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64 Cards in this Set
- Front
- Back
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What nerve is affected by a Colle's fracture?
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median nerve
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Treatment of Colle's fracture?
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Undisplaced: dorsal spline for 1-2 days until swelling resolved, then cast
Displaced: reduction under anaesthesia, usually heals in 5 weeks |
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Presentation of scaphoid fracture
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fall on outstretched hand
tenderness/fullness over anatomical snuff box |
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Specific complication of scaphoid fracture
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avascular necrosis due to poor blood supply of proximal part of bone
AVN more common if treatment is delayed |
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Treatment of scaphoid fracture
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even if no evidence on xray, immobilise in cast in dorsiflexed and thumb forward position - "glass holding position"
xray at 10-14 days to confirm |
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Which artery is affected by a supracondylar fracture of arm?
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brachial artery
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If suspected supracondylar fracture of arm, what position should the arm be in during xray?
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30 degree elbow flexion to prevent movement
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Treatment of supracondylar fractures of arm
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Undisplaced: immobilize at 90 degrees in splint or cast and sling
Posteriorly displaced: reduce under GA with Kirschner wires **Blueprints book says supracondylar fracture = emergency --> immediate ORIF |
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What is are good and bad prognostic indicators for bone remodelling?
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good: youth, proximity to end bone, angulation in natural joint motion plane
bad: fracture through epiphyseal plate |
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T/F Xrays are not necessarily reliable in lunate fractures
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True
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Nerve and artery affected in posterior elbow dislocation
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ulnar
brachial artery (5-13%) |
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Nerve affected in shoulder dislocation
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axillary nerve
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Treatment of subluxation of elbow
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no xray needed if mechanism known!
reduce by supination and flexion of elbow |
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What are signs of Volkmann's ischemic contracture?
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local edema, compromised tissue perfusion leading to tissue necrosis, deformity, stiffness; refusal to open hand; pain with passive extension
most commonly affected sites: forearm, hand, leg, foot Pulselessness is NOT a diagnostic sign! |
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What is a Galleazzi's fracture?
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Fracture of the distal radius with radioulnar joint dislocation
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What is a Monteggia's fracture?
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Fracture of proximal radius with radial head dislocation
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T/F Sternoclavicular dislocations are usually treated successfully with closed reduction
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False
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Treatment of scapular fracture
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sling for immobilization
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Treatment of acromoclavicular joint injuries
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simple sling
early mobilization rest, ice, analgesia |
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Nerve and artery affected by anterior shoulder dislocation
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axillary nerve and artery
rotator cuff injury common in 60+ |
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Most common mechanism for anterior shoulder dislocation
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abduction, extension, external rotation
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Most common mechanism for posterior shoulder dislocation
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seizure, electric shock
forceful internal rotation, adduction force to anterior shoulder |
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Fracture of the lesser tubercle of the humerus indicates what?
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posterior shoulder dislocation
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Fracture of greater tubercle of humerus implies what?
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possible rotator cuff tear
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What type of fracture has the greatest risk of hemorrhage in pelvis?
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vertical shear
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What type of femoral neck fracture is at risk of avascular necrosis?
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subcapital
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What is the neurovascular damage in a proximal humerus fracture?
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brachial plexus
axillary nerve |
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What is the treatment for minimally displaced proximal humerus?
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rest with arm in sling for 6 weeks
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What is the treatment for a two, three or four part fracture in the proximal humerus?
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2 part: closed reduction
3 part: ORIF 4 part: prosthetic replacement |
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What nerve can be damaged in a shaft of humerus fracture?
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radial nerve
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Treatment of humeral shaft fracture?
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cast with 90 degree elbow flecion
if unstable --> fixation with plate/screws |
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How do you treat condylar fractures of the humerus?
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undisplaced: posterior slab w elbow fixed at 90 degrees
displaced: open reduction and internal fixation |
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Treatment of non displaced, closed clavicle fractures
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sling for 4-6 weeks
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Which NOF fracture is predisposed to AVN?
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subcapital
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T/F Patients should avoid weight bearing for 12 weeks in a tibial plateau fracture
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true
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Difference between strain and sprain
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strain = stretching or tearing of fibres in ligament, presents w pain, swelling, bruising
sprain = painful wrenching of joint, short of actually tearing the ligaments, joint is painful, but little or no swelling/bruising |
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Rx of sprain
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reassurance and encouragement of mvmt and exercise from outset
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Rx of strain
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firmly strap joint and rest until pain subsides
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Rx of ligament rupture
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splintage, ice, NSAIDs
exchange splint for functional brace after a few days |
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What does the ACL do in regards to the tibia?
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prevents tibia from sliding forwards
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What does the PCL do in regards to the tibia?
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prevents tibia from moving backwards
injury to PCL usually from tibia being forced backwards |
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Treatment of anterior shoulder dislocation
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reduced under GA
pull arm in slight abduction while body is stabilized |
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Which is more common: anterior or posterior hip dislocation?
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posterior
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Presentation of posterior hip dislocation
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leg is short, adducted, internally rotated and slight flexed
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Treatment of patellar dislocation
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patella is pushed back while knee is extended
plaster splint applied and retained for 2-3 weeks quad exercises for 3 weeks pt walks with crutches |
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What nerve can be damaged in a Colles fracture?
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Median nerve.
By fracture fragments or compression from swelling and haematoma |
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A young man falls on outstretched hand. The associated fracture can result in disruption to what artery?
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Fall on outstretched hand usually results in scaphoid fracture.
Damage to dorsal scaphoid artery (a branch of the radial artery) can result in avacular necrosis of proximal pole of scaphoid. |
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Management of undisplaced scaphoid fracture?
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1) Position in ‘glass holding position’ (wrist dorsiflexed, thumb forwards)
2) Immobilise in cast from upper forearm to just short of metacarpophalangeal joints, incorporating proximal phalanx of thumb. |
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What neurovascular complications are associated with supracondylar fracture with posterior displacement?
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Brachial artery and median nerve
- monitor circulatory status for 24hrs after injury. If there is undue pain and one sign of compartment syndrome, institute urgent management. - Median nerve injury is temporary and should recover in 6-8 weeks |
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Mechanism of supracondular fracture with posterior displacment?
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Hyperextension injury.
Very common in children. |
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Proximal humerus fracture: what neurovascular damage?
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Brachial plexus or axillary nerve.
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What nerve is commonly damaged in hip dislocation
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Sciatic nerve
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What nerve is commonly damaged in Shoulder dislocation
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Axillary n.
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What nerve is commonly damaged in knee dislocation
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Peroneal n.
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Muscle death occurs after how many hours of total ischemia?
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4-6 hours
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Red flag of compartment syndrome?
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Pain on passive flexion.
The ‘5 Ps’ are LATE signs Pain Pallor Pulselessness Parasthesia Paralysis |
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What factors cause delayed or non-union?
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1) interposition of soft tissue
2) bone: poor blood supply, infection 3) surgeon: poor splintage, poor fixation 4) pt: smoking, NSAIDS |
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What types of non-union
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1) hypertrophic (florid periostial new bone which just needs stabilising)
2) atrophic (no signs of healing. May need bone graft and BMPs. Stope smoking improve nutrition, stabilise) 3) AVN |
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Patient presents after falling backwards on their outstretched hand. Their arm is slightly abducted and externally rotated at the shoulder? They have a lump just below the coracoid process. What important clinical signs do you need to check?
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This is an anterior shoulder dislocation.
Common neurovascular injury occurs to axillary nerve and axillary artery. Check axillary nerve function – contraction of deltoid Check axillary artery damage – check radial pulses |
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Most common pathogen in osteomyelitis
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Staph aureus
Hip replacement: Staph epidermidis Sickle cell: Salmonella Diabetic: multiple |
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Investigations in osteomyelitis
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Blood: increased WCC, ESR, CRP, +blood culture
Xrays: often neg, may show periosteal elevation bone scan: sensitive, not specific MRI: test of choice, shows high signal in bone marrow assoc w infection |
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Definitive dx test in osteomyelitis
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bone aspiration with gram stain and culture
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Treatment of osteomyelitis
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surgical debridement
IV antibiotics for 4-6 weeks - flucloxacillin |
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Which cancer can chronic osteomyelitis eventually lead to?
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squamous cell carcinoma
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