Upper Extremity Trauma Flashcards Preview

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Flashcards in Upper Extremity Trauma Deck (122)
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1
Q

what is the a classic pediatric injury in the humerus

A

supracondylar fracture of distal humerus

2
Q

how do supracondylar fractures occur

A

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

3
Q

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

A

extra-articular

posterior - falling on flexed elbow

4
Q

supracondylar fractures occur in children younger than what age

what is the peak age

male or female MC

A

less than 10 years old

5-7 is peak age

Male because we rowdy

5
Q

what are different types of supracondylar fractures

A

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

6
Q

are fracture lines present in supracondylar fractures

A

sometimes but not always

sooo check for indirect signs

7
Q

what are indirect signs of supracondylar fractures

A

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

8
Q

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

A

children - supracondylar fractures

adults - radial head fracture

9
Q

how does a intercondylar distal humerus fracture occur

A

FOOSH with elbow extension

T or Y fracture of distal humerus

10
Q

what accounts for 50% of distal humerus fractures in adults

A

intercondylar distal humerus fracture

11
Q

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

A

intercondylar distal humerus fracture

12
Q

how does a transcondylar distal humerus fracture occur

A

FOOSH and elow extension

fracture through both distal humeral condyles

13
Q

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

A

olecranon

14
Q

how do condylar distal humerus fractures develop

A

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

15
Q

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

A

Kocher fracture

16
Q

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

A

epicondylar fracture

also called little leager elbow

17
Q

what is the most common epicondyle involved in epicondylar fracture

due to what force

A

medial epicondyle

valgus force

18
Q

the avulsed epicondyle fragment may become entrapped in the joint when

what may happen

A

when no dislocation is present

the avulsed fragment may stimulate trochlear ossification center

19
Q

apophyseal ossification centers mneumonic

A

CRITOE - 1 3 5 7 9 11

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

20
Q

olecranon fractures occur as result of one of four mechanisms

A

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

21
Q

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

A

olecranon

22
Q

what view of a olecranon process is required for diagnosis

A

lateral view

23
Q

what is the complete radiological evaluation of an olecranon fracture

A
lucency reaching the trochlear groove*
coronoid fracture 
comminution 
distal humerus fracture 
radial head fracture or dislocation
24
Q

comminuted olecranon fracture is likely the result of what

A

direct blow

25
Q

olecranon fracture is likely the result of what

A

triceps contraction

26
Q

coronoid process fractures occur with result of a ___ elbow dislocation

A

posterior elbow dislocation

27
Q

coronoid process fractures occur as result of what?

A

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

28
Q

what xray views are needed to diagnose coronoid process fracture

A

lateral or 45 degree oblique

29
Q

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

A

radial head fractures
condyle fractures
coronoid fractures

30
Q

what are the most common fractures of elbow in adults

A

radial head fractures

31
Q

radial head fractures are more common in males or females

A

females

32
Q

how do radial head fractures occur

A
FOOSH with minimal elbow flexion 
or 
valgus pronation stress with radial head pushed into capitellum of the humerus 
or 
direct blow
33
Q

what are the views requires for radial head fracture

A

AP
lateral
oblique

34
Q

what confirms the diagnosis of radial head fracture on xray

A

fat pad sign or sail sign

35
Q

what is the classification system used for radial head fractures

A

mason classification

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

36
Q

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

A

moteggia fracture/dislocation

37
Q

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

A

galeazzi fracture

38
Q

galeazzi fractures are more common in what population

peak age

A

children 9-12

39
Q

moteggia fracture/dislocation classification systems

based on what

A

Bado classification

radial head dislocation and PRUJ

40
Q

galeazzi fracture classification system

A

based on position of distal radius

type 1 - dorsal distal radial displacement
type 2 - volar distal radial displacement

41
Q

how do you remember montaggia from galeazzi fracture and dislocations

A

GRUM - galeazzi radius montaggia ulnar

MUGR - mugger

42
Q

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

A

nightstick fracture

43
Q

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

A

nightstick fracture

44
Q

nightstick fractures have a high rate of what

A

delayed non union or non union

45
Q

what are other names for nightstick fractures

A

parry or tap fracture

46
Q

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

A

pulled elbow or nursemaids elbow

47
Q

pulled elbows are __ reducible

A

easily

48
Q

pulled elbow mechanism of injury

A

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

49
Q

is there any tear of ligaments in a pulled elbow

A

no

50
Q

how do you reduce a pulled elbow

A

flexion and supination of forearm

51
Q

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

A

colles fracture

52
Q

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

A

colles fracture

53
Q

colles fracture is common in who

A

osteoporotic elderly women

54
Q

what does colles fracture look like on an xray

A

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

55
Q

colles fracture is sometimes called ___ with dislocation of the ulna

A

moor fracture

56
Q

colles vs smith fracture causes

A

colles fracture FOOSH

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

57
Q

what is a complication of colles fracture

A

dinner fork deformity

  • avulsed ulnar styloid process
  • distal fragment of radius overides rest of bone
58
Q

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

A

smith fracture or reverse colles

59
Q

most smith fractures occur intra or extra-articular

A

extra-articular

60
Q

what is the difference between colles and smith fracture radiographically

A

colles - dorsal angulation
smith - volar or palmar angulation

both have ulnar styloid fracture

61
Q

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

A

barton fracture

62
Q

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

A

pronator fat pad

63
Q

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

A

reverse barton fracture

64
Q

what are intra-articular fractures of the radial styloid process

A

chauffer fractures or hutchinson fractures or backfire fracture

65
Q

what causes a chauffer fracture

A

blow to the back of the wrist or forced abduction and radial deviation of the wrist

turning crank and it rapidly spins backward

66
Q

what are complications of the chauffer fracture

A

scapholunate dissociation
transscaphoid perilunate dislocation
ulnar styloid fracture

67
Q

what is the most common carpal bone fractured in the hand

A

scaphoid

68
Q

what people are most commonly affected by scaphoid fracture

A

adolescents and young adults

69
Q

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

A

NOOOOO

more likely to fracture distal radius - usually colles fracture

70
Q

what is the clinical application of scaphoid fractures

A

pain in anatomically snuff box

initial xrays miss and must repeat after 4-7 days

71
Q

what view is needed to view the scaphoid

A

PA, medial oblique, lateral views

PA ulnar deviation is required!

72
Q

describe scaphoid fractures based on location

A

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

73
Q

what is a clear inidicator on xray of scaphoid fracture

A

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

74
Q

idiopathic AVN of the scaphoid is called

A

preiser disease

75
Q

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

A

signet ring sign

76
Q

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

A

3mm

77
Q

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

A

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

78
Q

what is the second most common carpal bone fracture

A

triquetral fracture

79
Q

triquetral fractures typically occur where on the bone

A

dorsal surface

80
Q

what view is essential in diagnosis of triquetral fracture

A

lateral

81
Q

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

A

dorsal radiocarpal lig

82
Q

lunate dislocation occurs when the lunate is displaced and rotated how

A

volar or palmar

83
Q

what is the most common dislocated carpal

A

lunate

84
Q

what is the difference between lunate dislocation and perilunate dislocation

A

lunate dislocation - lunate dislocates volarly or palmarly

perilunate dislocation - radiolunate articulation preserved and rest of carpals are displaced dorsally

85
Q

most common causes of scaphoid fracture and lunate dislocation

A

FOOSH

86
Q

what is pie sign

A

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

87
Q

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

A

carpal arcs of louis gilula

88
Q

what fracture may occur when hold a bat or club

A

hamate hook fracture

89
Q

what is best way to visualize hook of hamate fracture

A

CT

carpal tunnel view - 2nd

90
Q

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

A

bennett fracture
rolando fracture
gamekeepers thumb

91
Q

fractures of the __ metacarpal make up majority of metacarpal fractures

A

5th

92
Q

what fracture results from forced abduction of the thumb

A

bennett fracture

93
Q

radiographic features of bennet fracture

A

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

94
Q

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

A

rolando fracture

95
Q

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

A

rolando fracture

96
Q

what is a rolando fracture often referred to as

A

comminuted bennett fracture

97
Q

what is the mechanism of injury for rolando fracture

A

axial blow to a partially flexed wrist like a fist fight

98
Q

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

A

intra - bennets and rolandos

extra - transverse, oblique, epiphyseal separation

99
Q

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

A

gamekeeper thumb or skier thumb

also seen in breakdancers

100
Q

what is the mechanism of injury for gamekeepers thumb

A

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

101
Q

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

A

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

102
Q

what is a stener lesion

A

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

103
Q

what imaging is needed for gamekeepers thumb and stener lesion

A

MRI

104
Q

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

A

boxer fracture

105
Q

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

A

5th

106
Q

what is the most common type of metacarpal fracture

A

boxer fracture

107
Q

who is most commonly affected by boxer fracture

A

young adult males

caused by punching with clenched fist

108
Q

boxer fractures are usually angulated in a ___ direction

A

volar

109
Q

what is used to treat a boxer fracture

A

short arm gutter splint

110
Q

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

A

mallet finger or

baseball finger

111
Q

what is the most common site of mallet finger

A

middle finger - longest

112
Q

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

A

Mallet finger

113
Q

what does mallet finger show on radiograph

A

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

114
Q

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

A

jersey finger

115
Q

jersey finger most commonly affects what

A

4th digit as FDP insertion into ring finger

ring finger weaker than the middle finger

116
Q

how does jersey finger occur

A

sudden hyperextension of actively flexed finger

117
Q

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

A

jersey finger

118
Q

most dislocations of the interphalangeal joints are due to what

A

hyperextension

119
Q

what is the most common interphalangeal joint dislocated

where does the dislocation occur

A

PIP

dorsally

120
Q

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

A

volar plate

121
Q

what are commonly torn in interphalangeal joint dislocations

A

collateral ligaments

122
Q

how do you treat interphalangeal joint dislocations

A

local digital block and buddy splinting is good for dorsal dislocations

volar plate dislocations require immobilization in extension