Lecture 16 - UE Fractures

Question 1

clavicular # - MOI, where most commonly injured, and medical/surgical management

Answer 1

• reading p 2-3

Question 2

scapular # - MOI, location, medical/surgical management

Answer 2

• reading p 4

Question 3

proximal humerus # - types, what constitutes a displacement?, medical and surgical management

Answer 3

• reading p 4-5

Question 4

humoral shaft # - describe 3 locations and their displacement patterns

Answer 4

• reading p 6

Question 5

humoral shaft # - medical/surgical management and period of immobilization

Answer 5

readin p 6-7

Question 6

what are the types of distal humerous #?

Answer 6

• reading p 7-8

Question 7

medical/surgical management of distal humerus #

Answer 7

• reading p 8

Question 8

what is an Essex-Lopresti lesion

Answer 8

Essex-Lopresti lesion is a specific injury involving a longitudinal disruption of the interosseous ligament of the F/A, usually accompanied by a radial head Fx and/or dislocation, and an injury of the distal R/U joint.

Question 9

what muscles do proximal forearm #s involve? what is the typical MOI?

Answer 9

Any fracture of the olecranon will affect the triceps mechanism, interfering with active elbow extension. Any fracture of the radial head will interfere with, or cause pain with, forearm pronation and supination.

• reading p 9

Question 10

medical and surgical management of proximal forearm #? cast used and imobilization period?

Answer 10

• reading p 9

Question 11

what is a nightstick fracture?

Answer 11

Question 12

what is a Monteggia fracture

Answer 12

Question 13

what is a Galeazzi (a.k.a. Piedmont) fracture?

Answer 13

Question 14

MOI and medical/surgical management of radial and ulnar shaft #s - and period of immobilization

Answer 14

• reading p 10-11

Question 15

Distal Radius and Ulna Fx: Medical / Surgical Management - period of immobilization, MOI

Answer 15

• reading p 11-12

Question 16

what is a colles #?

Answer 16

Question 17

what is a Smith’s Fracture?

Answer 17

Question 18

what is a Barton’s Fracture?

Answer 18

Question 19

describe a # of radial or ulnar styloid process

Answer 19

Question 20

what are the most common types of carpal bone #s and MOI?

Answer 20

Fractures of the carpal bones are most commonly associated with FOOSH injury, or some similar mechanism. The scaphoid accounts for between 50-80% of carpal fractures, with the Triquetrum, Trapezium and Lunate (in descending order) also occasionally involved. A fracture of the other carpal bones is exceedingly rare.

Question 21

describe scaphoid #s - what findings lead to clinical impression?

Answer 21

• reading p 13

Question 22

scaphoid # - medical/surgical management - period of immobilization

Answer 22

• reading p 13-14

Question 23

medical/surgical management of other carpal #s (non-scaphoid)

Answer 23

reading p 14

Question 24

what is a Bennett Fracture?

Answer 24

Question 25

what is a boxers #?

Answer 25

Question 26

metacarpal and phalangeal #'s - MOI, surgical management and associated injuries

Answer 26

- reading p 14-15

Question 27

what are the 5 diagnostic P's?

Answer 27

Pain, Paralysis, Paresthesia, Pallor, Pulselessness

Question 28

UE # management - general principles

Answer 28

–Early fixation –Early mobilization –Early range of motion

Question 29

UE # rehab guided by... ?

Answer 29

Rehab guided by: –Medical / surgical management (Structures affected, Surgeon’s guidelines) –Functional goals –Detailed functional assessment

Question 30

General PT Management for fractures

Answer 30

GROUP Q: 1. What are the advantages of performing AAROM exercises… a) …rather than PROM? b) …rather than AROM? 2. Under what conditions would you opt for PROM exercises rather than AAROM exercises?

Question 31

PT management clavicular #

Answer 31

class Q: ## Footnote How might a deformity following the healing of a clavicular fracture affect long-term function?

Question 32

Scapula Fx - PT management

Answer 32

Question 33

Greater Tuberosity Fx - PT Management

Answer 33

Unstable Fx: –Rehab will begin ͞p ~4 wks –Then, follow same progression as non-displaced # \*Watch signs of shoulder stiffness (frozen sh) throughout rehab

Question 34

Proximal Humerus Fx – PT Management

Answer 34

•Refer to protocol posted on MyCourses for an example of the general PT management of proximal humerus fracture for non-operated vs operated cases

Question 35

Humeral Shaft Fx – PT management

Answer 35

Question 36

Distal Humerus Fx - PT management

Answer 36

_ORIF interventions and/or Transcondylar Fx_ –Early elbow ROM (as soon as patient tolerate mvt) _Supracondylar Fx (conservative)_ –Posterior splint immob for ~6 wks –Begin AA-AROM ͞p 1-2 wks (remove & replace splint) _Capitulum and/or Trochlea Fx (conservative)_ –Posterior splint immob for ~3 wks –Elb AA-AROM ex’s ͞p immobilization _Med Epicondylar Fx (conservative):_ –Immob 10-14 days –Elb AA-AROM ex’s ͞p immobilization _Lat Epicondylar or Supracondylar Process Fx:_ –Symptomatic immob + early motion

Question 37

Proximal Forearm Fx – PT Management (olecranon)

Answer 37

Early motion is key\*\*\* –Elbows will stiffen quickly –Some loss of ROM still expected (~ -10° ext)

Question 38

Proximal Forearm Fx – PT Management (radial head)

Answer 38

Early motion is key\*\*\* –Elbows will stiffen quickly –Some loss of ROM still expected (~ -10° ext)

Question 39

Nightstick Fx - PT Management

Answer 39

Question 40

Monteggia Fx - PT Management

Answer 40

Question 41

Galeazzi Fx - PT Management

Answer 41

Question 42

Distal Radius and Ulna Fx – PT management

Answer 42

group question: ## Footnote 85 y.o. ♀ s/p R Smith’s Fx 6 weeks ago, immobilized in a long-arm cast with elbow at 90o x 6 weeks, cast removed yesterday. What impairments would you expect the patient to have at this point?

Question 43

Scaphoid Fx – PT Management

Answer 43

Question 44

Other Carpal Fx (not scaphoid) – PT Management

Answer 44

–Begin once clinically healed –Follow general PT management principles

Question 45

Metacarpal & Phalangeal Fx – PT Management

Answer 45