Type 1_ Splint or Sling for __ to ___ days w/use of sling for comfort there after Early ROM is important (esp ____ and ____)

5 to 7 days Supination and Extension of elbow Most painful is (supination/extension) Most comf is 90 degree and pronation

High Impact (MC) MVA Fall from ladder/height Direct blow

What is a stable forearm fx called which involves mid to distal ulnar shaft fx? How is it tx?

"Nightstick Fx" policeman holding night stick/baton Individual who did something bad, police hit person w/ baton, so pt holds up forearm and baton strikes the ulna which gets fractured. (tx non-surg bc/ stable)

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2 MOI of Radial Head Fx and which is MC?

FOOSH w/ partially flexed elbow (MC) (radial head is jammed into humerus)
Posterior elbow dislocation

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Which fx?

Swelling over lateral elbow
Limited ROM (esp extension and supination)

Radial Head Fx

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What Classification is used for Radial Head Fx?

Mason

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Radial Head Fx - Mason Classification

Type 1

Type 2

Type 3

1: Single fx, no displacement
2: displacement
3: comminuted (multiple fxs)

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What 3 x-ray views should be obtained for Radial Head Fx?

AP
Lateral
Oblique (type 1 may be occult/hidden on initial x-ray), so look for fat pads

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Radial Head Fx

Nonsurg tx Type 1

Splint or Sling for __ to ___ days w/use of sling for comfort there after
Early ROM is important (esp ____ and ____)

5 to 7 days
Supination and Extension of elbow
Most painful is (supination/extension)
Most comf is 90 degree and pronation

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Radial Head Fx

Non-surg Type 2

Minimal displacement,
- splint for __ to ___ days w/ use of sling for comfort
- ______ ROM following D/C splint
Moderate displacement,
- ORIF (open reduction internal fixation)

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Radial Head Fx

Surgical for Type 3

Radial Head Replacement

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W/ Forearm Fxs, what creates the “stable ring?”

Proximal radioulnar joint
Distal radioulnar joint

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What classifies a forearm fx as “unstable” and how are they all managed?

Disruption in more than 1 component of ring –> unstable rx, (high likelyhood will shift)
Surgically.

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Forearm Fx

Fx of both bones w/o disruption of radioulnar joints

Unstable Fx

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Forearm Fx

Fx of single bone, w/ disruption of ONE radioulnar joint

Unstable fx

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2 MOI of Forearm Fx

High Impact (MC)
- MVA
- Fall from ladder/height
Direct blow

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What is a stable forearm fx called which involves mid to distal ulnar shaft fx?
How is it tx?

“Nightstick Fx”

policeman holding night stick/baton
Individual who did something bad, police hit person w/ baton, so pt holds up forearm and baton strikes the ulna which gets fractured.

(tx non-surg bc/ stable)

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Unstable Forearm Fractures

Radial shaft fx
Ulnar shaft fx

Both Bone forearm fx

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Unstable Forearm Fractures

Mid to proximal ulnar shaft fx
Associated radial head dislocation

Monteggia fx

(MUR)

Monteggia / Ulnar / Radial Head

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Unstable Forearm Fractures

Mid to distal radial shaft fx
Associated carpoulnar dislocation

Galeazzi Fx

(GRC)

Gal / Radial / Carpo

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How are unstable forearm fx managed?

Surgical

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Which fx?

MOI: FOOSH w/ wrist in extension (MC) –> Colle’s Fx
- Postmenopausal women 60-70%
FOOSH w/ wrist in flexion –> Smith’s fx
Direct Trauma

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Distal Radial Fx

“Every Cat wants Dinner and Finds Someone in the Garden”

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Distal radial Fx

Extension = Colle’s = dinner fork

Flexion = Smith’s = garden

Which fx?

Dinner fork deformity (colle’s)
Garden spade deformity (smith’s)
Localized swelling
Potential ___ nerve injury
Significant ROM limitation

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Distal Radial Fx

What x-ray views for Distal Radial Fxs

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AP
Lateral
Oblique

Distal Radial Fx

Non-surg

Non-displaced –>
Displaced –>

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Non: Short arm cast
Dis: Long arm cast

Indication for surgery in Distal Radial Fx

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Intra-articular extension
Severe comminution
Inability to maintain reduction

**Which fx?** * Radial torus "buckle" fx * MC in children \<\_\_\_ yrs * Distal metaphysis * Buckling of cortex due to compression fx

Pediatric Distal Radial Fx

* MOI of Buckle/torus/distal radial fx * Deformity? * Amt swelling?

* FOOSH * None visible * Mild to mod

Cast tx for TOrus / buckle fx / distal radial fx?

Short arm for 4-6 wks

Is greenstick or torus more common?

Torus

**Which fx?** * Complete fx of tension side w/ buckling of compression side * MOI: FOOSH

Greenstick Fx

**Greenstick fx** * Swelling? * Deformity?

* Mod to sig swelling * +/- visible deformity

Cast tx for Radial Greenstick Fx?

* short arm for 6-8 wks * (rarely surgery)

**Which fx?** * Most common carpal bone fx * FOOSH * Snuffbox pain / TTP * ROM limitations * Commonly occult on x-ray

Scaphoid fx

Scaphoid fx can cause limited blood supply which leads to high incidence of what 2 things?

* Nonunion * Osteonecrosis

4 x-ray views of Scaphoid fx

* PA * PA w/ ulnar deviation * Lateral * Semi-pronated oblique

Tx for scaphoid fx? (3)

* Long-arm thumb spica cast for 6-12 wks * If clinical exam is indicative of fx, but x-rays are negative --\> splint and repeat x-rays in 10-14 days * If FU x-ray negative, but clinical concern persists, get MRI.

**Fx of Metacarpals/Phalanges** * Displaced ___ and ____ fxs tend to angulate * ____ fxs tend to rotate

* Transverse and Oblique * Spiral

a : Transverse shaft fracture b : Oblique shaft fracture c : Spiral shaft fracture d : Metacarpal base fracture e : Metacarpal head fracture f : Comminuted fracture

What is shown? Which type of fx?

Malrotation Scaphoid

* What is the MC fx of the hand * MOI? * possibly malrotation deformity * possibly dropped knuckle deformity

* 5th metacarpal fx (boxer's fx) * Distal metaphysis of 5th metacarpal * Closed fist striking an object

**Tx for 5th metacarpal fx (boxers)** _Nonsurg:_ * \<15 degree angulation * transverse/oblique/base/head fxs

* Ulnar gutter splint

**Which fx?** * Traumatic injury to tip of fully extended finger --\> avulsion of extensor tendon at base of distal phalynx * Tender rupture/Tendon laceration * Visible deformity * Inability to ____ the affected ___ joint

**Extensor Tendon Avulsion Fx (mallet finger)** * extend * DIP

non-surg Tx for mallet/ extensor tendon avulsion fx

* Continuous splint 6-8 wks * (if extension is lost at all, healing is disrupted and the 6-8 week clock starts over again)

3 indications for surg tx or extensor tendon avulson/mallet

* conservative care fails * Complete tendon lac * Fx involving \>30% of articular surface

**Which fx?** * Traumatic forced extension of actively flexed finger --\> avulsion of flexor tendon at base of distal phalynx * Which finger? * Deformity?

**Flexor Tendon Avulsion Fx (Jersey finger)** 4th (ring) is MC inability to flex affected DIP

Tx for Flexor TEndon avulsion fx / jersey finger?

Early surgical repair in ALL cases Splint in presenting position and then hand surgeon referral Best recovery if repaired within 7-10 days of injury

**Which fx?** * MOI: direct blow from door/hammer * Subungual hematomas (be cautious)

Distal Phalanx Fx

Tx for Distal Phalanx Fx

* Mostly non-surg * Surg: angulated \>15 degrees / \>2mm displacement / non-union

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