Flashcards in Upper Extremity Fractures Deck (71):
MC clavicle fracture?
Middle 1/3 (80%)
MC fracture in children?
Common MOI for clavicle fracture
-Midshaft: direct blow from fall
-Lateral: blow to top of shoulder
Treatment of clavicle fracture
-Sling for comfort
-Most will heal on their own if fragments are touching
-ORIF may be necessary if fragments are way apart
Who is most affected by proximal humerus fractures?
-Elderly (65 yo)
-Open fractures are rare
When should a shoulder x-ray be ordered for suspected proximal humerus fracture?
Always - unless pain to palpation is past proximal 1/3 of the humerus
MC MOI for proximal humerus fracture?
Neuro injuries are MC in clavicle or proximal humerus fractures?
Treatment of proximal humerus fractures
-Good alignment should heal with sling only for 6 weeks
-May need ORIF, IM rod or hemiarthroplasty if malaligned or displaced
Treatment of proximal humerus dislocation if there is glenoid and humeral head destruction?
May require total shoulder arthroplasty
Most proximal and midshaft humeral fractures are ___ and treatment is:
Typical cause of humeral shaft fractures?
-Trauma such as direct blow or bending force (less commonly from a fall on outstretched hand/elbow)
-Can result from strong muscle contraction w/high velocity throwing or arm wrestling
Shortening of upper arm with suspected humeral fracture suggests:
What is the MC neuro injury of humeral fractures?
Radial nerve (results in weakness of wrist, fingers, thumb extension)
Types of humeral shaft fractures possible:
Follow up schedule of humeral shaft fractures?
Every 2 weeks to x-ray and follow healing of bone
What can be done to prevent shoulder stiffness in upper extremity fractures?
Pendulum exercises while in splint or brace
How should a hanging cast be applied to a humeral shaft fracture?
Bivalved to allow for swelling
MOI of scapula fractures
-Direct blow or fall
-Always from a high energy injury
Which fracture requires 3 x-ray views of shoulder?
Treatment of scapula fractures
If does NOT involve glenoid, can be treated conservatively w/sling
What is the MC dislocated major joint?
Who has the highest incidence of shoulder dislocation?
-20 to 30 yo males
-61 to 80 yo females
MC type of shoulder dislocation
Anterior shoulder dislocation MOI
-Force that causes ER and abduction
-In elderly, it can be FOOSH
X-ray view for anterior shoulder dislocation?
Shoulder w/dedicated Y view
Treatment of anterior shoulder dislocation
-Closed reduction usually w/conscious sedation
-Sling and swathe for 2 weeks then begin pendulum exercises and gentle ROM
What should be done to ensure proper reduction of anterior shoulder dislocation?
Always get a post-reduction x-ray
Define Bankart lesion
-Injury (tear/fx) to anterior inferior rim of glenoid
-Complication of anterior shoulder dislocation
Define Hill-Sachs deformity
-Impaction fx of posterolateral surface of humeral head against inferior rim of glenoid
-Occurs in 50% of anterior shoulder dislocations
Describe greater tuberosity fracture
-Pathognomonic for longitudinal rotator cuff tears
-Occurs in about 15% of anterior shoulder dislocations
What can a posterior shoulder dislocation be misdiagnosed as?
Frozen shoulder/adhesive capsulitis
Neuro injuries occur MC in which type of shoulder dislocation?
Inferior (60% of pts)
Which nerve is MC affected in inferior shoulder dislocation?
Neuro dysfunction of inferior shoulder dislocation usually resolves when?
What occurs in 80% of inferior shoulder dislocations?
Rotator cuff tears OR greater tuberosity fractures
Describe subluxation of shoulder
-Pt dislocates then spontaneously reduces dislocation
-Unstable cases will require surgery
Order of ligament injury in AC sprain?
1. AC ligaments damaged first
2. Attachments of deltoids and trapezius
3. Then coracoclavicular ligament
Which grades of AC sprain require prompt surgery?
What is the MC adult fracture of the elbow?
Radial head fracture
What is the best view to look for fat pad sign and radiocapitellar line?
Describe radiocapitellar line
Line drawn through proximal radial shaft and neck through the joint should pass to the articulating capitellum
What does an abnormal radiocapitellar line demonstrate?
Dislocation of radial head
What is the fat pad sign?
-Related to radial head fracture
-Intra-articular fracture will cause leakage of blood and marrow into the joint to give a joint effusion
-Fat pads are displaced away from bone
How does the anterior fat pad normally look on elbow x-ray? How does it look abnormally?
-Lucent line hugging anterior humeral cortex
-"Sail" or "thorn" sign (elevated anteriorly)
What does a visible posterior fat pad on elbow x-ray mean?
-Always abnormal and due to a large effusion
-Underlying fracture is very likely present somewhere
What is the MC pediatric elbow fracture?
What ages do supracondylar fractures occur?
5-10 yo (rare after 15 yo)
What is a supracondylar fracture?
Fracture of distal humerus superior to epicondyles
What is the MC complication of supracondylar fractures?
Cubitus varus deformity w/loss of carrying angle
What neurovasc injury is MC w/olecranon fracture?
Ulnar nerve injury
What type of elbow dislocation is MC?
Who is affected by Nursemaid's elbow?
-Children between 1-4 yo
-Can be recurrent in up to 20%
Nursemaid's elbow MOI
Any longitudinal pull w/forearm pronated
-Bone bends and cracks
-MC occurs in children bc their bones are softer and more flexible
What type of fracture occurs in children bc their bones are softer/more flexible?
Greenstick fracture MOI
Which type of fracture can present with a "roller coaster" type look to it?
Treatment of greenstick fracture
-If less than 10 degrees angulation: long arm cast 4-6 wks
-If greater than 10 degrees angulation: closed reduction w/long arm cast 4-6 wks
What is MC broken bone in arm?
Who is affected by distal radius fracture?
-Over age 60 - 4:1 female
-Adolescents - 3:1 male
Colles vs. Smith fractures
Distal radius fracture
MC fractured carpal bone?
What is the MC missed fracture?
What is the MC carpal instability?
-5th metacarpal neck
-Direct impact w/a closed fist
How is boxers fracture treated?
Ulnar gutter splint w/MCP joint flexed to 90 degrees
Game keepers/skiers thumb MOI
Treatment of game keepers/skiers thumb
Thumb spica splint and pinning or repair of UCL
Treatment of finger fractures
-Splinting is adequate in most cases
-Trephination may be required for tuft fractures w/subungual hematoma