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51 Cards in this Set

  • Front
  • Back
Suspect_________ in any young individual (< 25 yrs) with a medial clavicle or sternoclavicular injury
Medial Clavicle Physeal Fracture
Medial Clavicle Physeal Fracture Usually Salter-Harris Type __ or ____
Usually Salter-Harris Type I or II
Medial Clavicle Physeal Fractures _________ to visualize on AP. obtain __________ views. beam at _______deg ___________ tilt
Medial Clavicle Physeal Fractures difficult to visualize on AP. obtain serendipity views. beam at 40 deg cephalic tilt
Medial Clavicle Physeal fracture __________ views: _________dislocation/fxs affected clavicle is___________contralateral clavicle;__________ dislocation/fxs - affected clavicle is __________contralateral clavicle
Medial Clavicle Physeal serendipity views anterior dislocation/fxs affected clavicle is above contralateral clavicle posterior dislocation/fxs - affected clavicle is below contralateral clavicle
Medial Clavicle Physeal Fractures _______
is study of choice can differentiate from ___________ __________ can visualize ____________ __________ and injuries
Medial Clavicle Physeal Fractures CT scan
is study of choice can differentiate from sternoclavicular dislocations can visualize mediastinal structures and injuries
Medial Clavicle Physeal Fractures management Nonoperative: observation most injuries will remodel and do not require intervention. Closed reduction in OR indications:
_________________
__________________
indications
anterior displaced physeal fx
posterior displaced physeal fx
Medial Clavicle Physeal Fractures postreduction
_____________ for ______ weeks (_________displaced).
Medial Clavicle Physeal Fractures postreduction
figure of 8 harness for 3-4 weeks (anterior displaced).
Medial Clavicle Physeal Fractures ______________
indicated if _____________ ____ _________ in a patient _______ yrs old
Medial Clavicle Physeal Fractures open reduction
indicated if unreducible and symptomatic in a patient > 23 yrs old
Distal Clavicle Physeal Fractures _____injury accounting for only____ of clavicle fractures in children considered a childhood equivalent to adult ___ ____________.
Distal Clavicle Physeal Fractures Rare injury accounting for only 5% of clavicle fractures in children considered a childhood equivalent to adult AC separation.
Distal Clavicle Physeal Fractures Pathoanatomy:
__________ usually remains intact with injury,
clavicle displaces ________ _______ physis and ________ _________, both of which remain attached to the_____ and _____ _________.
Distal Clavicle Physeal Fractures Pathoanatomy:
periosteum usually remains intact with injury
clavicle displaces away from physis and periosteal sleeve, both of which remain attached to the AC and CC ligaments
Distal Clavicle Physeal Fractures classification.
Type I fractures: Minimally displaced and occur lateral to the CC ligaments but spare the AC joint, stability is conferred by the residual soft-tissue attachments
Type II fractures : Less stable than Type I and Type III fractures, proximal fragme...
Type I fractures: Minimally displaced and occur lateral to the CC ligaments but spare the AC joint, stability is conferred by the residual soft-tissue attachments
Type II fractures : Less stable than Type I and Type III fractures, proximal fragment is detached from CC ligaments, distal fragment is attached to scapula via the AC joint
Type III fractures: CC ligamentous attachments are intact, but fracture extends into AC joint, typically stable
Type IV fractures: Most common type in pediatric patients and are associated with displacement at the junction of the metaphysis and physis; the physis and epiphysis remain attached to the AC joint
Type V fractures: Similar to Type II injuries, distal and proximal fragments are not in continuity with CC ligaments, however, free boney piece may remain connected
Distal Clavicle Physeal Fractures Symptoms
______, __________, ________ in older children. Physical exam: ___-_______ of the affected ipsilateral extremity may be present in newborns
________ remain intact following isolated clavicle fractures, which can help differentiate from _________ _________ __________.
Distal Clavicle Physeal Fractures Symptoms
pain, dysfunction, ecchymosis in older children. Physical exam: pseudo-paralysis of the affected ipsilateral extremity may be present in newborns
reflexes remain intact following isolated clavicle fractures, which can help differentiate from brachial plexus injuries
Distal Clavicle Physeal Fractures Radiographs obtain__ and _________ view to help define injury
Distal Clavicle Physeal Fractures Radiographs obtain AP and serendipity view to help define injury
Distal Clavicle Physeal Fractures treatment Nonoperative______management indicated in ______cases, especially if periosteum is ____
Distal Clavicle Physeal Fractures treatment Nonoperative sling management indicated in most cases, especially if periosteum is intact.
Distal Clavicle Physeal Fractures operative surgical reduction indications (________ indicated) open, fractures severly displaced fractures in _______ patients with near _______ physis
Distal Clavicle Physeal Fractures operative surgical reduction indications (rarely indicated) open fractures severly displaced fractures in older patients with near closed physis
Proximal Humerus Fracture - Pediatric Epidemiology
accounts for _____ of fractures in children most common in ______ (peak age ____) due to increase in __________ _________
Proximal Humerus Fracture - Pediatric Epidemiology
accounts for < 5% of fractures in children most common in adolescents (peak age at 15 years) due to increase in sports participation
Proximal Humerus Fracture - Pediatric Mechanism
1)______ or _______ trauma. 2)________ injury commonly seen in ___________ 3)associated with _______ ________in neonates
Proximal Humerus Fracture - Pediatric Mechanism
direct or indirect trauma overuse injury commonly seen in throwers associated with birth trauma in neonates
Proximal Humerus Fracture - Pediatric
Pathoanatomy
displacement pattern is due to __________. musculature produces _______and __________ of the proximal fragment. _______ ______ and __________ muscles create _______ and shortening of the distal fragment
Proximal Humerus Fracture - Pediatric
Pathoanatomy
displacement pattern is due to deforming forces of muscle attachments rotator cuff musculature produces abduction and external rotation of the proximal fragment pectoralis major and deltoid muscles create adduction and shortening of the distal fragment
Proximal Humerus Fracture - Pediatric

_______ ______ fragment is often displaced __________ through the weaker and thinner periosteum
Proximal Humerus Fracture - Pediatric

distal shaft fragment is often displaced anteriorly through the weaker and thinner periosteum
Proximal Humerus Fracture - Pediatric
Prognosis ________ secondary to the abundant _________ __________ of the proximal humerus and ________________ of the shoulder joint
Proximal Humerus Fracture - Pediatric
Prognosis excellent secondary to the abundant remodeling potential of the proximal humerus and range of motion of the shoulder joint
Proximal Humerus Ossification
_________ centers of ossification. Secondary ossification centers unite together at age_____
Three centers of ossification
humeral head appears at 6 mos
greater tuberosity appears at 3 yrs
lesser tuberosity appears at 5 yrs
Secondary ossification centers unite together at age 6-7.
Proximal Humerus Ossification
Proximal humerus physis closes at______in girls,_________ in boys
Proximal Humerus Ossification
Proximal humerus physis closes at 14-17 in girls, 16-18 in boys
Proximal Humerus Ossification____ of humerus growth comes from the _________ physis
highest proximal:distal ratio difference (________ is second with 30:70 proximal:distal ratio)
Proximal Humerus Ossification 80% of humerus growth comes from the proximal physis
highest proximal:distal ratio difference (femur is second with 30:70 proximal:distal ratio)
Proximal Humerus Fracture - Pediatric
_______ -_________classification
_____ is most frequent in _____year olds
____is most frequent in ____year olds.

Alternative Classification:
type 1-4:
Proximal Humerus Fracture - Pediatric
SH-I is most frequent in <5 year olds
SH-II is most frequent in >12 year olds

Alternative Classification:
Neer-Horowitz classification.
type I is minimally displaced (< 5mm)
type II is displaced less than 1/3 of the shaft width
type III is displaced greater than 1/3 and less than 2/3 the shaft width
type IV is displaced greater than 2/3 the shaft width
Proximal humerus metaphyseal fractures
typically occur in ___ to ____year olds
Proximal humerus metaphyseal fractures
typically occur in 5 to 12 year olds
Little Leaguer's shoulder is a _____fracture secondary to _________. radiographs reveal a __________ of the physis and __________ changes
Little Leaguer's shoulder is a SH-I fracture secondary to overuse. adiographs reveal a mild widening of the physis and metaphyseal changes
Paeds Proximal humeral fracture non-operative indications
any amount of displacement in children 6 and under
almost all treated nonoperativley in any age due to remodeling ability and shoulder range of motion
excellent functional results expected
Paeds Proximal humeral fracture non-operative technique
immobilization with a sling, sling and swathe, shoulder immobilizer, or coaptation splint begin gentle glenohumeral ROM exercises in 1-2 weeks when pain is controlled
Paed s proximal humerus operative indications
1.
2.
3.
4.
1. severly displaced fractures in adolescents
(<50% apposition or >45° angulation, Neer-Horowitz III-IV)
2. open fractures in any age
3. fractures associated with vascular injuries
4. intra-articular displacement
Paeds proximal humeral closed reduction performed with the arm in____________ and ____________
Paeds proximal humeral closed reduction performed with the arm in 90° abduction and 90° external rotation
Paeds proximal humeral fracture blocks to reduction: (3)
long head the biceps tendon
joint capsule
periosteum
Paeds proximal humrus fracture immobilization options
immobilization, percutaneous pins, screw fixation or retrograde flexible nail fixation
Paeds proximal humerus complications:
_______, _________(___ _______) , ______ ______(______)
Nerve, malunion(well tolerated) , growth arrest (rare)
Paeds proximal humerus complications Nerve injuries : occur in __________% of cases. typically are __________associated with a ________ displaced______(proximity of _______ _________) functional recovery by ____ _________ without treatment
Paeds proximal humerus complications Nerve injuries : occur in less than 1% of cases. typically are neuropraxias. associated with a medially displaced shaft (close proximity to brachial plexus) functional recovery by 9 months without treatment
Humerus Shaft Fracture - Pediatric Mechanism
typically associated with_______ most common long bone injury associated with______ _______. consider a ________process if fracture is a result of a low energy mechanism
Humerus Shaft Fracture - Pediatric Mechanism
typically associated with trauma. most common long bone injury associated with child abuse. consider a pathologic process if fracture is a result of a low energy mechanism
Humerus Shaft Fracture - Pediatric
Associated injuries
as with adults, a ______ nerve palsy can be seen in_____and ______ third fractures
associated with up to___ of humeral shaft fractures
Humerus Shaft Fracture - Pediatric
Associated injuries
as with adults, a radial nerve palsy can be seen in middle and distal third fractures
associated with up to 5% of humeral shaft fractures
Humerus Shaft Fracture - Pediatric
associated with enormous ________ __________and _____ requires surgical intervention
up to ____of angulation is associated with excellent outcomes due to the large range of motion of the shoulder
Humerus Shaft Fracture - Pediatric
associated with enormous remodeling potential and rarely requires surgical intervention
up to 30° of angulation is associated with excellent outcomes due to the large range of motion of the shoulder
Humerus Shaft Fracture - Pediatric
Radial nerve palsy symptoms
weakness or absence of wrist and digit extension
Humerus Shaft Fracture - Pediatric
Nonoperative indications
uncomplicated diaphyseal fracture without intra-articular involvement in a child of any age
utilized for almost all pediatric humeral shaft fractures
Humerus Shaft Fracture - Pediatric Nonoperative techniques
sling and swathe or cuff and collar in children___ _____
Sarmiento functional brace in children ____ ______
ROM exercises can be initiated in _______ weeks once pain is controlled
Humerus Shaft Fracture - Pediatric Nonoperative techniques
sling and swathe or cuff and collar in children < 3 years
Sarmiento functional brace in children > 3 years
ROM exercises can be initiated in 2-3 weeks once pain is controlled
Humerus Shaft Fracture - Pediatric Operative indications
(5)
open fractures
neurovascular compromise after reduction
multiply injured patient
floating elbow
associated shoulder injury
Humerus Shaft Fracture - Pediatric Operative techniques
flexible intramedullary nail fixation
anterior, anterolateral or posterior approach with plate fixation
Humerus Shaft Fracture - Pediatric Complications
Radial nerve palsy typically due to a ______. _________resolution is expected. if function has not returned in ______then EMGs are performed and exploration considered
Humerus Shaft Fracture - Pediatric Complications
Radial nerve palsy typically due to a neuropraxia spontaneous resolution is expected. if function has not returned in 3-4 m then EMGs are performed and exploration considered
Humerus Shaft Fracture - Pediatric Complications.
Malunion_______ produces funtional deficits due to the wide range of motion at the shoulder
up to____of angulation is associated with excellent outcomes due to the large range of motion of the shoulder
Humerus Shaft Fracture - Pediatric Complications.
Malunion
rarely produces funtional deficits due to the wide range of motion at the shoulder
up to 30° of angulation is associated with excellent outcomes due to the large range of motion of the shoulder
Humerus Shaft Fracture - Pediatric Complications.
(4)
Humerus Shaft Fracture - Pediatric Complications.
Malunion
Radial nerve palsy
Limb length discrepancy
Compartment syndrome
Distal Humerus Physeal Separation - Pediatric
Also called __________ distal humerus fracture
Also called transphyseal distal humerus fracture
Distal Humerus Physeal Separation - Pediatric
Typically seen in children under the age of ______
Typically seen in children under the age of 3
Distal Humerus Physeal Separation - Pediatric
Associated conditions (?%)
abuse or battered child syndrome (up to 50%)
Distal Humerus Physeal Separation - Pediatric
Radiographs
In infant only sign may be __________displacement of the radial and ulnar shafts relative to the distal humerus
In infant only sign may be posteromedial displacement of the radial and ulnar shafts relative to the distal humerus
Distal Humerus Physeal Separation - Pediatric
Treatment
Non-operative:
Operative:
Nonoperative
posterior molded splint then long arm casting
indications
nondisplaced fractures
Operative
CRPP vs ORIF
indications
displaced fractures
Distal Humerus Physeal Separation - Pediatric
Complications x2
Cubitus varus
Medial condyle AVN