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Disciplines 3 Shea > Fx Shea > Flashcards

Fx Shea Flashcards

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1
Q

2 Mechanisms of Injury for Clavicular fx and which is most common?

A
  • Direct fall on shoulder w/ arm at side (MC)
  • Direct blow
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2
Q

List the locations of clavicular fractures from most to least common (3 areas)

A
  1. Middle clavicle (75%)
  2. Distal 1/3 of clavicle
  3. Proximal/Medial 1/3 of clavicle
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3
Q

Why do most clavicle fx happen in middle?

A
  • Weakened
  • Downward pressure fall/blow
  • Sternocleidomastoid pulls superiorly ( so when broken the medial/proximal clavicle is pulled upward)
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4
Q

What 4 groups are at increased risk of clavicular fx?

A
  • Contact sports
  • Males <25-30
  • Males >55
  • Women >75
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5
Q
  • Is there usually displacement and deformity of clavicular fx?
  • What else is seen on clinical presentation?
A
  • Yes, deformity usually at midline
  • Pain and pain w/ palpation
  • Crepitus w/ active ROM
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6
Q

Which 2 vessels should you perform a neurovascular exam on if pt has a Clavicular Fx?

A
  • Subclavian vessels
  • Brachial plexus
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7
Q

What movements can a pt w/ clavicular fx perform and not perform?

A
  • Limited ROM and discomfort w/: shoulder abduction, adduction, and extension (moving shoulder girdle)
  • FROM of: internal/external rotation (not moving shoulder girdle)
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8
Q

What 2 x-rays should you get of clavicular fx?

A
  • AP view
  • 45 degree cephalic tilt (x-ray is below clavicle, important bc/ w/ normal AP you may not be able to identify the fx)
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9
Q

Non-operative tx for clavicular fx?

A
  • Is the “standard of care”
  • sling or figure 8 brace
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10
Q
  • Which tx of clavicular fx has less discomfort?
  • Which has better outcomes? (functional/cosmetic)
  • What do providers prefer to give?
A
  • Sling has less discomfort
  • Both have similar outcomes
  • Provider preference is 50/50
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11
Q

3 “definitive indications” for surgical management of clavicular fx?

A
  • Open fx (broken skin) bone could be contaminated/very displaced
  • Neurovascular injury (surgeon can visualize structures and possibly repair vasculature)
  • Tenting of skin –> can lead to open fx if untreated
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12
Q

What are 5 reasons for surgical intervention of clavicular fx?

A
  • Widely displaced >3cm?
  • Multiple fx segments
  • Displaced lateral 1/3 fx (takes forever to heal due to movement)
  • Dominant extremity in overhead athlete
  • Cosmetic concerns
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13
Q

What is the surgery called of repairing clavicular fx?

A

Open reduction internal fixation

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14
Q
  • What is this?
  • How do you treat and why?
A
  • Clavicular fx
  • Surgical tx w/ Open Reducation Internal Fixation bc/ it is located distal 1/3 and is displaced
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15
Q
  • What is the most common mechanism of injury of Proximal Humerus Fx?
  • What are 3 other MOI?
A
  • Fall out outstretched hand (MC)
  • Direct trauma
  • 75% occur in people over 60yrs w/ simple fall bc at increased risk for fall/decreased bone density
  • High energy trauma in younger pts (fall from roof / bunk bed)
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16
Q

Clinical presentation of Proximal Humerus Fx (5)

A
  • Swelling
  • Delayed Ecchymosis (24-48 hrs bc blood and this will move down arm due to gravity)
  • Significant pain
  • Guarding/cradling bad arm w/ good arm
  • Limited ROM (will not perform internal/external rotation = differentiates from clavicular who will do internal/external)
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17
Q

What is used to classify Proximal Humerus Fxs?

A

Neer Classification

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18
Q

What are the 4 components of the Neer Classification for Proximal Humerus Fx?

A
  • Greater tuberostiy
  • Lesser tuberosity
  • Anatomical neck
  • Surgical neck

(tube/tube/neck/neck)

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19
Q

Proximal Humerus Fx - Neer Classification

  • ANY fx pattern w/ less than 1cm of displacement
A

1 part Proximal Humerus Fx

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20
Q

Proximal Humerus Fx - Neer Classification

  • Neck OR Tuberosity
  • Displaced by 1cm or more
Study These Flashcards
A

2 part Proximal Humerus Fx

21
Q

Proximal Humerus Fx - Neer Classification

  • Neck AND Tuberosity
  • Displaced by 1cm or more
Study These Flashcards
A

3 part Proximal Humerus Fx

22
Q

Proximal Humerus Fx - Neer Classification

  • Neck + both tuberosities (3 things)
  • Displaced by 1cm or more
Study These Flashcards
A

4 part Proximal Humerus Fx

23
Q

3 x-ray views to obtain for suspected Proximal Humerus Fx

Study These Flashcards
A
  • AP view
  • Transcapular / Y view (differentiate fx from dislocation)
  • C axillary view (differentiate fx from dislocation)
24
Q

Which Proximal Humerus Fxs require:

  • non-surgical tx
  • surgical tx? (5 things)
Study These Flashcards
A
  • Non-surg:
    • Neer 1
  • Surg: Open Reduction Internal Fixation
    • Neer 2, 3, 4
    • Neurovasc injury
    • Open fx
    • sig distortion of bicipital groove (rotational deformity)
    • Fx dislocation

*(50% managed surgically get a shoulder replacement instead of ORIF)

25
26
3 MOI for Midshaft Humerus Fx
* Direct blow * Bending force (fulcrum) * FOOSH (falling on outstretched hand) = pathologic fx
27
Midshaft Humerus Fx in Peds pts MOI?
Suspect abuse
28
2 unique Clinical Presentations of Midshaft Humerus Fx compared to Proximal
* +/- visible shortening * Potential for neurovasc injury (radial nerve)
29
**Midshaft Humerus Fx - Neuro Screen** * _Radial Nerve_ * sensory * motor
**Sensory:** dorsum of hand **Motor:** wrist dorsiflexion
30
**Midshaft Humerus Fx - Neuro Screen** * _Median Nerve_ * Sensory * Motor
* **Sensory:** palmar aspect of thumb, index, middle fingers * **Motor:** thumb opposition
31
**Midshaft Humerus Fx - Neuro Screen** * _Ulnar Nerve_ * Sensory * Motor
* **Sensory:** Palmar aspect of little finger * **Motor:** pinki abduction
32
**Midshaft Humerus Fx** * Vascular Screen (2 major things)
* **Distal pulses** * radial * ulnar * (these are easier to identify than brachial) * document as 2+ and equal bilaterally * **Cap refill (brisk 2 seconds/eq bi)**
33
What are 2 x-ray views to get for Midshaft Humerus Fx?
* AP * Lateral
34
Explain why a Midshaft Humeral Fx can be pathologic?
If there is a bone cyst (unicameral) area of weakened bone w/ decreased calcium, if force is applied to bone that would otherwise not cause fx, this is pathologic.
35
Non-surgical tx of Midshaft Humerus Fx
* Functional Humerus Brace * Early shoulder ROM to reduce risk of adhesive capsulitis (frozen shoulder)
36
Surgical tx for Midshaft Humerus Fx (5 criteria)
* Neurovasc injury * Open fx * Pathologic Fx (bone cyst unicameral) * \>3cm shortening * \>30 degree angulation
37
What should/should not be visible on x-ray of lateral elbow?
* Should see anterior fat pad of elbow on lateral view * Should NOT see posterior fat pad (hidden fx)
38
1/3 of the ____ lies in front of the anterior line of the \_\_\_\_\_. (on elbow lateral view)
* capitellum * humerus
39
Pediatric Ossification Centers of Elbow
**CRITOE** **13579 11** * 1 yr Capitellum (will be marked on exam w/ star) * 3 yr Radial head * 5 yr Internal/Medial Epicondyle * 7 yr Trochlea * 9 yr Olecranon * 11 yr External/Lateral Epicondyle
40
MOI of Supracondylar Fx (2)
* Hyperextension injury w/ Falling On Outstretched Hand (MC) ==\> extension type * Direct blow ==\> extension or flexion type
41
Which fx is common in Peds pts?
Supracondylar Fracture (falling off bike)
42
Clinical Presentation/Complication of Supracondylar Fx?
* **Forearm Compartment Syndrome** (Volkmann's Ischemia/contracture) * marked swelling of forearm * Palpable tenseness * Pain w/ passive extension of fingers
43
A supracondylar fx can mimic what?
Posterior Elbow Dislocation
44
**Volkman's Ischemia / Contracture** (forearm compartment syndrome) from supracondylar fx - flexor muscles - shortening - also called "wolfman"
45
What is the Classification for Supracondylar Fractures called?
Garland (judy garland riding a bike)
46
What 2 x-ray views for Supracondylar Fx?
* AP * Lateral
47
Non-surgical Tx for Supracondylar fxs (2)
* **Type 1 Garland:** no displacement, so just immobilize and cast later * **Type 2 Garland:** needs to be reduced
48
Surgical tx for Supracondylar Fx (4)
* Type 2 which was reduced, but is now not alligned again (failed reduction) * Type 3 * Open fx * Neurovasc injury
49
* What is seen here? * What fx is it used for?
* Percutaneous pinning * Supracondylar Fx

Disciplines 3 Shea (13 decks)

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