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16 Cards in this Set
- Front
- Back
What is the Salter-Harris classification of fractures?
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1: S - slipped
2: A - above 3: L - lower 4: T - through 5: R - cRushed/Rammed |
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What are the three phases of fracture healing?
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1: Inflammation. Hematoma and osteogenic precursors. Lasts several days.
2. Repair. Begins @ 24 hours and peaks at 2-3 weeks. Collagen and callus formation, endochondral ossification. 3. Remodeling. Months to years. Lamellar bone formation and repopulation of marrow, callus resorption. |
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When is external callus visible on XR?
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3-6 weeks after formation.
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What is the average time to clinical bony union?
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4-8 weeks.
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What is delayed union? Nonunion?
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Delayed = not healing in time period expected for that fracture
Nonunion = >3-6 months with no evidence of healing |
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How does a metacarpal neck fracture angulate? Why?
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Apex dorsal, because intrinsics volar to axis of rotation of MCPJ
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What are indications for treatment of a metacarpal neck or shaft fracture?
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Angulation (>10-70 deg)
Scissoring Shortening > 3 mm |
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What are operative indications for metacarpal shaft fracture?
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Multiple fractures
Unstable reduction Open fracture |
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What is the position of a Bennett fracture?
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Thumb base subluxes radially and dorsally at the metacarpal base. ulnar fracture fragment held in anatomic position by anterior oblique ligament
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What is the position of a reverse/baby bennett?
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Metacarpal base subluxes proximally and dorsally, accentuated by FCU, ECU, and ADM
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What is a Rolando fracture?
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Any comminuted intraarticular fracture of thumb MC base
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How is a Bennett fracture reduced before pinning? Is the fragment pinned?
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Longitudinal traction with pressure on metacarpal base and thumb pronation. Fragment is not fixed. Kwires placed into trapezium and second metacarpal
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What is the mechanism of a dorsal MCPJ dislocation? What digits do they occur in?
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Via forced hyperextension of digit. Occurs in border digits (if central, a border digit is likely also dislocated)
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How is a dorsal MCPJ dislocation treated?
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Simple, reducible: Proximal phalanx locked in 80 degrees hyperextension. Flex wrist to take pressure off flexor tendons, apply distal and volar traction to base.
Complete dislocation: base of proximal phalanx protrudes between lumbricals and flexor tendons. Volar plate impinged. Flexor sheath taut. Requires open release of A1 pulley. |
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Which collateral ligament of the MCPJ tends to rupture? What tends to produce these injuries and how do they present?
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Isolated radial ligament rupture is more common than ulnar (very rare). Often in athletes after forced ulnar deviation of digit with MP joints flexed - in ulnar 3 digits. Presents late with swelling, radial joint tender, pain with passive flexion.
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How is a MCPJ radial collateral ligament rupture treated?
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Immobilize joint in 30 degrees flexion for 3 weeks, re-evaluate. Buddy tape x2-3 more weeks if instability persists. May require OR if instability doesn't resolve.
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