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Orthopaedics > Upper extremities > Flashcards

Upper extremities Flashcards

1
Q

what is the most commonly dislocated joint of the body?

A

the shoulder

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2
Q

which is the most common direction of dislocation of the shoulder joint?

A

Anterior (96%)

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3
Q

which part of the clavicle is most prone to fx?

A

Mid 3rd

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4
Q

what mechanism most likely causes clavicle fx?

A

fall onto the affected shoulder

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5
Q

what adjacent structures may be affected in clavicle fx?

A

brachial plexus, subclavian vessels, apex of lung

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6
Q

what will the patient w/ clavicle fx be like?

A
  • splinting
  • arm adducted across the chest and supported by the contralateral hand
  • proximal end tents the skin
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7
Q

how to detect an apical lung injury leading to ipsilateral pneumothorax?

A

listen to breath sounds

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8
Q

how to treat minimally displaced clavicle fx?

A
  1. comfort and pain relief
  2. immobilization(4-6wks): sling/figure of 8 bandages
  3. active ROM
  4. radiographs
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9
Q

what worring consequence may skin tenting in clavicle fx lead to?

A

Open fx

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10
Q

what may be the complications of clavicle fx?

A
  1. neurovascular compromise
  2. malunion
  3. nonunion
  4. posttraumatic arthritis
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11
Q

standard trauma series of the shoulder

A

AP, scapular-Y, axillary view

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12
Q

ligaments that maintain stability of the AC joint

A
  • AC lig

- coracoclavicular lig(conoid, trapezoid)

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13
Q

which dislocation of SC joint is more common?

A

Ant

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14
Q

which dislocation of SC joint is associated w/ pulm / neurovascular injuries?

A

Post

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15
Q

comolli sign

A

triangle swelling of the post thorax overlying the scapula and is suggestive of hematoma resulting in increased compartment p

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16
Q

sup shoulder suspensory complex(SSSC)

A

bone-soft tissue ring:

  • glenoid process
  • coracoid process
  • coracoclavicular lig
  • distal clavicle
  • AC joint
  • acromion process
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17
Q

floating shoulder

A

double disruptions of sup shoulder suspensory complex(SSSC)

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18
Q

bankart lesion

A

avulsion of anterioinferior labrum off the glenoid rim

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19
Q

hill sachs lesion

A

a posterolateral head defect is caused by an impression fx on the glenoid rim [ant. dislocation]

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20
Q

shoulder dislocation associated w/ rotator cuff tear is commonly seen in _______ individuals.(older/younger)

A

older

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21
Q

which imaging technique is used for rotator cuff tear?

A

US

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22
Q

how will patients w/ ant. shoulder dislocation present?

A

injured shoulder held in slight abduction and external rotation;
painful

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23
Q

which nerves may ant. shoulder dislocation injure?

A

axillary n.

musculocutaneous n.

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24
Q

positive apprehension test

A

if not in acute pain, passive movement of the shoulder in the provacative position (abduct, exten, extern rotat) reproduces the patient’s sense of instability and pain

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25
Q

closed reduction of ant. shoulder dislocation

A

traction-countertraction

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26
Q

a shorter period of immobilization (ant. shoulder dislocation)may be used for patients > 40yr because

A

stiffness of the ipsilateral hand, wrist, elbow, and shoulder

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27
Q

the most common commplication after dislocation is

A

recurrent dislocation

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28
Q

electric shock / convulsive mechanisms may produce ______ (ant/post) dislocation

A

post

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29
Q

the position of post. shoulder dislocation

A

internal rotation and adduction

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30
Q

signs suggestive of post. shoulder dislocation (AP view)

A
  • absence of the nl elliptic overlap
  • vacant glenoid sign(>6mm)
  • trough sign(reverse hill-sachs)
  • loss of profile of humeral neck (full int. rota)
  • void in the sup/inf glenoid fossa
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31
Q

glenohumeral dislocations are most readily on the _____ view

A

axillary

32
Q

which shoulder dislocation will present in a salute fashion?

A

inferior

33
Q

most common humerus fx

A

proximal

34
Q

what may be considered if an older individual gets a prox humerus fx after a simple fall?

A

osteoporosis

35
Q

fx fragments displaced by the pull of muscles on proximal humerus

A
  1. humeral head
  2. lesser tuberosity
  3. greater tuberosity
  4. humeral shaft
36
Q

nerve injuries noted in proximal humerus fx

A

axillary n

37
Q

what will anatomic humerus neck fx lead to?

A

osteonecrosis

38
Q

surgery for proximal humerus fx

A

ORIF / arthroplasty

39
Q

chronic unreduced fx-dx and repeated closed recuct may lead to

A

myositis ossificans

40
Q

humeral shaft

A

pectoralis major insertion to supracondylar ridge

41
Q

nerve function noted in humersl shaft fx

A

radial n

42
Q

what should be considered when extreme swelling in the affected arm is encountered?

A
  • serial neurovascular exam

- compartment pressures

43
Q

complications of extraarticular supracondylar fx

A
  1. volkmann ischaemic contracture
  2. loss of elbow ROM
  3. hetertopic bone formation
44
Q

which is the most common elbow dislocation?

A

post

45
Q

during elbow dislocatin, the capsuloligamentous structures of the elbow are injured in a ___ to ____ fashion.

A

lateral; medial (hori cycle)

46
Q

which structures should be repaired for elbow stability?

A

trochlear notch, radial head, LCL (rarely MCL)

47
Q

complications of elbow dislocation

A
  • loss of motion(stiffness)
  • ulnar n
  • brachial a.
  • compartment syn(volkmann contracture)
  • persist instab/redislocat
  • arthrosis
  • heterotopic bone/myositis ossificans
48
Q

monteggia fx

A

proximal ulnar fx w/ radial head dislocation

49
Q

nightstick fx

A

results from direct trauma to the ulna along its subcutaneous border

50
Q

galeazzi fx

A

distal radial fx w/ distal radioulnar joint disruption

51
Q

which is more common, monteggia fx / galeazzi fx?

A

galeazzi fx

52
Q

colles fx

A

distal radial fx : dorsal angula “dinner fork”

53
Q

smith fx

A

distal radial fx : volar angula

54
Q

bartons fx

A

distal radial intraarticular fx disloc/sublux

55
Q

which distal radial fx is indicated for closed reduction?

A

all

56
Q

why extreme wrist flexion should be avoided in distal radial fx?

A

cause it increases carpal canal pressure and digital stiffness

57
Q

which nerve may distal radial fx damage?

A

median n

58
Q

tendon that ruptures in distal radial fx

A

extensor pollicis longus

59
Q

carpal bones

A

distal: Tm-Td-C-H
proximal: S-L-T-P

60
Q

the 0 degree capitolunate angle

A

Lateral(neutral position):

a straight line drawn down the third metacarpal shaft, c, l, and shaft of radius

61
Q

watson shift test

A

painful dorsal scaphoid displacement as the wrist is moved from ulnar to radial deviation w/ palm press on the tuber

62
Q

___ scaphoid fx is prone to nonunion and osteonecrosis

A

proximal

63
Q

blood supply of scaphoid

A

distal 20%-30%: volar scaphoid branches

proximal 70-80%: dorsal scaphoid branches

64
Q

most commonly fractured carpal bone

A

scaphoid

65
Q

carpal keybone

A

lunate

66
Q

“spilled tea cup sign”

A

volar dislocation of the lunate (lateral)

67
Q

Terry Thomas Sign

A

widening of the scapholunate space >3mm (nl<2mm)

68
Q

contracture of soft tissues begin around ___ hrs following hand injuries.

A

72

69
Q

protected splinting position of metacarpal head

A

MCP flex>70

70
Q

Bennett fx

A

1MC base intraarticular fx dislocation (abductor pollicis longus)

71
Q

Rolando fx

A

comminuted Bennett fx

72
Q

Boxer’s fx

A

fx of the metacarpal neck with volar angulation of the distal fragment

73
Q

Gamekeeper’s Thumb (skier’s thumb)

A

disruption of the ulnar collateral ligament of the 1

MCPJ, oft w/ a fx of the base of the prox phalanx

74
Q

dx of Carpal tunnel syndrome

A

EMG

75
Q

fracture of the hook of the hamate can damage ____ nerve

A

ulnar

76
Q

MRI of Carpal tunnel syndrome

A

thickening of the median n proximal to the carpal tunnel, flattening of the median n in the

Orthopaedics (4 decks)

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