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16 Cards in this Set

  • Front
  • Back
What is the Salter-Harris classification of fractures?
1: S - slipped
2: A - above
3: L - lower
4: T - through
5: R - cRushed/Rammed
What are the three phases of fracture healing?
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.
When is external callus visible on XR?
3-6 weeks after formation.
What is the average time to clinical bony union?
4-8 weeks.
What is delayed union? Nonunion?
Delayed = not healing in time period expected for that fracture
Nonunion = >3-6 months with no evidence of healing
How does a metacarpal neck fracture angulate? Why?
Apex dorsal, because intrinsics volar to axis of rotation of MCPJ
What are indications for treatment of a metacarpal neck or shaft fracture?
Angulation (>10-70 deg)
Scissoring
Shortening > 3 mm
What are operative indications for metacarpal shaft fracture?
Multiple fractures
Unstable reduction
Open fracture
What is the position of a Bennett fracture?
Thumb base subluxes radially and dorsally at the metacarpal base. ulnar fracture fragment held in anatomic position by anterior oblique ligament
What is the position of a reverse/baby bennett?
Metacarpal base subluxes proximally and dorsally, accentuated by FCU, ECU, and ADM
What is a Rolando fracture?
Any comminuted intraarticular fracture of thumb MC base
How is a Bennett fracture reduced before pinning? Is the fragment pinned?
Longitudinal traction with pressure on metacarpal base and thumb pronation. Fragment is not fixed. Kwires placed into trapezium and second metacarpal
What is the mechanism of a dorsal MCPJ dislocation? What digits do they occur in?
Via forced hyperextension of digit. Occurs in border digits (if central, a border digit is likely also dislocated)
How is a dorsal MCPJ dislocation treated?
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.
Which collateral ligament of the MCPJ tends to rupture? What tends to produce these injuries and how do they present?
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.
How is a MCPJ radial collateral ligament rupture treated?
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.