what is the a classic pediatric injury in the humerus
supracondylar fracture of distal humerus
how do supracondylar fractures occur
FOOSH with valgus component
accidental trauma
falling from height - monkey bars
supracondylar fracture results in a ____ fracture line and ___ dislocation of the distal humerus
extra-articular
posterior - falling on flexed elbow
supracondylar fractures occur in children younger than what age
what is the peak age
male or female MC
less than 10 years old
5-7 is peak age
Male because we rowdy
what are different types of supracondylar fractures
type 1 - undisplaced
type 2 - displaced with intact cortex
type 3 - complete displacement - posterior dislocation*
are fracture lines present in supracondylar fractures
sometimes but not always
sooo check for indirect signs
what are indirect signs of supracondylar fractures
anterior fat pad sign - also called sail sign - elevated joint effusion that appears as triangle shaped lucency on lateral projection
posterior fat pad sign - not visualized on normal xrays
anterior humeral line - should intersect middle third of capitellum - children under 4, the line will pass the anterior third of capitellum
positive posterior fat pad sign is diagnostic of what in children and what in adults
children - supracondylar fractures
adults - radial head fracture
how does a intercondylar distal humerus fracture occur
FOOSH with elbow extension
T or Y fracture of distal humerus
what accounts for 50% of distal humerus fractures in adults
intercondylar distal humerus fracture
what fracture are mostly a T or Y appearence and occur intra articular* at the distal humerus
intercondylar distal humerus fracture
how does a transcondylar distal humerus fracture occur
FOOSH and elow extension
fracture through both distal humeral condyles
___ fossa is the thinnest part of the distal humerus and the ___ process may go through this fossa
olecranon
how do condylar distal humerus fractures develop
extended elbow and valgus force that shears through the medial and lateral condyles
what is the name of the osteochondral fragment that may be sheared off the articular surface of the capitellum duing a condylar distal humerus fracture
Kocher fracture
what distal humerus fracture is common in children and occurs usually in boys after FOOSH with avulsion or strong throwing or pitching
epicondylar fracture
also called little leager elbow
what is the most common epicondyle involved in epicondylar fracture
due to what force
medial epicondyle
valgus force
the avulsed epicondyle fragment may become entrapped in the joint when
what may happen
when no dislocation is present
the avulsed fragment may stimulate trochlear ossification center
apophyseal ossification centers mneumonic
CRITOE - 1 3 5 7 9 11
capitellum, radius, internal epicondyle, trochlea, olecranon, external epicondyle
olecranon fractures occur as result of one of four mechanisms
direct blow or fall
FOOSH with elbow flexion
avulsion of the triceps
stress fracture - athletes and gymnast
the ulnar nerve is closely related to the medial aspect of the ____ and can occasionally be damaged during this fracture
olecranon
what view of a olecranon process is required for diagnosis
lateral view
what is the complete radiological evaluation of an olecranon fracture
lucency reaching the trochlear groove* coronoid fracture comminution distal humerus fracture radial head fracture or dislocation
comminuted olecranon fracture is likely the result of what
direct blow
olecranon fracture is likely the result of what
triceps contraction
coronoid process fractures occur with result of a ___ elbow dislocation
posterior elbow dislocation
coronoid process fractures occur as result of what?
hyperextension with elbow alvusion of brachialis muscle tendon and shearing off of the trochlea
what xray views are needed to diagnose coronoid process fracture
lateral or 45 degree oblique
posterior dislocation is the most common cause of what 3 fractures?
radial head fractures
condyle fractures
coronoid fractures
what are the most common fractures of elbow in adults
radial head fractures
radial head fractures are more common in males or females
females
how do radial head fractures occur
FOOSH with minimal elbow flexion or valgus pronation stress with radial head pushed into capitellum of the humerus or direct blow
what are the views requires for radial head fracture
AP
lateral
oblique
what confirms the diagnosis of radial head fracture on xray
fat pad sign or sail sign
what is the classification system used for radial head fractures
mason classification
type 1 - vertical undisplaced fracture < 1cm also called chissel fracture
type 2 - 4 are displaced and require surgery
what is a fracture of the ulna shaft that causes dislocation the proximal radio-ulnar joint
moteggia fracture/dislocation
what is a fracture of the distal part of the radius with dislocation of distal radioulnar and an intact ulna
galeazzi fracture
galeazzi fractures are more common in what population
peak age
children 9-12
moteggia fracture/dislocation classification systems
based on what
Bado classification
radial head dislocation and PRUJ
galeazzi fracture classification system
based on position of distal radius
type 1 - dorsal distal radial displacement
type 2 - volar distal radial displacement
how do you remember montaggia from galeazzi fracture and dislocations
GRUM - galeazzi radius montaggia ulnar
MUGR - mugger
what are isolated fractures of the ulna that are typically in the mid diaphysis resulting from a direct blow
nightstick fracture
what is a characteristic defensive fracture when the patient tries to ward off an overhead blow from an assailant
nightstick fracture
nightstick fractures have a high rate of what
delayed non union or non union
what are other names for nightstick fractures
parry or tap fracture
what is subluxation of the radial head out of the annular ligament
pulled elbow or nursemaids elbow
pulled elbows are __ reducible
easily
pulled elbow mechanism of injury
lifting of child while holding wrist and hands that allows radial head to slip out
is there any tear of ligaments in a pulled elbow
no
how do you reduce a pulled elbow
flexion and supination of forearm
what is a extra-articular fracture of the distal radius that occurs as result of foosh with forearm pronation and dorsiflexion during forward falls
colles fracture
what extra-articular fracture of the distal radius metaphysis with dorsal distal radius angulation and impaction
colles fracture
colles fracture is common in who
osteoporotic elderly women
what does colles fracture look like on an xray
dorsal angulation of the distal fragment is present to a variable degree
impaction with resultant shortening of the radius
asssoicated with ulnar styloid fracture
colles fracture is sometimes called ___ with dislocation of the ulna
moor fracture
colles vs smith fracture causes
colles fracture FOOSH
smiths fracture falling on wrist in flexion or direct blow to back of wrist
what is a complication of colles fracture
dinner fork deformity
- avulsed ulnar styloid process
- distal fragment of radius overides rest of bone
what is the fracture of the distal radius with palmar or volar angulation of the distal fracture fragment
smith fracture or reverse colles
most smith fractures occur intra or extra-articular
extra-articular
what is the difference between colles and smith fracture radiographically
colles - dorsal angulation
smith - volar or palmar angulation
both have ulnar styloid fracture
what fracture of the distal radius extends through the dorsal aspect of the articular surface but not the volar surface
barton fracture
during distal radial fractures of the wrist, what would be present that indicates intra-articular effusion
pronator fat pad
what intra-articular fracture of the distal radius extends through the volar aspect
reverse barton fracture
what are intra-articular fractures of the radial styloid process
chauffer fractures or hutchinson fractures or backfire fracture
what causes a chauffer fracture
blow to the back of the wrist or forced abduction and radial deviation of the wrist
turning crank and it rapidly spins backward
what are complications of the chauffer fracture
scapholunate dissociation
transscaphoid perilunate dislocation
ulnar styloid fracture
what is the most common carpal bone fractured in the hand
scaphoid
what people are most commonly affected by scaphoid fracture
adolescents and young adults
older patients are more likely to have scaphoid fracture than young adults? t/f
NOOOOO
more likely to fracture distal radius - usually colles fracture
what is the clinical application of scaphoid fractures
pain in anatomically snuff box
initial xrays miss and must repeat after 4-7 days
what view is needed to view the scaphoid
PA, medial oblique, lateral views
PA ulnar deviation is required!
describe scaphoid fractures based on location
waist of scaphoid - MC - highest risk of AVN
proximal pole - highest risk of non union
distal pole - also called scaphoid tubercle - best prognosis
what is a clear inidicator on xray of scaphoid fracture
scaphoid fat pad sign - obliteration or lateral displacement of a straight or convex lucent line on the lateral aspect of the scaphoid
terry thomas sign - scapholunate lig dissociation - clenched fist view
idiopathic AVN of the scaphoid is called
preiser disease
scapholunate dissociation leads to what sign with rotatory subluxation of the scaphoid
signet ring sign
scapholunate dissociation is present when the widened scapholunate space is greater than __ mm
3mm
scapholunate advanced collapse SLAC, how do you differentiate from scaphoid fracture
SLAC - dorsal or volar tilt of the lunate must be present - DISI and VISI - dorsal and volar intersegmental instability
what is the second most common carpal bone fracture
triquetral fracture
triquetral fractures typically occur where on the bone
dorsal surface
what view is essential in diagnosis of triquetral fracture
lateral
what ligament may cause a dorse avulsion fracture on the dorsal aspect of the lunate
dorsal radiocarpal lig
lunate dislocation occurs when the lunate is displaced and rotated how
volar or palmar
what is the most common dislocated carpal
lunate
what is the difference between lunate dislocation and perilunate dislocation
lunate dislocation - lunate dislocates volarly or palmarly
perilunate dislocation - radiolunate articulation preserved and rest of carpals are displaced dorsally
most common causes of scaphoid fracture and lunate dislocation
FOOSH
what is pie sign
lunate dislocation sign where lunate overlaps capitate and it has charateristic triangle appearence
what is used for radiographic evaluation of carpal fractures (arc?)
carpal arcs of louis gilula
what fracture may occur when hold a bat or club
hamate hook fracture
what is best way to visualize hook of hamate fracture
CT
carpal tunnel view - 2nd
what are fractures/dislocation of the base of the first metacarpal of the thumb
bennett fracture
rolando fracture
gamekeepers thumb
fractures of the __ metacarpal make up majority of metacarpal fractures
5th
what fracture results from forced abduction of the thumb
bennett fracture
radiographic features of bennet fracture
two piece* fracture or dislocation at base of thumb - important
intra-articular
1st metacarpal dorsolateral dislocation
dislocation fragment articulates with trapezium
what fracture is caused by axial blow to partially flexed thumb such as a fist fight
rolando fracture
what is a three peice or comminuted intra articular fracture or dislocation of the base of the thumb
rolando fracture
what is a rolando fracture often referred to as
comminuted bennett fracture
what is the mechanism of injury for rolando fracture
axial blow to a partially flexed wrist like a fist fight
what are the intra and extra articular fractures of the 1st MC bone
intra - bennets and rolandos
extra - transverse, oblique, epiphyseal separation
what is it called when an avulsion or rupture occurs to the ulnar collateral ligament of the thumb
gamekeeper thumb or skier thumb
also seen in breakdancers
what is the mechanism of injury for gamekeepers thumb
thumb is forced into abduction causing ligament disruption or avulsion on the ulnar side of the base of the 1st proximal phalanx
if avulsion fracture occurs at the ulnar side of the base of 1st proximal phalanx as seen in gamekeeps thumb, what could this lead to
ligament could be displaced dorsal to the adductor pollicis muscle creating a STENER LESION
what is a stener lesion
slippage of the otrn end of the ulnar collateral ligament superficial to the adductor pollicis m causing interposition of adductor pollicis between the ulnar collateral ligament and the MCP joint
what imaging is needed for gamekeepers thumb and stener lesion
MRI
what fracture is transverse and located on the 4th and 5th metacarpals
boxer fracture
boxer fracture is more common on the 4th or 5th
5th
what is the most common type of metacarpal fracture
boxer fracture
who is most commonly affected by boxer fracture
young adult males
caused by punching with clenched fist
boxer fractures are usually angulated in a ___ direction
volar
what is used to treat a boxer fracture
short arm gutter splint
what is disruption of the extensor mechanism of the finger at the DIP
mallet finger or
baseball finger
what is the most common site of mallet finger
middle finger - longest
patient presents with inability to extend finger at DIP because they have slight flexion deformity
Mallet finger
what does mallet finger show on radiograph
triangle avulsion fragment at the extensor aspect of the distal phalanx at the DIP joint
what injury occurs when there is avulsion of the flexor digitorum profundus tendon at the base of the DIP
jersey finger
jersey finger most commonly affects what
4th digit as FDP insertion into ring finger
ring finger weaker than the middle finger
how does jersey finger occur
sudden hyperextension of actively flexed finger
patient present with an inability to flex the finger at the DIP joint with localized pain
jersey finger
most dislocations of the interphalangeal joints are due to what
hyperextension
what is the most common interphalangeal joint dislocated
where does the dislocation occur
PIP
dorsally
what is crucial in maintaining interphalangeal joint stability and preventing hyperextension of the joint
volar plate
what are commonly torn in interphalangeal joint dislocations
collateral ligaments
how do you treat interphalangeal joint dislocations
local digital block and buddy splinting is good for dorsal dislocations
volar plate dislocations require immobilization in extension