Mcphs H And P Ii Primary Care Fractures

Front 1

What are three types of directions for fracture lines?

Back 1

Transverse

Oblique

Spiral

Front 2

a fracture which goes at an angle to the axis

Back 2

Oblique

Front 3

a fracture of many relatively small fragments

Back 3

Comminuted

Front 4

a fracture which runs around the axis of the bone

Back 4

Spiral

Front 5

a fracture (also called open) which breaks the skin

Back 5

Compound

Front 6

What do you look for in the general condition of a bone with fractures?

8 things

Back 6

– comminuted
– segmental
– pathologic
– stress fracture
– bone loss
– avulsion
– incomplete
• greenstick

Front 7

What do you look for in the general condition of the soft tissue with fractures?

Back 7

Is it an open or a closed fracture

Front 8

What are four types of fracture deformity?

Back 8

Displacement
Angulation
Rotation
Shortening

Front 9

Any cut or opening associated with a fracture needs to be considered what?

Back 9

An open fracture

Front 10

What are the mechanisms of injury for distal phalangeal fractures?

Back 10

Crush injuries

Front 11

What four ways are distal phalangeal fractures usually classified?

Back 11

Longitudinal
Comminuted
Transverse
Open vs. Closed

Front 12

What is the TX for a distal phalangeal fracture?

Back 12

Stax splint 3-4 weeks

Front 13

What complications are associated with distal phalangeal fractures?

Back 13

nail bed injuries

Front 14

What is the mechanism of injury for mallet finger?

Back 14

Forced fingertip flexion while in an extended position

Front 15

What is the treatment for mallet finger?

Back 15

stax splint for six weeks

Front 16

What are the complications associated with a mallet finger injury?

Back 16

Deformity (swan neck)

Nail bed injury

Subluxation

Front 17

What is the mechanism of injury for a fracture of the proximal and middle phalanges?

Back 17

Direct blow

Torque injuries

Front 18

What are the classifications for proximal and middle phalange fractures?

Back 18

Extra-articular - Stable/Unstable

Intra-articular

Front 19

What is the treatment for proximal and middle phalanges?

Back 19

•Treatment:
–
Stable extra-articular:
fractures: buddy taped
for 3-4 weeks
–
Unstable extraarticular:
reduce
(longitudinal traction)
place in a gutter splint
for 4 weeks
–
Intra-articular: Open Reduction Internal Fixation

Front 20

What is the mechanism of injury for metacarpal fractures?

Back 20

Direct impact force

Front 21

What is the classification of metacarpal fractures?

Back 21

Classification:
–
Neck:
5th MC (Boxer’s
Fracture)
–
Shaft

Front 22

What is the treatment for metacarpal fractures?

Back 22

Treatment:
–
2nd and 3rd require
ORIF
–
4th and 5th MC neck
fractures with 20-40
degrees angulation can
be reduced and splinted
in ulnar gutter splint
for 4 weeks

Front 23

What is the mechanism of injury for a 1st metacarpal base fracture?

Back 23

Axial load against a partially flexed thumb.

Front 24

What are the classifications for a 1st metacarpal base fracture?

Back 24

Classification:
–Extra-articular
–
Intra-articular lip Fx
(Bennett’s)
–
Intra-articular “Y” Fx
(Rolando’s)

Front 25

Bennet's fracture presents in how many pieces?

Back 25

1 piece

Front 26

Rolando's fracture presents in how many pieces?

Back 26

2 pieces

Front 27

How do you treat a first metacarpal base fracture?

Back 27

•Treatment:
–
Extra-articular
fractures can be
immobilized in a
thumb spica cast for 4
weeks
•
Bennett’s and
Rolando’s fractures
need ORIF

Front 28

What is the mechanism of injury for a distal radius fracture?

Back 28

Fall on an outstretched hand

Front 29

What is the classifications for a distal radius fracture?

Back 29

Classification:
–
For purposes of
primary care:
•
Extra-articular (Colle’s)
•
Intra-articular

Front 30

What is the treatment for distal radius fractures?

Back 30

•Treatment:
–
Distract, manipulate,
sugartong splint
–Short arm cast within 1
week for 4-6 weeks
•
Intra-articular
fractures and unstable
fractures need ORIF

Front 31

What is the mechanism of a scaphoid fracture?

Back 31

Fall on an outstretched hand. Falls during sports are common causes.

Front 32

Classification for scaphoid fractures are based on?

Back 32

Anatomic location

Front 33

What is the treatment for scaphoid fractures?

Back 33

•Treatment:
–
Initially thumb spica
splint
–
Long arm cast 10-20
weeks
–
ORIF for displaced
fractures or nonunion
•
Complications:
– Nonunion

Front 34

Why is there complications of nonunion in scaphoid fractures?

Back 34

Because there is a poor blood supply

Front 35

If you aren't sure if a patient has a scaphoid fracture, but still suspect such, what do you do?

Back 35

Keep patient in a spica splint/cast and then bring them back later for examination.

Front 36

What is the mechanism of injury for fractures that occur to both the radius and ulna?

Back 36

Mechanism of Injury:
–
High energy injuries
–
Most commonly motor
vehicle accidents
–
Direct blow with a
blunt object
–
A fall from a height or
during athletic
competition

Front 37

What are the classifications for radius and ulnar fractures?

Back 37

Displaced and Nondisplaced

Front 38

What is the treatment for radius and ulnar fractures?

Back 38

Treatment:
–
Nondisplaced
fractures: long arm cast
for 12-16 weeks
–
Displaced fractures:
ORIF

Front 39

An ulnar fracture by itself is known as a?

Back 39

nightstick fractures

Front 40

What is the mechanism of injury for an ulnar fracture?

Back 40

Mechanism of Injury:
–
Blunt trauma
–
Common in motor
vehicle accidents

Front 41

What is the treatment for nighstick (ulnar) fractures?

Back 41

Treatment:
–
Nondisplaced
fractures: posterior
splint for 3 weeks;
functional brace
thereafter
–
Displaced fractures:
ORIF

Front 42

Primary care providers should do what with suspected fractures of the elbow?

Back 42

should defer all
confirmed or
suspected fractures
about the elbow to an
orthopaedic specialist

Front 43

Longitudinal fractures lead to?

Back 43

Flexion contracture

Front 44

How do Radial Head Fractures occur and what is the treatment?

Back 44

•Fall on an outstretched, straight arm, Ice, snowboarding
•
ORIF to preserve joint
space

Front 45

What is the mechanism of action for fracture of the humerus shaft?

Back 45

–Direct blow to the midhumerus
–
Falls
–
Motor vehicle
accidents

Front 46

What is the treatment for fractures of the humeral shaft?

Back 46

–Initially = coaptation
splint, functional brace
or sugartong splint
–
Pathologic fractures,
segmental fractures,
those involving
neurovascular
compromise, or
unsatisfactory
reduction require ORIF

Front 47

• Most common Fx
• Mechanism of Injury:
–
Fall or direct blow

– 25% of hockey injuries
–
Common biking injury
•
Classification:
– Distal third – I, II, III
– Middle third – 80%
– Proximal third - rare

Back 47

Clavicle Fractures

Front 48

If you see a clavicle fracture it is important to also check for what?

Back 48

Any underlying trauma/problems with the major blood vessels around this area.

Front 49

What is the treatment for a clavicle fracture?

Back 49

Treatment:
–
Distal 1/3, type I & II:
sling or clavicle splint
–
Distal 1/3, type III:
ORIF
–
Middle 1/3 and
proximal 1/3 fractures
sling or clavicle splint

Front 50

Mechanism of Injury:
• Slip and fall
• Elderly
• Osteoporosis
•
Three main types:
– Femoral Neck
– Intertrochanteric
– Subtrochanteric

Back 50

Hip Fractures

Front 51

What are two things that a provider should do if a patient has a hip fracture?

Back 51

Orthopaedic consult

ORIF required

Front 52

What is the mechanism for a patella fracture/injury?

Back 52

• Direct blow
• Usually stellate
• Usually nondisplaced

Front 53

What is the treatment for a patella fracture/injury?

Back 53

•Cylinder cast 4-6 weeks
•
Ortho consultation:
–
> 3 mm separation of
fragments
–
> 2 mm articular stepoff
– Severely comminuted
fractures
•
Patella dislocations should
be reduced and
immobilized for 3-6
weeks

Front 54

• Common sites in young athletes
• Repetitive forces
• Runners, ballet dancers, and
military personnel
• Frequently negative within the
first 2-4 weeks after onset of
symptoms

Back 54

Tibial Stress Fractures

Front 55

What is the TX for tibial stress fractures?

Back 55

• Very slow to heal
• Nonunion
• Recurrence
• Eliminate impact loading
activity for 4-6 weeks
• Crutches for comfort only
• Orthopaedic consult for
nonunion

Front 56

What is the mechanism of injury for fractures surrounding the ankle?

Back 56

•Twisting motion
•
Inversion = lateral malleolus
injuries
•
Eversion = medial malleolus
injuries

Front 57

What is the treatment for fractures of the ankle?

Back 57

Short leg walking cast 4-6
weeks
•
Ankle ROM and strengthening
exercises
•
Orthopaedic Consultation:
– Unstable fractures
– Bimalleolar and trimalleolar
fractures

Front 58

Direct blow, or twisting
forces
•
Stress fractures common –
March fracture

Back 58

Fracture of the metatarsal shaft

Front 59

What is the treatment for fracture of the metatarsal shaft?

Back 59

•Nondisplaced fx: Short leg
walking cast for 2-3 weeks
•
Reduced fx: Short leg
non-weightbearing cast for
2-3 weeks followed by
short leg walking cast for
3-4 weeks

Front 60

•Inversion of the ankle
•
Repetitive stresses
•
Three distinct types:
Stress fractures
–Jones fractures
Avulsion fractures

Back 60

Proximal Fifth Metatarsal fracture

Front 61

How do you treat a styloid avulsion fracture in a proximal fifth metatarsal fracture?

Back 61

Short leg walking cast
for 2 weeks.
–
Radiographs at 6-8 weeks

Referral if displaced greater than 3 mm

Front 62

How do you treat a stress fracture in a proximal fifth metatarsal fracture?

Back 62

Stress Fractures
–Short leg nonwalking cast
for up to 20 weeks
–
Consider referral
weeks

Front 63

How do you treat a Jone's fracture in a proximal fifth metatarsal fracture?

Back 63

Jones’ Fractures
–
Short leg nonwalking
cast for 6-10 weeks
–
Referral if fracture is
displaced or nonunion
remains after 3 months

Front 64

What is the mechanism of injury and the treatment for toe fractures?

Back 64

• Direct force
• Hyperextension
•
Buddy taping and use of
a hard soled shoe for 4-6
weeks