Upper Extremity Fractures Flashcards Preview

Clin Med II MHM - FINAL > Upper Extremity Fractures > Flashcards

Flashcards in Upper Extremity Fractures Deck (71):
1

MC clavicle fracture?

Middle 1/3 (80%)

2

MC fracture in children?

Clavicle

3

Common MOI for clavicle fracture

-Midshaft: direct blow from fall
-Lateral: blow to top of shoulder

4

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

5

Who is most affected by proximal humerus fractures?

-Female
-Elderly (65 yo)
-Open fractures are rare

6

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

7

MC MOI for proximal humerus fracture?

Fall

8

Neuro injuries are MC in clavicle or proximal humerus fractures?

Proximal humerus

9

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

10

Treatment of proximal humerus dislocation if there is glenoid and humeral head destruction?

May require total shoulder arthroplasty

11

Most proximal and midshaft humeral fractures are ___ and treatment is:

-Non-displaced
-Treated conservatively

12

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

13

Shortening of upper arm with suspected humeral fracture suggests:

Significant displacement

14

What is the MC neuro injury of humeral fractures?

Radial nerve (results in weakness of wrist, fingers, thumb extension)

15

Types of humeral shaft fractures possible:

Spiral
Oblique
Transverse

16

Follow up schedule of humeral shaft fractures?

Every 2 weeks to x-ray and follow healing of bone

17

What can be done to prevent shoulder stiffness in upper extremity fractures?

Pendulum exercises while in splint or brace

18

How should a hanging cast be applied to a humeral shaft fracture?

Bivalved to allow for swelling

19

MOI of scapula fractures

-Direct blow or fall
-Always from a high energy injury

20

Which fracture requires 3 x-ray views of shoulder?

Scapula

21

Treatment of scapula fractures

If does NOT involve glenoid, can be treated conservatively w/sling

22

What is the MC dislocated major joint?

Glenohumeral (shoulder)

23

Who has the highest incidence of shoulder dislocation?

-20 to 30 yo males
-61 to 80 yo females

24

MC type of shoulder dislocation

Anterior (97%)

25

Anterior shoulder dislocation MOI

-Force that causes ER and abduction
-In elderly, it can be FOOSH

26

X-ray view for anterior shoulder dislocation?

Shoulder w/dedicated Y view

27

Treatment of anterior shoulder dislocation

-Closed reduction usually w/conscious sedation
-Sling and swathe for 2 weeks then begin pendulum exercises and gentle ROM

28

What should be done to ensure proper reduction of anterior shoulder dislocation?

Always get a post-reduction x-ray

29

Define Bankart lesion

-Injury (tear/fx) to anterior inferior rim of glenoid
-Complication of anterior shoulder dislocation

30

Define Hill-Sachs deformity

-Impaction fx of posterolateral surface of humeral head against inferior rim of glenoid
-Occurs in 50% of anterior shoulder dislocations

31

Describe greater tuberosity fracture

-Pathognomonic for longitudinal rotator cuff tears
-Occurs in about 15% of anterior shoulder dislocations

32

What can a posterior shoulder dislocation be misdiagnosed as?

Frozen shoulder/adhesive capsulitis

33

Neuro injuries occur MC in which type of shoulder dislocation?

Inferior (60% of pts)

34

Which nerve is MC affected in inferior shoulder dislocation?

Axillary

35

Neuro dysfunction of inferior shoulder dislocation usually resolves when?

After reduction

36

What occurs in 80% of inferior shoulder dislocations?

Rotator cuff tears OR greater tuberosity fractures

37

Describe subluxation of shoulder

-Pt dislocates then spontaneously reduces dislocation
-Unstable cases will require surgery

38

Order of ligament injury in AC sprain?

1. AC ligaments damaged first
2. Attachments of deltoids and trapezius
3. Then coracoclavicular ligament

39

Which grades of AC sprain require prompt surgery?

Grades 4-6

40

What is the MC adult fracture of the elbow?

Radial head fracture

41

What is the best view to look for fat pad sign and radiocapitellar line?

Lateral

42

Describe radiocapitellar line

Line drawn through proximal radial shaft and neck through the joint should pass to the articulating capitellum

43

What does an abnormal radiocapitellar line demonstrate?

Dislocation of radial head

44

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

45

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)

46

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

47

What is the MC pediatric elbow fracture?

Supracondylar fracture

48

What ages do supracondylar fractures occur?

5-10 yo (rare after 15 yo)

49

What is a supracondylar fracture?

Fracture of distal humerus superior to epicondyles

50

What is the MC complication of supracondylar fractures?

Cubitus varus deformity w/loss of carrying angle

51

What neurovasc injury is MC w/olecranon fracture?

Ulnar nerve injury

52

What type of elbow dislocation is MC?

Posterior (85-90%)

53

Who is affected by Nursemaid's elbow?

-Children between 1-4 yo
-Can be recurrent in up to 20%

54

Nursemaid's elbow MOI

Any longitudinal pull w/forearm pronated

55

Greenstick fracture

-Bone bends and cracks
-MC occurs in children bc their bones are softer and more flexible

56

What type of fracture occurs in children bc their bones are softer/more flexible?

Greenstick

57

Greenstick fracture MOI

FOOSH

58

Which type of fracture can present with a "roller coaster" type look to it?

Greenstick

59

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

60

What is MC broken bone in arm?

Distal radius

61

Who is affected by distal radius fracture?

-Over age 60 - 4:1 female
-Adolescents - 3:1 male

62

Colles vs. Smith fractures

Distal radius fracture
Colles: outward
Smith: inward

63

MC fractured carpal bone?

Scaphoid

64

What is the MC missed fracture?

Scaphoid

65

What is the MC carpal instability?

Scapho-lunate dissociation

66

Boxers fracture

-5th metacarpal neck
-Direct impact w/a closed fist

67

How is boxers fracture treated?

Ulnar gutter splint w/MCP joint flexed to 90 degrees

68

Game keepers/skiers thumb MOI

Abduction force

69

Treatment of game keepers/skiers thumb

Thumb spica splint and pinning or repair of UCL

70

Treatment of finger fractures

-Splinting is adequate in most cases
-Trephination may be required for tuft fractures w/subungual hematoma

71

Treatment of finger dislocation

-Closed reduction and splinting
-Always get post reduction x-ray
-Make sure no tendon or neurovasc injury after reduction