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64 Cards in this Set

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  • Back
What nerve is affected by a Colle's fracture?
median nerve
Treatment of Colle's fracture?
Undisplaced: dorsal spline for 1-2 days until swelling resolved, then cast
Displaced: reduction under anaesthesia, usually heals in 5 weeks
Presentation of scaphoid fracture
fall on outstretched hand
tenderness/fullness over anatomical snuff box
Specific complication of scaphoid fracture
avascular necrosis due to poor blood supply of proximal part of bone
AVN more common if treatment is delayed
Treatment of scaphoid fracture
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
Which artery is affected by a supracondylar fracture of arm?
brachial artery
If suspected supracondylar fracture of arm, what position should the arm be in during xray?
30 degree elbow flexion to prevent movement
Treatment of supracondylar fractures of arm
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
What is are good and bad prognostic indicators for bone remodelling?
good: youth, proximity to end bone, angulation in natural joint motion plane
bad: fracture through epiphyseal plate
T/F Xrays are not necessarily reliable in lunate fractures
Nerve and artery affected in posterior elbow dislocation
brachial artery (5-13%)
Nerve affected in shoulder dislocation
axillary nerve
Treatment of subluxation of elbow
no xray needed if mechanism known!
reduce by supination and flexion of elbow
What are signs of Volkmann's ischemic contracture?
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!
What is a Galleazzi's fracture?
Fracture of the distal radius with radioulnar joint dislocation
What is a Monteggia's fracture?
Fracture of proximal radius with radial head dislocation
T/F Sternoclavicular dislocations are usually treated successfully with closed reduction
Treatment of scapular fracture
sling for immobilization
Treatment of acromoclavicular joint injuries
simple sling
early mobilization
rest, ice, analgesia
Nerve and artery affected by anterior shoulder dislocation
axillary nerve and artery
rotator cuff injury common in 60+
Most common mechanism for anterior shoulder dislocation
abduction, extension, external rotation
Most common mechanism for posterior shoulder dislocation
seizure, electric shock
forceful internal rotation, adduction
force to anterior shoulder
Fracture of the lesser tubercle of the humerus indicates what?
posterior shoulder dislocation
Fracture of greater tubercle of humerus implies what?
possible rotator cuff tear
What type of fracture has the greatest risk of hemorrhage in pelvis?
vertical shear
What type of femoral neck fracture is at risk of avascular necrosis?
What is the neurovascular damage in a proximal humerus fracture?
brachial plexus
axillary nerve
What is the treatment for minimally displaced proximal humerus?
rest with arm in sling for 6 weeks
What is the treatment for a two, three or four part fracture in the proximal humerus?
2 part: closed reduction
3 part: ORIF
4 part: prosthetic replacement
What nerve can be damaged in a shaft of humerus fracture?
radial nerve
Treatment of humeral shaft fracture?
cast with 90 degree elbow flecion
if unstable --> fixation with plate/screws
How do you treat condylar fractures of the humerus?
undisplaced: posterior slab w elbow fixed at 90 degrees
displaced: open reduction and internal fixation
Treatment of non displaced, closed clavicle fractures
sling for 4-6 weeks
Which NOF fracture is predisposed to AVN?
T/F Patients should avoid weight bearing for 12 weeks in a tibial plateau fracture
Difference between strain and sprain
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
Rx of sprain
reassurance and encouragement of mvmt and exercise from outset
Rx of strain
firmly strap joint and rest until pain subsides
Rx of ligament rupture
splintage, ice, NSAIDs
exchange splint for functional brace after a few days
What does the ACL do in regards to the tibia?
prevents tibia from sliding forwards
What does the PCL do in regards to the tibia?
prevents tibia from moving backwards
injury to PCL usually from tibia being forced backwards
Treatment of anterior shoulder dislocation
reduced under GA
pull arm in slight abduction while body is stabilized
Which is more common: anterior or posterior hip dislocation?
Presentation of posterior hip dislocation
leg is short, adducted, internally rotated and slight flexed
Treatment of patellar dislocation
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
What nerve can be damaged in a Colles fracture?
Median nerve.
By fracture fragments or compression from swelling and haematoma
A young man falls on outstretched hand. The associated fracture can result in disruption to what artery?
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.
Management of undisplaced scaphoid fracture?
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.
What neurovascular complications are associated with supracondylar fracture with posterior displacement?
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
Mechanism of supracondular fracture with posterior displacment?
Hyperextension injury.
Very common in children.
Proximal humerus fracture: what neurovascular damage?
Brachial plexus or axillary nerve.
What nerve is commonly damaged in hip dislocation
Sciatic nerve
What nerve is commonly damaged in Shoulder dislocation
Axillary n.
What nerve is commonly damaged in knee dislocation
Peroneal n.
Muscle death occurs after how many hours of total ischemia?
4-6 hours
Red flag of compartment syndrome?
Pain on passive flexion.
The ‘5 Ps’ are LATE signs
What factors cause delayed or non-union?
1) interposition of soft tissue
2) bone: poor blood supply, infection
3) surgeon: poor splintage, poor fixation
4) pt: smoking, NSAIDS
What types of non-union
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
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?
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
Most common pathogen in osteomyelitis
Staph aureus
Hip replacement: Staph epidermidis
Sickle cell: Salmonella
Diabetic: multiple
Investigations in osteomyelitis
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
Definitive dx test in osteomyelitis
bone aspiration with gram stain and culture
Treatment of osteomyelitis
surgical debridement
IV antibiotics for 4-6 weeks - flucloxacillin
Which cancer can chronic osteomyelitis eventually lead to?
squamous cell carcinoma