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

Upper Extremity Fractures Flashcards

1
Q

MC clavicle fracture?

A

Middle 1/3 (80%)

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2
Q

MC fracture in children?

A

Clavicle

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3
Q

Common MOI for clavicle fracture

A
  • Midshaft: direct blow from fall

- Lateral: blow to top of shoulder

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4
Q

Treatment of clavicle fracture

A
  • Sling for comfort
  • Most will heal on their own if fragments are touching
  • ORIF may be necessary if fragments are way apart
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5
Q

Who is most affected by proximal humerus fractures?

A
  • Female
  • Elderly (65 yo)
  • Open fractures are rare
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6
Q

When should a shoulder x-ray be ordered for suspected proximal humerus fracture?

A

Always - unless pain to palpation is past proximal 1/3 of the humerus

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7
Q

MC MOI for proximal humerus fracture?

A

Fall

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8
Q

Neuro injuries are MC in clavicle or proximal humerus fractures?

A

Proximal humerus

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9
Q

Treatment of proximal humerus fractures

A
  • Good alignment should heal with sling only for 6 weeks

- May need ORIF, IM rod or hemiarthroplasty if malaligned or displaced

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10
Q

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

A

May require total shoulder arthroplasty

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11
Q

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

A
  • Non-displaced

- Treated conservatively

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12
Q

Typical cause of humeral shaft fractures?

A
  • 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
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13
Q

Shortening of upper arm with suspected humeral fracture suggests:

A

Significant displacement

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14
Q

What is the MC neuro injury of humeral fractures?

A

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

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15
Q

Types of humeral shaft fractures possible:

A

Spiral
Oblique
Transverse

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16
Q

Follow up schedule of humeral shaft fractures?

A

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

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17
Q

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

A

Pendulum exercises while in splint or brace

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18
Q

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

A

Bivalved to allow for swelling

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19
Q

MOI of scapula fractures

A
  • Direct blow or fall

- Always from a high energy injury

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20
Q

Which fracture requires 3 x-ray views of shoulder?

A

Scapula

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21
Q

Treatment of scapula fractures

A

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

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22
Q

What is the MC dislocated major joint?

A

Glenohumeral (shoulder)

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23
Q

Who has the highest incidence of shoulder dislocation?

A
  • 20 to 30 yo males

- 61 to 80 yo females

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24
Q

MC type of shoulder dislocation

A

Anterior (97%)

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25
Q

Anterior shoulder dislocation MOI

A
  • Force that causes ER and abduction

- In elderly, it can be FOOSH

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26
Q

X-ray view for anterior shoulder dislocation?

A

Shoulder w/dedicated Y view

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27
Q

Treatment of anterior shoulder dislocation

A
  • Closed reduction usually w/conscious sedation

- Sling and swathe for 2 weeks then begin pendulum exercises and gentle ROM

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28
Q

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

A

Always get a post-reduction x-ray

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29
Q

Define Bankart lesion

A
  • Injury (tear/fx) to anterior inferior rim of glenoid

- Complication of anterior shoulder dislocation

30
Q

Define Hill-Sachs deformity

A
  • Impaction fx of posterolateral surface of humeral head against inferior rim of glenoid
  • Occurs in 50% of anterior shoulder dislocations
31
Q

Describe greater tuberosity fracture

A
  • Pathognomonic for longitudinal rotator cuff tears

- Occurs in about 15% of anterior shoulder dislocations

32
Q

What can a posterior shoulder dislocation be misdiagnosed as?

A

Frozen shoulder/adhesive capsulitis

33
Q

Neuro injuries occur MC in which type of shoulder dislocation?

A

Inferior (60% of pts)

34
Q

Which nerve is MC affected in inferior shoulder dislocation?

A

Axillary

35
Q

Neuro dysfunction of inferior shoulder dislocation usually resolves when?

A

After reduction

36
Q

What occurs in 80% of inferior shoulder dislocations?

A

Rotator cuff tears OR greater tuberosity fractures

37
Q

Describe subluxation of shoulder

A
  • Pt dislocates then spontaneously reduces dislocation

- Unstable cases will require surgery

38
Q

Order of ligament injury in AC sprain?

A
  1. AC ligaments damaged first
  2. Attachments of deltoids and trapezius
  3. Then coracoclavicular ligament
39
Q

Which grades of AC sprain require prompt surgery?

A

Grades 4-6

40
Q

What is the MC adult fracture of the elbow?

A

Radial head fracture

41
Q

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

A

Lateral

42
Q

Describe radiocapitellar line

A

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

43
Q

What does an abnormal radiocapitellar line demonstrate?

A

Dislocation of radial head

44
Q

What is the fat pad sign?

A
  • 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
Q

How does the anterior fat pad normally look on elbow x-ray? How does it look abnormally?

A
  • Lucent line hugging anterior humeral cortex

- “Sail” or “thorn” sign (elevated anteriorly)

46
Q

What does a visible posterior fat pad on elbow x-ray mean?

A
  • Always abnormal and due to a large effusion

- Underlying fracture is very likely present somewhere

47
Q

What is the MC pediatric elbow fracture?

A

Supracondylar fracture

48
Q

What ages do supracondylar fractures occur?

A

5-10 yo (rare after 15 yo)

49
Q

What is a supracondylar fracture?

A

Fracture of distal humerus superior to epicondyles

50
Q

What is the MC complication of supracondylar fractures?

A

Cubitus varus deformity w/loss of carrying angle

51
Q

What neurovasc injury is MC w/olecranon fracture?

A

Ulnar nerve injury

52
Q

What type of elbow dislocation is MC?

A

Posterior (85-90%)

53
Q

Who is affected by Nursemaid’s elbow?

A
  • Children between 1-4 yo

- Can be recurrent in up to 20%

54
Q

Nursemaid’s elbow MOI

A

Any longitudinal pull w/forearm pronated

55
Q

Greenstick fracture

A
  • Bone bends and cracks

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

56
Q

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

A

Greenstick

57
Q

Greenstick fracture MOI

A

FOOSH

58
Q

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

A

Greenstick

59
Q

Treatment of greenstick fracture

A
  • 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
Q

What is MC broken bone in arm?

A

Distal radius

61
Q

Who is affected by distal radius fracture?

A
  • Over age 60 - 4:1 female

- Adolescents - 3:1 male

62
Q

Colles vs. Smith fractures

A

Distal radius fracture
Colles: outward
Smith: inward

63
Q

MC fractured carpal bone?

A

Scaphoid

64
Q

What is the MC missed fracture?

A

Scaphoid

65
Q

What is the MC carpal instability?

A

Scapho-lunate dissociation

66
Q

Boxers fracture

A
  • 5th metacarpal neck

- Direct impact w/a closed fist

67
Q

How is boxers fracture treated?

A

Ulnar gutter splint w/MCP joint flexed to 90 degrees

68
Q

Game keepers/skiers thumb MOI

A

Abduction force

69
Q

Treatment of game keepers/skiers thumb

A

Thumb spica splint and pinning or repair of UCL

70
Q

Treatment of finger fractures

A
  • Splinting is adequate in most cases

- Trephination may be required for tuft fractures w/subungual hematoma

71
Q

Treatment of finger dislocation

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

Clin Med II MHM - FINAL (16 decks)

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