Upper/Lower Extremity Lecture

Question 1

90% of elbow dislocations are…

Answer 1

posterolateral

Question 2

MOI usually FOOSH

pt holds elbow in 45 degrees of flexion, signifcant swelling obscures olecranon (which is displaced posteriorly)

Answer 2

Elbow dislocations

Question 3

Ulnar Nerve
Brachial artery

..most frequently injured structres in?

Answer 3

Elbow dislocations

Question 4

Reduction
Long arm posterior splint to immobilize elbow in slightly less than 90 degrees flexion

Answer 4

Elbow dislocation tx

Question 5

95% of supracondylar fractures are extra articular and commonly seen in…

Answer 5

kids

Question 6

Lateral elbow pain and tenderness

inability to fully extend elbow

(RADIAL HEAD, SUPRACONDYLAR OR OLECRANON FX?)

Answer 6

Radial head

Question 7

Significant swelling, tenderness and limited ROM

(RADIAL HEAD, SUPRACONDYLAR OR OLECRANON FX?)

Answer 7

Inter and supracondylar fractures

(supracondylar fractures may resemble a posterior elbow dislocation)

Question 8

Presence of abnormal fat pads on XRay
(any posterior effusion or a very prominent anterior fat pad called a “sail sign”

Answer 8

Elbow fracture!

Question 9

What type of splint do you use for a elbow fracture

Answer 9

Long arm posterior splint

Question 10

True or False..

Middle third of clavicle is involved in 80% of fractures

Answer 10

True

Question 11

Most common injury associated with scapula fractures?

Answer 11

Rib fractures

Question 12

MOI= direct trauma to shoulder with arm adducted

Type I-III: treat with sling immobilization, ice, analgesics, early ROM at 7-14 days
Type IV-VI: ortho for surg repair

Answer 12

AC joint injuries

Question 13

Glenohumeral joint dislocations are most commonly ________ dislocations

Answer 13

Anterior

Question 14

MC nerve injured with glenohumeral dislocations

(can be tested by testing sensation over lateral deltoid)

Answer 14

Axillary N

Question 15

MC population of ppl who have prximal humerus (humeral head) fractures?
and MC MOI?

Answer 15

Elderly pts with osteoporosis, FOOSH

Question 16

Pain, swelling, ecchymosis, tenderness, abnormal mobility

MC injury= axillary N

Tx= sling immobilization

Answer 16

Proximal humerus fracture

Question 17

Fracture of the proximal ulna shaft with radial head dislocation

Presents with significant pain and swelling over elbow

*VERY obvious XRay

Answer 17

Monteggia Fracture-Dislocation

Question 18

Fracture of the distal radius with an associated distal radioulnar joint dislocation

presents with localized swelling and tenderness over distal radius and wrist

*very obvious xray

Answer 18

Galeazzi Fracture-dislocation

Question 19

Thumb ulnar collateral ligament rupture, AKA

Answer 19

Gamekeeper’s thumb

Question 20

Forced radial abduction at MCP joint

tx= splint in thumb spica and refer

Answer 20

Gamekeeper’s thumb (thumb ulnar collateral ligament rupture)

Question 21

increased pressure in a confined muscle compartment that results in functional and circulatory impairment of a limb

MC sites= legs and forearm

Answer 21

Compartment syndrome

Question 22

normal tissue perfusion is <10 mmHg

comparment pressures of _______mmHg are detrimental to nerves and muscles

Answer 22

30-50 mmHg

Question 23

Severe, out of proportion pain
pain with passive stretch

swollen, firm and tender to palpation
(color and temp are normal. pulses are felt until late in dz process)

Answer 23

Compartment syndrome

Question 24

A delta pressure of ______mmHg is used to diagnosed acute compartment syndrome

Answer 24

30 mmHg

Question 25

Tx= **surgical fasciotomy!!** elevate affeected limb to level of heart remove any restrictive casts, dressings, etc

Answer 25

Comparment syndrome

Question 26

For compartment syndrome, the best outcomes happen if treatment occurs within...

Answer 26

6 hours

Question 27

Sulcus sign is seen with...

Answer 27

Glenohumeral dislocation

Question 28

MC shoulder dislocations are **anterior** ..what are the 2 causes of posterior dislocations?

Answer 28

Seizure Lightening

Question 29

a dent in the back of the humeral head which occurs during the dislocation as the humeral head impacts against the front of the glenoid.

Answer 29

Hill-Sachs lesion

Question 30

Key exam finding for rotator cuff injury?

Answer 30

Limited ROM

Question 31

Which type of pelvic fracture is "stable" and pts can walk in

Answer 31

Ramus fracture

Question 32

What should you do before putting a foley in a pelvic fx patient

Answer 32

Check urethral opening for blood

Question 33

2 best images for pelvic fx pts

Answer 33

XRay CT

Question 34

If pt has a negative xray but cannot walk, what image should you get next?

Answer 34

CT (acetabular fractures do not always show up on xrays)

Question 35

Shortened and **externally rotated**

Answer 35

classic **hip fracture**

Question 36

Shortened and **internally rotated**

Answer 36

hip **dislocation**

Question 37

90% of hip dislocations are \_\_\_\_\_\_\_

Answer 37

posterior (may have associated acetabular or femoral head fracture)

Question 38

If a hip fracture is not seen on XRAY, this image has a near 100% sensitivity for occult fractures

Answer 38

MRI

Question 39

Hallmark ED management for a femur fracture

Answer 39

Traction splint (Hare)

Question 40

If a pt has an open femur fracture, what do they need

Answer 40

Broad spectrum abx

Question 41

MC knee dislocations are \_\_\_\_\_\_\_

Answer 41

anterior (**spontaneous reduction occurs in ~50%**)

Question 42

\_\_\_\_\_\_ dislocations are more common in women and result from a twisting injury on an extended knee

Answer 42

patellar

Question 43

A high incidence of associated injuries to the **popliteal artery and peroneal nerve**, as well as ligaments and meniscus exists with...

Answer 43

knee dislocations (aka why only ortho should deal with them)

Question 44

In a knee dislocation, do normal distal pulses rule out popliteal artery injury?

Answer 44

NO

Question 45

What is the management of a knee dislocation?

Answer 45

**Contact ortho ASAP!!!** Need immediate reduction Admission is mandatory for obsevation of neurovascular status

Question 46

ACL tears account for ~\_\_\_% of all hemarthroses

Answer 46

75% **ACL..positive Lachman, Anterior drawer**

Question 47

Posterior drawer tests for...

Answer 47

PCL

Question 48

what is the most common, medial or lateral mensical injury?

Answer 48

medial! bc it is connected to the MCL, whereas the lateral side is not connected to anything and can move more freely

Question 49

painful locking of knee popping, clicking or snaping sense of instability +McMurrarys test (but not sensitive)

Answer 49

Meniscal injury

Question 50

What movement should you always ask your knee injury pts to do? and why?

Answer 50

Knee extension (to rule out quad rupture)

Question 51

MOI: valgus or varus forces combined with axial load that drives the femoral condyle into the tibia Tx= non-displaced, unilateral fx: knee immobilizer with non weightbearing. refer to ortho 2-7 days

Answer 51

Tibial plateau fractures **THESE ARE VERY HARD TO SEE ON XRAY!!**

Question 52

Bi and trimalleolar fractures required...

Answer 52

open reduction internal fixation (ORIF)

Question 53

Wet sterile dressing coverage Splinting Tetatnus 1st generation cephalosporin ...treatment for what kind of ankle fractures

Answer 53

Open fractures

Question 54

How should you splint an Achilles rupture?

Answer 54

Splint in **full plantar flexion**

Question 55

True or False... calcaneal fractures usually happen bilaterally

Answer 55

True

Question 56

combination of spiral fracture of the proximal fibula and ankle injury which could manifest by widening of the ankle joint due to distal tibiofibular syndesmosis and/or deltoid ligament disruption, or fracture of the medial malleolus. It is caused by pronation external-rotation mechanism

Answer 56

Maisonneuve fracture (**always check the proximal fibula for tenderness with an ankle injury**)