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80 Cards in this Set
- Front
- Back
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what percent of foot fractures are metatarsal fractures
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35%
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which metatarsals are more stable
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internal metatarsals
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which metatarsals have independent axis of motion
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1st and 5th
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what kind of bone is in the epiphysis
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cancellous with thin cortical shell
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what kind of bone is in metaphysis
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vascular corticocancellous bridge
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what kind of bone is in the diaphysis
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thick cortical bone with medullary canal
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what is the physis
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site of growth plate
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what do met bases articulate with
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lesser tarsus and adjacent mets
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what stabilizes the met bases
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dorsal, plantar, and interosseous ligaments
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which met base is most stable
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2nd
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the internal metatarsals are the site of origin of what muscles
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dorsal and plantar interosseous muscles
oblique head of adductor hallucis |
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nutrient artery enters on what side of metatarsals
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lateral side 1-4
medial side of 5 |
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what are the other sources of blood supply to mets
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metaphyseal/epiphyseal plexus
periosteal circulation |
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comminuted fracture
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fracture with 2+ fracture lines
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What words are used to describe displacement of fracture
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rotated
lateral shift overriding impacted angulated distracted |
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direct injury
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crush injury
direct impact forces |
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indirect injury
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torque
twisting forces abnormal biomechanical stress avulsion fxs |
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most common lesser met fracture
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stress fracture
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stress fracture
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bony adaptation is overwhelmed by increased load applied to bone
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what are the pathomechanics of stress fracture
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increased workload + biomechanical imbalance=muscle fatigue=altered gait=abnormal stress distribution=periosteal inflammation=subperiosteal new bone formation=stress fracture
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pathological fracture
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in abnormal bone where bony structure is unable to withstand forces that would not result in injury to normal bone
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classification of long bone fractures
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salters classification
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what are parts to salters classification
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site
extent within bone configuration relative position relationship to external environment |
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what things are you looking for in objective assessment
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mechanism of injury
neurovascular status compartment syndrome active and passive ROM tuning fork for site of maximal tenderness |
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what is primary imaging technique
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plain flim x-ray
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what x-rays should be taken
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three views at 90 degrees to each other
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when are stress fractures radiographically evident
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2-4 wks
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what is bone scanning good for
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stress fractures quicker diagnosis then plain flim
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what imaging is good for stress fractures but less invasive than bone scanning
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MRI STIR imaging
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what are some causes of lesser met fractures
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PF metatarsals, met primus elevatus, hypermobile 1st ray, atrophic fat pad
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what happens with fx that heal in a DF or PF position
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cause plantar lesions and put more stress on adjacent mets
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what happens with mets that heal in a shortened position
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inc stress on adjacent mets
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#1 objective of treatment
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bony union
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relative position of fx fragments determines what
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dictates fxn results
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sagittal plane displacement leads to what
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hyperkeratotic lesion
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what do you do when you close reduce the fragment
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increase the deformity then decrease the deformity
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closed reduction is done under what anesthesia
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IV sedation with local block, spinal, epidural, or general
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when is ORIF indicated
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when closed reduction fails
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when is ORIF contraindicated
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active infection, insufficient size of fx fragments, bad bone stock, nondisplaced fxs, traumatic skin conditions
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k-wire can be combined with circlage wire for what type of fractures
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comminuted
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what is process of K-wire fixation technique
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small incision dorsal to fx site
Fx freshened .062 k-wire bend wire into interspace |
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what is the structure that is in the way if you just dorsiflex the to to drive the K-wire
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plantar plate
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what type of fractures are fixated with plate fixation
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transverse or comminuted fxs
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what is best method to achieve exact anatomic alignment
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plate fixation
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what plates are used in plate fixation
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1/3 tubular, L or T plate
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what is disadvantage to plate fixation
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plate is placed on dorsal compression side of fracture
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neutralization plate
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neutralizes/absorbs any disruptive forces to which bone may be subjected
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buttress plate
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maintain length/resist displacement when subjected to compressive forces
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when is external fixation indicated
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severe comminution
severe loss of bone stock |
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what is post op with ORIF
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NWB BK cast for 4-6 wks
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what kind of cast can you put on for early ROM
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bivalve cast
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what is treatment for intra-articular fractures
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ORIF
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what is treatment for very small intrarticular fragments
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closed tx
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what are your options for closed treatment of very small intraarticular fragments
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darco shoe
orthoses early ROM |
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what type of fractures are met neck fractures usually
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transverse fractures often with displaced and dislocation of MPJ
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what must be reduced with neck fractures
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FX and JT dislocation
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what must be corrected with met neck fractures
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sagittal plane malalignment
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what are the two parts of closed reduction
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traction and manipulation
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diaphyseal fractures are most often what type of fracture
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oblique fracture
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what forces usually cause diaphyseal fractures
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direct trauma or twisting forces
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what is treatment of nondisplaced diaphyseal fractures
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NWB cast 4-6 wks
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what must be avoided with diaphyseal fractures
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sagittal plane malalignment and significant shortening
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what should be attempted with diaphyseal fractures
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closed reduction
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treatment for comminuted diaphyseal fractures
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external fixation +/- bone graft
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what structures attach to fifth met
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peroneus brevis, lateral band of plantar fascia, ligaments, abductor digiti minimi, peroneus longus
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extraosseous blood supply to 5th met
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dorsal and planatar metatarsal arteries, fibular plantar marginal artery
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intraosseous blood supply to 5th met
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periosteal plexus, nutrient artery, metaphyseal plexus
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where is zone of relative avascularity on 5th met
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proximal diaphysis
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what is classification for 5th met fractures
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stewart classification
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stewart type 1
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jones fracture
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stewart type 2
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intra-articular fracture of 5th met base
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stewart type 3
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avulsion fracture of 5th met base
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stewart type 4
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comminuted intra-articular fx of 5th met base
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stewart type 5
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partial avulsion of ephiphysis (seen in peds)
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what must an avulsion fracture be differintiated from
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os vesalianum
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causes of tuberosity avulsion fx of 5th met
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sudden inversion force, direct blow, ankle sprain and pull of p. brevis
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jones fracture
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transverse proximal diaphyseal fracture 1.5cm-3.0cm distal to tuberosity
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there is a high incidence of what with jones fracture
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non union
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what is treatment for jones fracture in athelete
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ORIF
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what is treatment for jones fracture in sedentary patient
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NWB BK cast for 6-8 wks
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