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UL Ox > UL Fracture Ox > Flashcards

UL Fracture Ox Flashcards

(38 cards)

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1
Q

Common Fx locations for Long Bones Ox Management

Anatomy Review

A

Diaphysis (middle of bone)

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2
Q
  • Normal
  • Transverse
  • Oblique

Types of Fx

A
  • No Fx
  • perpendicular to long axis
  • angled fx
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3
Q
  • Spiral
  • Comminuted
  • Segmental
  • Avulsion

Types of Fx

A
  • Fx in a twisting pattern
  • bunch of fractures
  • chunk out of the bone
  • yanked by tendon
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4
Q
  • Impacted
  • Torus
  • Greenstick

Types of Fx

A
  • bone smushes itself
  • pediatric; buckle fracture
  • bone partially fractures
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5
Q

Spatial Relationships

Fracture Terminology

A
  • Distracted - seperation in long axis
  • Displaced - seperation along the short axis
  • Angulated - angle of fracture
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6
Q

Fracture Heal General Process

A
  • Inflammation/hematoma
  • Blood floods the fracture, bruising occurs
  • new blood vessels form (callus grows)
  • outer surface of callus hardens
  • osteoblasts develop
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7
Q

X-Rays needed to evaluate healing

A

AP - varus
Lateral - Ext. (AKA anterior angulation)

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8
Q

What does “cloudiness” indicate on a radiograph of a fracture healing?

A

Osteoblasts formation

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9
Q

Remodeling

Fx healing

A

tries to make bone the original shape and size

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10
Q

What can you measure to evaluate a fx after it heals?

A

Varus angle

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11
Q

Surgical Cons

Fracture Management

A
  • bone fragments are rigidly fixed (no motion)
  • frequent pain and Sx complications
  • delayed healing
  • bone is relatively weaker after Sx
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12
Q

Orthotic Pros

Fracture Management

A
  • micromotion at fx site
  • movement of adjacent joints
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13
Q

Sarmiento Treatment Principles

A
  • micromotion at fracture site (osteogenesis)
  • soft tissue compression
  • minor shortening, angulation, and rotation are NOT complications
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14
Q

Humeral Fx

MOI

A
  • Adults - low energy injury (fall from height; rotation)
  • Pediatrics - high energy injury (MVA)
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15
Q

Ulnar Fx

MOI

A
  • Adult - Direct Blow
  • Pediatrics - Indirect injury; typically a fall an outstretched hand or child abuse
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16
Q

Colles Fx (distal radius)

MOI

Study These Flashcards
A
  • Fall on outstretched hand
  • wrist ext. and radial deviation

usually older patients

17
Q

Humeral Fx - Sx indications

Clinical Descision Making

Study These Flashcards
A
  • unaccepted position after reduction
  • radial nerve palsy
  • open fx
  • comminuted fx
  • pathologic fx (cancer)
  • both forearm bones
  • poly-trauma
  • compartment syndrome
18
Q

Humeral Fx

Acceptable Outcomes

Study These Flashcards
A
  • anterior angualtion < 20 degrees
  • varus angulation < 30 degrees (loss of carrying angle)
  • no more that 1” of shortening
19
Q

Humeral Fx - Ox indications

Clinical Decision Making

Study These Flashcards
A
  • capable of performing ROM exercises (crucial for osteogenesis)
  • normal sensation
  • no open wounds
  • can follow/adhere to protocol
20
Q

Ox typical wear schedule

Study These Flashcards
A

usually full time; removed for hygiene if cleared by physician

21
Q

Pre-Ox Management

Humeral Fx

Study These Flashcards
A

Coaptation (“Sugar Tong”) Splint

controls pain and edema

22
Q

Initial Application

Humeral Fx

23
Q

Fitting Parameters

Humeral Fx Ox

Study These Flashcards
A
  • 1” distal to axilla
  • 1” proximal to humeral epicondyles

Does not need to extend past the fracture

Key Mechanism - Compression of Soft Tissue

24
Q

Treatment Protocol

Humeral Fx Ox

Study These Flashcards
A

Orthosis is worn full time
* Codman’s “home” exercises
* avoid active shoulder abduction

25
Discontinuation of Ox | Humeral Fx Ox
* abscence of pain * observation of osseous bony bridge between fragments
26
Compications | Humeral Fx Ox
* **Nerve Palsy** - radial nerve; entrapment of nerve in callous * **Malalignment** - deformities are usually well tolerated; cosmesis * **Delayed Union** - frank motion is present at fx site * **Re-fracture** - very rare; new fx will occur above or below old fx site
27
Ulnar Fx - Sx indications | Clinical Decision Making
* unacceptable position post reduction * unstable * more than 50% displaced * open fx * more than 15 degrees angulation * disruption of interosseous membrane
28
Ulnar Fx - Sx | Acceptable Outcomes
* less than 15 degrees angulation * shortening is not a concern (other bone)
29
What level is Ox management effect for? | Ulnar Fx
distal 2/3 of forearm | proximal 1/3 will need Sx (i.e. Monteggia)
30
Ulnar Fx Ox | Treatment Protocol
* distal 2/3 only * start w/ long arm cast for 1 week (elbow at 90 and in supination) * transition to sleeve orthosis
31
Ulnar Fx Ox | Fitting Parameters
* free motion of wrist and elbow * no explicit guidelines (except bicepital mark)
32
Ulnar Fx Ox | Treatment Protocol
* full time except for bathing and exercises * discontinued after resolution of symptoms (regardless of healing phase)
33
Ulnar Fx Ox | Complications
* **Malalignment** - rare; interosseous membrane usually prevents this * **Delayed Union**- failure to achieve will require sx * **Re-fracture** - very rare with ox, common with plating
34
Colle's Fx | Clinical Decision Making
* Limited evidence that Ox is beneficial * Moderate evidence that rigid immobilization is better than Ox * Sx usually indicated
35
Surgical Indications | Colle's Fx
* Higher incidence instability vs. more proximal fx * displacement more common and difficult to reduce with cast or Ox * Percutaneous pinning techniques usually advocated
36
Colle's Fx Orthoses | Design and Indication
Originally used to address re-dislocation following closed reduction * Long arm cast for one week (90 degrees flexed and in supination) * Replaced with a Muenster style cast or Ox | Cast designed to eliminate pronation/supination
37
Colle's Fx Ox | Treatment Protocol
* Full time except for bathing and exercises
38
Colle's Fx | Complications
* **Malalignment** - rare; interosseous membrane usually prevents this * **Delayed Union**- failure to achieve will require sx * **Re-fracture** - very rare with ox, common with plating

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