UE Fractures part 1

Question 1

what is the most common MOI for a clavicular fracture

Answer 1

Direct fall on the shoulder with arm at side

Question 2

what is the another MOI for a clavicular fracture

Answer 2

a direct blow

Question 3

risk factors for clavicular factors

Answer 3

contact sports and being a male until age 75

Question 4

what age do females become more likely to experience clavicular fractures

Answer 4

over 75 years old

Question 5

how does a clavicular present

Answer 5

deformity at fracture site usually midline
defect may be palatable
crepitus with AROM

Question 6

with a clavicular Fracture a neuromuscular exam is needed due to

Answer 6

the subclavian vessels and the brachial plexus

Question 7

Clavicular Fracture locations in order of likely hood

Answer 7

middle
distal
medial

Question 8

is a Clavicular Fracture a non operative treatment?

Answer 8

typically yes

Question 9

how do manage Clavicular Fracture

Answer 9

sling or figure 8 brace (sling provide more comfort and results and alignment are identical)

choice usually based upon provider preference

Question 10

when do you need surgical management for a Clavicular Fracture (definitive indications)

Answer 10

it is an open fracture
there is a neruovascular injury
tenting of the skin is present

Question 11

when do you need surgical management for a Clavicular Fracture (relative indications) (5)

Answer 11

1. widely displace fractures
2. multiple fracture segments
3. displaced laterally (distal 1/3 fractures)
4. the clavicle fracture is on the dominant extremity in overhead athlete (throwing, baseball, volleyball, tennis)
5. cosmetic concerns

Question 12

most common Proximal Humerus Fracture MOI

Answer 12

fall onto an outstretched hand

direct trauma may also cause this

Question 13

Proximal Humerus Fracture other MOI age groups

Answer 13

simple fall in older people (increased fall risk and decreased bone density)
high energy trauma in young patients

Question 14

Proximal Humerus Fracture clinical presentation

Answer 14

swelling, ecchymosis, pain, guarding, limited ROM

Question 15

1 part Proximal Humerus Fracture

Answer 15

Surgical neck, anatomic neck, lesser tuberosity or greater tuberosity
Any fracture pattern with less than 1 cm displacement

Question 16

2 part Proximal Humerus Fracture

Answer 16

Surgical neck, anatomic neck, lesser tuberosity or greater tuberosity
Fragments must be displaced by 1 cm

Question 17

3 part Proximal Humerus Fracture

Answer 17

Surgical neck and greater tuberosity or surgical neck and lesser tuberosity
Fragments must be displaced by 1 cm

Question 18

4 part Proximal Humerus Fracture

Answer 18

Surgical neck, lesser and greater tuberosities

Fragments must be displaced by 1 cm

Question 19

non surgical Proximal Humerus Fracture management need for

Answer 19

neer type 1

Question 20

surgical Proximal Humerus Fracture management need for

Answer 20

associated neurovascular injury
Open Fx
Neer types 2, 3, and 4
Significant distortion of the bicipital groove
Fracture dislocation

Question 21

Midshaft Humerus Fracture MOI

Answer 21

there is a direct blow to humerus
or a bending force applied to the humerus

falling on an out starched hand can also cause this type of fracture this however is a PATHOLOGIC FRACTURE

Question 22

is a pediatric patient presents with Midshaft Humerus Fracture suspect what?

Answer 22

child abuse

Question 23

Midshaft Humerus Fracture clinical presentation

Answer 23

swelling, ecchymosis

a visible shortening may be present

Question 24

radial nerve neurological screen sensory

Answer 24

dorsum of hand

Question 25

radial nerve neurological screen motor

Answer 25

perform wrist dorsiflex

Question 26

medial nerve neurological screen sensory

Answer 26

palmar aspect of thumb | index finger middle fingers

Question 27

ulnar nerve neurological screen sensory

Answer 27

palmar aspect of pinkie

Question 28

ulnar nerve neurological screen motor

Answer 28

perform finger abduction

Question 29

medial nerve neurological screen motor

Answer 29

perform thumb opposition

Question 30

Midshaft Humerus Fracture vascular screen

Answer 30

distal pulses radial and ulnar | cap refill

Question 31

the majority of the time Midshaft Humerus Fracture is managed how?

Answer 31

non surgical with a functional humerus brace

Question 32

Early shoulder range of motion in mid shaft humerus should be done to

Answer 32

reduce the risk of adhesive capsulitis

Question 33

what is and adhesive capsulitis also known as

Answer 33

frozen shoulder

Question 34

when are surgical interventions used for a mid shaft humerus fracture?

Answer 34

``` Neurovascular injury Open Fx Pathologic Fx > 3 cm shortening > 30° angulation ```

Question 35

Pediatric ossification centers (CRITOE)

Answer 35

``` Capitellum Radial head Internal (medial) epicondyle Trochlea Olecranon External (lateral) epicondyle ```

Question 36

Supracondylar Fracture most common MOI

Answer 36

hyperextension injury associated with falling on outstretched hands, resulting in a extension Supracondylar Fracture

Question 37

other Supracondylar Fracture MOI

Answer 37

a direct blow that will cause a extension or flexion type Supracondylar Fracture

Question 38

Supracondylar Fractures are seen more commonly in which patient population

Answer 38

pediatrics

Question 39

Supracondylar Fracture clinical presentation

Answer 39

possible palatable displaced fragment swelling ecchymosis Potential for neurovascular injury Forearm compartment syndrome

Question 40

Forearm compartment syndrome results in what and presents as what

Answer 40

Volkmann’s ischemia / contracture Marked swelling of the forearm Palpable tenseness Pain with passive extension of the finger

Question 41

Supracondylar Fracture can mimic which dislocation

Answer 41

posterior elbow dislocation

Question 42

when do we use a non surgical approach to Supracondylar

Answer 42

type I and type II with reduction

Question 43

when do we use a surgical approach to Supracondylar

Answer 43

theres a neuromuscular injury open fracture type III

Question 44

Radial Head fracture Most common MOI

Answer 44

FOOSH w/ partially flexed elbow

Question 45

Radial Head fracture additional MOI

Answer 45

Posterior elbow dislocation

Question 46

Radial Head fracture clinical presentation

Answer 46

swelling over lateral elbow | limited ROM

Question 47

which ROMs are especially difficult for patients with Radial Head fracture

Answer 47

Extension, supination

Question 48

which type of x ray should you get for a suspected Radial Head Fracture and what sign are you looking for

Answer 48

AP, lateral views AND oblique view look for fat pad sign *Type I Fx may be occult on initial x-rays

Question 49

Radial Head Fracture type I Non surgical

Answer 49

Splint or sling for 5-7 days allow patients to use the sling for comfort after this time period Early ROM

Question 50

Radial Head Fracture type II Non surgical -- Minimal displacement

Answer 50

Minimal displacement Splint for 10-14 days allow patients to use the sling for comfort after this time period Aggressive ROM after splint removal

Question 51

Radial Head Fracture type II Moderate displacement management

Answer 51

open reduction and internal fixation (ORIF)-- surgical intervention

Question 52

Radial Head Fracture type III management

Answer 52

surgery