Upper Extremity Trauma

Question 1

what is the a classic pediatric injury in the humerus

Answer 1

supracondylar fracture of distal humerus

Question 2

how do supracondylar fractures occur

Answer 2

FOOSH with valgus component
accidental trauma
falling from height - monkey bars

Question 3

supracondylar fracture results in a ____ fracture line and ___ dislocation of the distal humerus

Answer 3

extra-articular

posterior - falling on flexed elbow

Question 4

supracondylar fractures occur in children younger than what age

what is the peak age

male or female MC

Answer 4

less than 10 years old

5-7 is peak age

Male because we rowdy

Question 5

what are different types of supracondylar fractures

Answer 5

type 1 - undisplaced
type 2 - displaced with intact cortex
type 3 - complete displacement - posterior dislocation*

Question 6

are fracture lines present in supracondylar fractures

Answer 6

sometimes but not always

sooo check for indirect signs

Question 7

what are indirect signs of supracondylar fractures

Answer 7

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

Question 8

positive posterior fat pad sign is diagnostic of what in children and what in adults

Answer 8

children - supracondylar fractures

adults - radial head fracture

Question 9

how does a intercondylar distal humerus fracture occur

Answer 9

FOOSH with elbow extension

T or Y fracture of distal humerus

Question 10

what accounts for 50% of distal humerus fractures in adults

Answer 10

intercondylar distal humerus fracture

Question 11

what fracture are mostly a T or Y appearence and occur intra articular* at the distal humerus

Answer 11

intercondylar distal humerus fracture

Question 12

how does a transcondylar distal humerus fracture occur

Answer 12

FOOSH and elow extension

fracture through both distal humeral condyles

Question 13

___ fossa is the thinnest part of the distal humerus and the ___ process may go through this fossa

Answer 13

olecranon

Question 14

how do condylar distal humerus fractures develop

Answer 14

extended elbow and valgus force that shears through the medial and lateral condyles

Question 15

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

Answer 15

Kocher fracture

Question 16

what distal humerus fracture is common in children and occurs usually in boys after FOOSH with avulsion or strong throwing or pitching

Answer 16

epicondylar fracture

also called little leager elbow

Question 17

what is the most common epicondyle involved in epicondylar fracture

due to what force

Answer 17

medial epicondyle

valgus force

Question 18

the avulsed epicondyle fragment may become entrapped in the joint when

what may happen

Answer 18

when no dislocation is present

the avulsed fragment may stimulate trochlear ossification center

Question 19

apophyseal ossification centers mneumonic

Answer 19

CRITOE - 1 3 5 7 9 11

capitellum, radius, internal epicondyle, trochlea, olecranon, external epicondyle

Question 20

olecranon fractures occur as result of one of four mechanisms

Answer 20

direct blow or fall
FOOSH with elbow flexion
avulsion of the triceps
stress fracture - athletes and gymnast

Question 21

the ulnar nerve is closely related to the medial aspect of the ____ and can occasionally be damaged during this fracture

Answer 21

olecranon

Question 22

what view of a olecranon process is required for diagnosis

Answer 22

lateral view

Question 23

what is the complete radiological evaluation of an olecranon fracture

Answer 23

lucency reaching the trochlear groove*
coronoid fracture 
comminution 
distal humerus fracture 
radial head fracture or dislocation

Question 24

comminuted olecranon fracture is likely the result of what

Answer 24

direct blow

Question 25

olecranon fracture is likely the result of what

Answer 25

triceps contraction

Question 26

coronoid process fractures occur with result of a ___ elbow dislocation

Answer 26

posterior elbow dislocation

Question 27

coronoid process fractures occur as result of what?

Answer 27

hyperextension with elbow alvusion of brachialis muscle tendon and shearing off of the trochlea

Question 28

what xray views are needed to diagnose coronoid process fracture

Answer 28

lateral or 45 degree oblique

Question 29

posterior dislocation is the most common cause of what 3 fractures?

Answer 29

radial head fractures condyle fractures coronoid fractures

Question 30

what are the most common fractures of elbow in adults

Answer 30

radial head fractures

Question 31

radial head fractures are more common in males or females

Answer 31

females

Question 32

how do radial head fractures occur

Answer 32

``` FOOSH with minimal elbow flexion or valgus pronation stress with radial head pushed into capitellum of the humerus or direct blow ```

Question 33

what are the views requires for radial head fracture

Answer 33

AP lateral oblique

Question 34

what confirms the diagnosis of radial head fracture on xray

Answer 34

fat pad sign or sail sign

Question 35

what is the classification system used for radial head fractures

Answer 35

mason classification type 1 - vertical undisplaced fracture < 1cm also called chissel fracture type 2 - 4 are displaced and require surgery

Question 36

what is a fracture of the ulna shaft that causes dislocation the proximal radio-ulnar joint

Answer 36

moteggia fracture/dislocation

Question 37

what is a fracture of the distal part of the radius with dislocation of distal radioulnar and an intact ulna

Answer 37

galeazzi fracture

Question 38

galeazzi fractures are more common in what population | peak age

Answer 38

children 9-12

Question 39

moteggia fracture/dislocation classification systems based on what

Answer 39

Bado classification radial head dislocation and PRUJ

Question 40

galeazzi fracture classification system

Answer 40

based on position of distal radius type 1 - dorsal distal radial displacement type 2 - volar distal radial displacement

Question 41

how do you remember montaggia from galeazzi fracture and dislocations

Answer 41

GRUM - galeazzi radius montaggia ulnar | MUGR - mugger

Question 42

what are isolated fractures of the ulna that are typically in the mid diaphysis resulting from a direct blow

Answer 42

nightstick fracture

Question 43

what is a characteristic defensive fracture when the patient tries to ward off an overhead blow from an assailant

Answer 43

nightstick fracture

Question 44

nightstick fractures have a high rate of what

Answer 44

delayed non union or non union

Question 45

what are other names for nightstick fractures

Answer 45

parry or tap fracture

Question 46

what is subluxation of the radial head out of the annular ligament

Answer 46

pulled elbow or nursemaids elbow

Question 47

pulled elbows are __ reducible

Answer 47

easily

Question 48

pulled elbow mechanism of injury

Answer 48

lifting of child while holding wrist and hands that allows radial head to slip out

Question 49

is there any tear of ligaments in a pulled elbow

Answer 49

no

Question 50

how do you reduce a pulled elbow

Answer 50

flexion and supination of forearm

Question 51

what is a extra-articular fracture of the distal radius that occurs as result of foosh with forearm pronation and dorsiflexion during forward falls

Answer 51

colles fracture

Question 52

what extra-articular fracture of the distal radius metaphysis with dorsal distal radius angulation and impaction

Answer 52

colles fracture

Question 53

colles fracture is common in who

Answer 53

osteoporotic elderly women

Question 54

what does colles fracture look like on an xray

Answer 54

dorsal angulation of the distal fragment is present to a variable degree impaction with resultant shortening of the radius asssoicated with ulnar styloid fracture

Question 55

colles fracture is sometimes called ___ with dislocation of the ulna

Answer 55

moor fracture

Question 56

colles vs smith fracture causes

Answer 56

colles fracture FOOSH | smiths fracture falling on wrist in flexion or direct blow to back of wrist

Question 57

what is a complication of colles fracture

Answer 57

dinner fork deformity - avulsed ulnar styloid process - distal fragment of radius overides rest of bone

Question 58

what is the fracture of the distal radius with palmar or volar angulation of the distal fracture fragment

Answer 58

smith fracture or reverse colles

Question 59

most smith fractures occur intra or extra-articular

Answer 59

extra-articular

Question 60

what is the difference between colles and smith fracture radiographically

Answer 60

colles - dorsal angulation smith - volar or palmar angulation both have ulnar styloid fracture

Question 61

what fracture of the distal radius extends through the dorsal aspect of the articular surface but not the volar surface

Answer 61

barton fracture

Question 62

during distal radial fractures of the wrist, what would be present that indicates intra-articular effusion

Answer 62

pronator fat pad

Question 63

what intra-articular fracture of the distal radius extends through the volar aspect

Answer 63

reverse barton fracture

Question 64

what are intra-articular fractures of the radial styloid process

Answer 64

chauffer fractures or hutchinson fractures or backfire fracture

Question 65

what causes a chauffer fracture

Answer 65

blow to the back of the wrist or forced abduction and radial deviation of the wrist turning crank and it rapidly spins backward

Question 66

what are complications of the chauffer fracture

Answer 66

scapholunate dissociation transscaphoid perilunate dislocation ulnar styloid fracture

Question 67

what is the most common carpal bone fractured in the hand

Answer 67

scaphoid

Question 68

what people are most commonly affected by scaphoid fracture

Answer 68

adolescents and young adults

Question 69

older patients are more likely to have scaphoid fracture than young adults? t/f

Answer 69

NOOOOO more likely to fracture distal radius - usually colles fracture

Question 70

what is the clinical application of scaphoid fractures

Answer 70

pain in anatomically snuff box initial xrays miss and must repeat after 4-7 days

Question 71

what view is needed to view the scaphoid

Answer 71

PA, medial oblique, lateral views PA ulnar deviation is required!

Question 72

describe scaphoid fractures based on location

Answer 72

waist of scaphoid - MC - highest risk of AVN proximal pole - highest risk of non union distal pole - also called scaphoid tubercle - best prognosis

Question 73

what is a clear inidicator on xray of scaphoid fracture

Answer 73

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

Question 74

idiopathic AVN of the scaphoid is called

Answer 74

preiser disease

Question 75

scapholunate dissociation leads to what sign with rotatory subluxation of the scaphoid

Answer 75

signet ring sign

Question 76

scapholunate dissociation is present when the widened scapholunate space is greater than __ mm

Answer 76

3mm

Question 77

scapholunate advanced collapse SLAC, how do you differentiate from scaphoid fracture

Answer 77

SLAC - dorsal or volar tilt of the lunate must be present - DISI and VISI - dorsal and volar intersegmental instability

Question 78

what is the second most common carpal bone fracture

Answer 78

triquetral fracture

Question 79

triquetral fractures typically occur where on the bone

Answer 79

dorsal surface

Question 80

what view is essential in diagnosis of triquetral fracture

Answer 80

lateral

Question 81

what ligament may cause a dorse avulsion fracture on the dorsal aspect of the lunate

Answer 81

dorsal radiocarpal lig

Question 82

lunate dislocation occurs when the lunate is displaced and rotated how

Answer 82

volar or palmar

Question 83

what is the most common dislocated carpal

Answer 83

lunate

Question 84

what is the difference between lunate dislocation and perilunate dislocation

Answer 84

lunate dislocation - lunate dislocates volarly or palmarly perilunate dislocation - radiolunate articulation preserved and rest of carpals are displaced dorsally

Question 85

most common causes of scaphoid fracture and lunate dislocation

Answer 85

FOOSH

Question 86

what is pie sign

Answer 86

lunate dislocation sign where lunate overlaps capitate and it has charateristic triangle appearence

Question 87

what is used for radiographic evaluation of carpal fractures (arc?)

Answer 87

carpal arcs of louis gilula

Question 88

what fracture may occur when hold a bat or club

Answer 88

hamate hook fracture

Question 89

what is best way to visualize hook of hamate fracture

Answer 89

CT carpal tunnel view - 2nd

Question 90

what are fractures/dislocation of the base of the first metacarpal of the thumb

Answer 90

bennett fracture rolando fracture gamekeepers thumb

Question 91

fractures of the __ metacarpal make up majority of metacarpal fractures

Answer 91

5th

Question 92

what fracture results from forced abduction of the thumb

Answer 92

bennett fracture

Question 93

radiographic features of bennet fracture

Answer 93

two piece* fracture or dislocation at base of thumb - important intra-articular 1st metacarpal dorsolateral dislocation dislocation fragment articulates with trapezium

Question 94

what fracture is caused by axial blow to partially flexed thumb such as a fist fight

Answer 94

rolando fracture

Question 95

what is a three peice or comminuted intra articular fracture or dislocation of the base of the thumb

Answer 95

rolando fracture

Question 96

what is a rolando fracture often referred to as

Answer 96

comminuted bennett fracture

Question 97

what is the mechanism of injury for rolando fracture

Answer 97

axial blow to a partially flexed wrist like a fist fight

Question 98

what are the intra and extra articular fractures of the 1st MC bone

Answer 98

intra - bennets and rolandos | extra - transverse, oblique, epiphyseal separation

Question 99

what is it called when an avulsion or rupture occurs to the ulnar collateral ligament of the thumb

Answer 99

gamekeeper thumb or skier thumb also seen in breakdancers

Question 100

what is the mechanism of injury for gamekeepers thumb

Answer 100

thumb is forced into abduction causing ligament disruption or avulsion on the ulnar side of the base of the 1st proximal phalanx

Question 101

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

Answer 101

ligament could be displaced dorsal to the adductor pollicis muscle creating a STENER LESION

Question 102

what is a stener lesion

Answer 102

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

Question 103

what imaging is needed for gamekeepers thumb and stener lesion

Answer 103

MRI

Question 104

what fracture is transverse and located on the 4th and 5th metacarpals

Answer 104

boxer fracture

Question 105

boxer fracture is more common on the 4th or 5th

Answer 105

5th

Question 106

what is the most common type of metacarpal fracture

Answer 106

boxer fracture

Question 107

who is most commonly affected by boxer fracture

Answer 107

young adult males caused by punching with clenched fist

Question 108

boxer fractures are usually angulated in a ___ direction

Answer 108

volar

Question 109

what is used to treat a boxer fracture

Answer 109

short arm gutter splint

Question 110

what is disruption of the extensor mechanism of the finger at the DIP

Answer 110

mallet finger or | baseball finger

Question 111

what is the most common site of mallet finger

Answer 111

middle finger - longest

Question 112

patient presents with inability to extend finger at DIP because they have slight flexion deformity

Answer 112

Mallet finger

Question 113

what does mallet finger show on radiograph

Answer 113

triangle avulsion fragment at the extensor aspect of the distal phalanx at the DIP joint

Question 114

what injury occurs when there is avulsion of the flexor digitorum profundus tendon at the base of the DIP

Answer 114

jersey finger

Question 115

jersey finger most commonly affects what

Answer 115

4th digit as FDP insertion into ring finger | ring finger weaker than the middle finger

Question 116

how does jersey finger occur

Answer 116

sudden hyperextension of actively flexed finger

Question 117

patient present with an inability to flex the finger at the DIP joint with localized pain

Answer 117

jersey finger

Question 118

most dislocations of the interphalangeal joints are due to what

Answer 118

hyperextension

Question 119

what is the most common interphalangeal joint dislocated where does the dislocation occur

Answer 119

PIP dorsally

Question 120

what is crucial in maintaining interphalangeal joint stability and preventing hyperextension of the joint

Answer 120

volar plate

Question 121

what are commonly torn in interphalangeal joint dislocations

Answer 121

collateral ligaments

Question 122

how do you treat interphalangeal joint dislocations

Answer 122

local digital block and buddy splinting is good for dorsal dislocations volar plate dislocations require immobilization in extension