Imaging

Question 1

Describe shoulder dislocations

Answer 1

90% anterior disloc - medial and inferior displacement with humeral head ending up inferior to corocoid process

20% of anterior disloc can result in Hill Sachs (impaction of post superior humeral head); can also get Bankart lesion
- 1 or both of these can increase chances of recurrent dislocations

Question 2

Describe elbow dislocation

Answer 2

Can have associated fractures with this (i.e coronoid process or radial head); also check pulses

relocation = traction of forearm (pt prone with arm hanging off the table holding a weight; with time it will relocate)

mobilise as early as possible - elbow tends to stiffen up quickly

Question 3

What is nursemaids elbow and how is it treated?

Answer 3

• radial head subluxation
• typically child will hold it flexed and pronated
• relocation:
  > full extension + full supination + downward traction + flexion
  > extension + hyperpronation

Question 4

Describe Moteggia and Galeazzi fractures and describe fractures in this area with regards to:
MOI
Mx

Answer 4

Monteggia - # of ulna with disloc of radius
Galeazzi - # of radius with disloc of ulna
- reason for disloc of the other bone is d/t interrosseous membrane which pulls the other bone out depending on the severity/displacement of the other bone’s fracture

MOI = FOOSH
Mx = ORIF (perfect reduction is needed)
- in kids < 10º displacement is acceptable

Question 5

Describe Colles fracture

Answer 5

MOI - fall on hyperextended wrist
F>M; more common in kids
Can include comminution/impaction
Fracture of distal radius with dorsal displacement of distal radius
- dinner fork deformity

Mx - depends on:

• angulation of fracture, age, health
• volar splint, internal fixation (more common now d/t surgical advnacements, casting

Question 6

Describe scaphoid fracture

Answer 6

MOI - FOOSH
- most common wrist fracture
- high incidence of malunion/AVN
> bc of blood supply is distal to proximal!
> fractures PROXIMAL to the waist+displacement = damaged blood supply to proximal pole
> fractures of DISTAL pole/tubercle = not complicated by AVN

Question 7

What would necessitate surgical mx in scaphoid fracture?

Answer 7

1. Unstable displaced fracture
2. Fracture of proximal pole
3. Fracture/dislocation
4. Non union
5. Pathological fracture

Question 8

In what cases might a scaphoid fracture be managed conservatively? How long would you immob?

Answer 8

• if its stable/non displaced
• a tubercle fracture
• immob 6-12 weeks

Question 9

Describe the boxer’s brawler’s fracture:

Answer 9

MOI - axial load/direct trauma
common over shaft of 5th MC (bc it’s the most mobile)
Fracture stability is prime consderatoin - if stable then early ROM
Surgical mx depends on:
- open fx, multiple fx’s, displaced intraarticular, failed conservated mx

Question 10

Describe MC # of thumb

Answer 10

Bennett fracture - # to base of first MC extending into CMC joint
MOI - axial force on flexed thumb - usually always has displacement
If minimal displacement/no joint instability - immob in spica
>1mm displacement = internal fixation
- affects ability to pinch/oppose/grip