Section 19 - injuries to bones, joints, soft tissue Flashcards
1
Q
What radiographs are required for diagnosis of an injury to a long bone?
A
- Joint proximal and distal xray
2
Q
Common diagnoses missed by xray?
A
- Scaphoid, radial head, metatarsal shaft fx
3
Q
Salter-harris type 1?
A
- Through the epiphysis
4
Q
Salter-harris type 2?
A
- Above the physis (metaphysis)
5
Q
Salter-harris type 3?
A
- Below the physis (epiphysis)
6
Q
Salter-harris type 4?
A
- Through the epi/meta/physis
7
Q
Salter-harris type 5?
A
- Compression of the physis
8
Q
5 signs of compartment syndrome?
A
- Pain, pallor, paresthesias, pulselessness, paralysis
9
Q
Tx of fracture/sprain/strain? Open fx?
A
- Control swelling, pain control, remove objects such as rings/watches, reduction of fx/dislocation
- Open fx need abx, irrigation, debridement
10
Q
Test for median nerve motor function on hand?
A
- Flex thumb against resistance
11
Q
Test for ulnar nerve motor function on hand?
A
- Spread fingers against resistance
12
Q
Test for radial nerve motor function on hand?
A
- Maintaining extension of wrist and fingers against resistance
13
Q
What is the best way to test tendon function?
A
- Test tendon function against resistance, 90% can be torn and still move without resistance
14
Q
What is mallet finger?
A
- Rupture of extensor tendon at DIP, flexed at 40 degrees, splint in hyperextension
15
Q
What is boutonniere deformity?
A
- Flexor at PIP and hyperextensor of DIP joint, splint PIP in extension
16
Q
Tx of DIP and PIP joint dislocations?
A
- Digital block, reduce by distraction, hyperextension, then reposition, splint in full extension
- Be concerned about irreducible joint
17
Q
Tx of MCP joint dislocations?
A
- Most likely need surgery, attempt closed reduction and splint with MCP joint flexed 70-90 degrees
18
Q
Thumb IP joint dislocations tx?
A
- Closed reduction, thumb in spica splint
19
Q
Tx of thumb MCP dislocations?
A
- Reduce by flexing and abducting metacarpal with pressure, place in thumb spica
20
Q
Tx of thumb MCP ulnar collateral ligament rupture?
A
- Place in thumb spica splint (gamekeeper or skier thumb)
21
Q
Tx of MC fractures of fourth or fifth? Tx of MC fractures of second or third? Tx of MC fractures of thumb?
A
- Ulnar gutter splint, radial gutter splint, thumb spica splint
22
Q
Which wrist bones can cause avascular necrosis of bone?
A
- Scaphoid, lunate, capitate
23
Q
What is a colles fracture?
A
- Distal radius displaced proximally and dorsally, ulnar styloid may be fractured
24
Q
What is a smith fracture?
A
- Distal radius displaced proximally and volarly
25
What is a barton fracture?
- Volar and proximal displacement of radial articular surface, volar displacement of carpus, radial styloid may be fractured
26
Difference between proximal long head biceps tendon rupture vs distal tendon rupture?
- Elbow flexion maintained with proximal, weak with distal tendon rupture
27
How do you test for distal biceps tendon rupture?
- Examiner squeezes muscle belly of bicep with elbow flexed and forearm resting on patient’s lap
28
Tx of biceps/triceps tendon ruptures?
- Sling, ice, analgesics and referral to ortho surgeon for definitive management, repair in young active patients
29
Majority of elbow dislocations?
- Posterolateral
30
What should you be concerned about in elbow dislocation?
- Neurovasc compromise: absence of radial pulse before reduction, systemic injuries suggestive of arterial injury
31
Which elbow fracture is concerning for NV compromise? What is one feared complication?
- Supracondylar fracture, Volkmann ischemic contracture: refusal to open hand, pain with passive extension of fingers, forearm tenderness, also all nerve problems
32
Tx of elbow fx nondisplaced?
- Sling immobilization and ortho referral
33
Tx of elbow fx displaced, open, or NV compromise?
- Admit with immediate ortho
34
What is monteggia fx?
- Proximal third of ulna with radial head dislocation
35
What is galeazzi fx?
- Fracture of distal radius with associated distal radioulnar dislocation
36
Tx of forearm fx?
- Nondisplaced with long-arm splint and referral
| - Displaced need ortho consult
37
Feared complications of sternoclavicular sprains and dislocations?
- Hoarseness, dysphagia, dyspnea, upper extremity paresthesias or weakness = PTX, great vessel problem, trachea problem, esophagus problem
38
Tx of sternoclavicular sprains/disloactions?
- Ice, analgesics, sling immobilization, if posterior call ortho for ORIF
39
What should one look for with scapula fx?
- Associated intrathoracic injuries
40
Views for glenohumeral joint dislocation?
- Ap and scapular Y view
41
What nerve is injured with proximal humeral fractures?
- Axillary nerve and artery
42
What nerve is injured with humeral shaft fractures?
- Radial nerve
43
Tx of pelvic fx?
- Bind, look for other source of bleeding, send to angio with embolization and external fixation, ORIF
