Orthopedic Xray Presentation Flashcards
(33 cards)
Introduction
Name DOB
Date
Part of body
View
History key questions
Age, Sex, Handedness, Occupation and hobbies
MOI and date
Smoking - affects bone healing
PMHs, AC/AP use - fitness for GA, LA
Examination
Closed
Open - is there a pathway between environment and bone
Neurovascularly intact before and after every intervention
-UL - median, radial, ulnar
Specific tests
-Scaphoid # - press on AS
Management
Analgesia - pain relief
Reduce
Hold - cover half of arm with plaster
Distal radius fracture in adults
High energy, comminuted
Colles - FOOSH, dinnerfork, EA DA
Smiths - inverse FOOSH, EA, VA
Bartons - V or D
Chauffeurs - IA, radial styloid fracture, scaphoid-lunate ligament diastasis
Radial inclination - 22deg
Radial height - 11mm
Ulnar variance +-2mm
Volar tilt - 11-15deg
ORIF needed if
- unstable
- dorsal comminution
- dorsal angulation 20deg+
- IA
- age
- ulnar fracture
- radial height
- prereduction position
Distal radius fractures in children
INCOMPLETE
Often incomplete => buckle, torus
-periosteum is thicker in children so they buckle instead of break
Very rarely need plaster
Splints may be enough
Salter Harris classification - break in relation to growth break
1S - separation
2A - above MOST COMMON
3L - lower
Scaphoid fractures
High index of suspicion - often not visible on initial xray
MOI - high energy, sports
Clinical examination
- press on AS
- scaphoid tubercle tenderness
- deep flexion, extension painful, ulnar deviation
Imaging
-scaphoid series or MRI
IMPORTANT TO DOCUMENT SPECIFICALLY
Proximal pole - poorest blood supply
Greenstick
Could this be non accidental injury - Hx is key
Galeazzi vs Monteggia
GR
Distal 1/3 radius fracture
Ulnar dislocation
UM
Proximal 1/3 ulnar fracture
Radial dislocation
Olecranon
extensor mechanism may be disrupted
Consider age
Elbow radiographic lines
Elbow fat pads - occult bony injury
Supracondylar humerus fracture in paeds
Gartland 1 - UD => plaster 2 - disrupted ant humeral line 3 - displaced 4 - displaced, rotational unstable
Puncture wound, pucker sign Check AIN - ok sign Ulnar nerve Brachial artery Pulse Check colour
Clavicle
SLing
Humeral
Holstein Lewis spiral fracture - radial nerve palsy
Collar and cuff
Hand examination
CRT - injured and non injured comparison
Sensation of both sides of finger
Passive, active movement of fingers
Joint stability comparisons
Passive lateral MCPJ and PIPJ stress
AP - test volar plate
Hand imaging
ASK FOR SPECIFIC IMAGES OF AREA OF CONCERN Xray CT MRI US - dynamic concerns, tendons Bone scan
Sensory innervation of hand
Ulnar - little finger
Radial - dorsal between 1st and 2nd finger
Median - palmar index
Motor function of hand
Ulnar - key pinch’
-Froments sign - thumb flexion = median compensating for ulnar issue
Median -
Radial - wrist drop
Sharp injuries
Concerns over FDS FDP
Tendon lacerations
Must test specifically unless you can see the damage
-FDS, FDP
Wound exploration
zig zag incisions
-prevent contractures forming over joints
Mallet finger
Drooping distal phalanx - unable to ext
-ext tendon ruptured or avulsed bone
Tendinous - finger splints
-keeps finger straight
Bony - Kwire
Digital nerve laceration
Microsurgical nerve repair
Hand infections
-common organisms
Most common - trauma, post op, foreign bodies
S aureus
Mixed - staph, streph
Anaerobes - dog/cat/human bites, IV, DM, dental scrapings
Occupational
-works with water, fish tanks
