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109 Cards in this Set

  • Front
  • Back

what is a subluxation?

partial disruption of a joint (partial dislocation) in which some degree of contact b/w the articular surfaces remain

FOOSH injuries are concerning for what fracture:

fracture of radial head (may be occult at time of xray)

landing flat on your feet from a heigh is concerning for what frx?

Calcaneus, tibial plateau, acetabular frx, and vertebral compression fx

direct blow to medial clavicle w/ dysphagia is concerning for what?

posterior sternoclavicular dislocation (only seen on CT in general)

Reference points used by orthopedists to describe the location of a fracture along the shaft of a long bone:

1) midshaft


2) junction of proximal and middle thirds


3) junction of the middle and distal thirds

when a fracture extends into adjacent joint, it is called...?

intraarticular fracture

fracture line orientation terms:

transverese - straight across


oblique - at an angle


spiral - self explanatory


comminuted - splintering or shattering


segmental - 2 distinct frx lines making a floating piece of bone


torus - bulging area of stress


greenstick - found in kids, one cortical side frx

direction of displacement of a fracture is described in terms of what?

based on the position of the distal fragment relative to the proximal

Describe the salter harris classifications:

1 - entire epiphysis broken off


2 - entire epiphysis along w/ portion of metaphysis


3 - portion of the epiphyisis


4 - portion of epiphysis along w/ portion of metaphyisis


5 - compression of epiphyseal plate


Straight across


Above


Lower


Two/through


cRush

how many typical plaster layers are needed for the adult splints:

12 layers

What 4 common ortho injuries to use a shoulder immobilizer on:

1) clavicle fx


2) acromioclavicular separation


3) shoulder dislocation, post-reduction


4) humeral neck fracture

splint to use on clinically suspected fractures or non-displaced fractures of the radial head:

sling

when to use a long arm gutter splint:

elbow fracture and/or dislocation


supracondylar / distal humeral fractures

when to use a sugar tong splint

wrist or forearm fracture

when to use short arm gutter splints

ulnar gutter - 4th/5th metacarpal or prox phalanx fracture


radial gutter - 2nd/3rd metacarpal or prox phalanx

when to use thumb spica:

scapholid fracture or thumb metacarpal or prox thumb phalanx

when to use knee immobilizer (5 instances)

1) fracture or reduced subluxation of patella

2) knee dislocation, post-reduction


3) tibila plateau fracutre


4) knee ligmant injury


5) suspected meniscal tear (if the knee can be fully extended)


When to use posterior ankle mold splint with/wo above knee extension or ankle sugar tong

1) ankle dislocation or fracture-dislocation


2) unstable ankle fractures (high distal fibular fracture or medial and or posterior malleolar fractures)


3) widened medial mortise


4) metatarsal fracture

When to use ankle stirrup

1) ankle sprain


2) stable lateral malleolus fracutre (below the superior border of the talus) w/o other ankle involvement (ie no medial swelling or tenderness)

when to use hard-soled shoe

1) toe fracture


2) some metatarsal fractures

When to use short-leg walking boot

some toe and foot contusions or fractures when weight bearing is allowed

instructions for wearing shoulder immobilizer

http://www.hopkinsmedicine.org/orthopaedic-surgery/_documents/specialty-areas/shoulder/shoulderimmobilizer.pdf

for long arm gutter splint, the arm is placed in what position? and where does the splint begin and end?

90 degree "sling" position; splint begins on ulnar surface of the hand at the metacarpal heads and extends along the ulnar surface of forearm, past the elbow, to a spot high on the lateral surface of upper arm, sort of mid-way up

picture of long arm gutter splint

http://image.slidesharecdn.com/presentationfinal1-140704054255-phpapp01/95/ortho-splinting-traction-pop-40-638.jpg?cb=1404522673

picture of a sugar tong splint:

http://image.slidesharecdn.com/presentationfinal1-140704054255-phpapp01/95/ortho-splinting-traction-pop-41-638.jpg?cb=1404522673

picture of the 2 short-arm gutter splints

http://image.slidesharecdn.com/presentationfinal1-140704054255-phpapp01/95/ortho-splinting-traction-pop-44-638.jpg?cb=1404522673

picture of a thumb spica splint:

http://sfghed.ucsf.edu/Education/ClinicImages/Thumbspica.gif

how long can you leave a knee immobilizer on? what should you encourage pt's to do while wearing it?

only for MAX of 7 days before seeing orthopedist


encourage taking it off and doing:


1) passive flexion or gravity-assisted flexion


2) straight leg raise while lying flat



picture of posterior ankle mold splint

http://image.slidesharecdn.com/presentationfinal1-140704054255-phpapp01/95/ortho-splinting-traction-pop-48-638.jpg?cb=1404522673

exercises to restore ankle strength and stability after injury:

1) active dorsiflexion / plantar flexion - lie on back and life leg while doing this


2) passive dorsiflexion - stand w/ palms braced against wall and bend knee towards wall


3) eversion/dorsi/plantarfelxion against resistance - manulaly applying counterforce w/ an elastic cord or standing on toes

what type of metatarsal frx can you use a hard sole shoe?

toe and 2nd thru prox 5th metatarsal

the bledsoe boot is an alternative for what type of foot/leg fractures?

toe/forefoot sprains or fractures that allow weight bearing

identify the bones of the wrist (in this image)


https://xvif.files.wordpress.com/2013/05/normal-metacarpal-3.jpg

answer: http://www.newhealthadvisor.com/images/1HT04003/the-hand-and-wrist-3.jpg

how to test for the median nerve on the hand (3 tests):

-flex distal phalanx of thumb against resistance


-oppose the tip of thumb to tip of little finger


-place hand palm up, abduct thumb by raising it to perpendicular while palpating belly of abductor pollicis to ensure ctx

how to test for ulnar nerve injury on hand:

-spread fingers apart against resistance, and bring them together against resistance


- straighten fingers and abduct pinky out


- adduct thumb against index finger and try to pull piece of paper out (ulnar innervates the adductor pollicis)

how to examine radial nerve injury on hand:

-extend fingers and wrist


-place thumb in hitchhiking position and test its resistance to further extension



how long can you leave a penrose drain / tourniquet on the finger?

no more than 20 minutes

5 hand injuries that require immediete hand consultation:

COACH


1) C - Compartment syndrome


2) O - ortho - Open fracture / irreducible dislocation


3) A - amputation


4) C - Crush injury (severe)


5) H - high pressure injection

what is gamekeepers thumb and what is the splint to use for it

thumb ulnar collateral ligament tear - use thumb spica

what is mallet finger and what is the splint for it?

extensor tendor disruption at the DIP - treat w/ dorsal splint, full extension of DIP for 8 weeks

splint for flexor tendon laceration

they need close hand f/u, but place in dorsal splint w/ 30-degree wrist flex, 70 degree MCP flex, and 45 degree PIP flex

splint for DIP and PIP dislocation

DIP - dorsal splint - full extension


PIP - dorsal splint - 30 degree PIP flexion

MCP joint dislocation splint

buddy taping

distal phalanx frx splint

volar or hairpin splint NOT immobilizing PIP

middle and prox phalanx frx splint:

stable - buddy taping


unstable - gutter splint w/ 90degree MCP flex, 15 degree PIP flex, 5 degree DIP

thumb prox phalanx frx splint

thumb spica

metacarpal frax splint

index and middle - radial gutter - 20 degree wrist flexion, 90 degree MCP flexion, PIP left mobile


ring and small - ulner gutter, similar flexion

Describe the injury/prognosis of the zones of flexor injuries

Zone 1 - from insertion of flexor digitorum superficialis to profundus tendon, they lose DIP flexion; retrieval difficult


Zone 2 - involves portion of digital canal occupied by fds and fdp tendons; lacerations are common and need exact repair


Zone 3 - distal edge of carpal tunnel to proximal edge of flexor sheath; outcomes favorable


Zone 4 - carpal tunnel; likely not an isolated injury


Zone 5 - proximal to carpal tunnel; primary repair within 12 hours but secondary repair can wait 4 weeks

a zone 1 extensor injury is also called what?

mallet finger

How are mallet finger injuries classified and treated?

Type I - tendon only, and Type II - partial avulsion --> both treated well with DIP immobilization in slight hyperextension for 7 weeks


Type III - >25% avulsion of articular surface of DIP; sometimes a hand surgeon will want to treat this eventually so better to call

Extensor tendon Zone III injury and treatment

this is the central slip and lateral band injury that can result in boutonniere deformity; treat w/ splinting in extension for 5 weeks and close hand f/u

treatment of Zone V extensor injury

this is over the MCP joint (knuckles) and should be thought of as human bites until proven otherwise and undergo delayed repair after a course of broad spectrum abx

What is unique about Zone VI, VII and VII extensor tendon injury? how do you splint?

They usually require operative repair and special sutures and K-wires


splint - wrist 15 degree flexion, MCP joint 15 degree flex, and IP joints in 15 degree flex

reduce a DIP dislocation how?

they are almost always dorsal dislocation, so you apply traction and hyperextension, followed by dorsal pressure

a dislocated PIP joint is deviated USUALLY which way?

ulnar-ly deviated, b/c the radial collateral ligament is 6x more likely to tear

how to splint a PIP dislocation after reduction, and for how long

in 30 degree flexion for 3 weeks

An MCP dislocation/subluxation is usually where the joint appears to be hyperextended 60-90 degrees; how do you reduce this?

flexing the wrist to relax the felxor tendon and apply pressure over the dorsum of teh proximal phalanx in a distal and volar direction; complete dislocations are usually not reducible, but subluxations are

reduction of a CMC joint dislocation how?

traction and FLEXION of wrist w/ simultaneous longitudinal pressure on the metacarpal base

when is hand referrel necessary for gamekeepers thumb?

when there is weakness in pincer function and tenderness over the volar-ulnar aspect of the thumb


AND/OR


on exam more than 40 degree radial angulation on testing the ligamement

stable proximal and middle phalanx fractures are treated how?

by buddy taping

when should you reduce a IV and V metacarpal fracture (boxer fracture) in the MC neck?

If there is angulation >20 degrees in the 4th MC or angulation >40 degrees in the 5th MC, then you should attempt reduction

if manipulative reduction in metacarpal shaft fractures is necessary, can you get away w/o surgical fixation?

usually not, it's needed

bennett vs rolando fracture:

Bennett - intra-articular frx of thumb CMC joint w/ associated subluxation/dislocation.


Rolando - more of a comminuted type fracture


*both require thumb spica and surgical f/u

treatment of hand injection injury:

- immobilize and elevate hand


- give tetanus and broad spectrum abx


- provide pain relief


- EMERGENT hand consultation for surgical decompression and debridement

children are most likely to get wrist injuries where?

in the immature, weaker epiphyseal plate or metaphysis or the radius, sparing the still-cartilaginous carpal bone

the 3 smooth arcs of the wrist are known as the:

Gilula lines

normal scapho-lunate axis angle

30-60 degrees

purpose of oblique wrist views:

to move the pisiform or scaphotrapezium joints away from overlapping bone

the lateral wrist view is good for looking for what?

radius/ulnar fractures


lunate/perilunate d/l


dorsal intercalated segment instability


volar intercalate segment instability

scaphoid view of wrist is good for what:

looking for scaphoid fracture and scapholunate d/l

carpal tunnel view of wrist is good for what:

looking for pisiform and hamate fractures

dorsal intercalated segment instability is what?

when the lunate tilts dorsal and slides palmar, increasing capitolunate angle and increasing the scapholunate angle

the most commonly injured lig of the wrist is...

the scapho-lunate ligament

the 3 radiographic signs of scapho-lunate ligament injury:

1) scapholunate dissociation - wideing of joint space >3mm on PA view


2) rotary subluxation of scaphoid - scaphoid rotates palmar causing shorter scaphoid and a "cortical ring sign" on PA view and inc in scapholunate angle on lateral view


3) dorsal intercalated segement instability - lunate tilts dorsal and scaphoid tilts more palmar

ED treatment of scapho-lunate disruption or instability:

radial gutter splint or short arm volar posterior mold, and close ortho f/u for closed reduction and pinning or surgery

triquentrolunate lig injury occurs usually how?

FOOSH with landing on the hypothenar eminence primarily

radiographic appearance of triquentrolunate injury:

- lunate tilts palmar, capitate extends lightly, causing capitolunate angle to be increased >10degrees but scapholunate angle decreases <30 degrees or be unaffected

treatment of triquentrolunate injury:

ulnar gutter or short arm posterior mold and ortho f/u for 6 week cast

what is the mech of injury or lunate or perilunate d/l?

usually FOOSH but much greater force - MVA, fall from a height, sporting event

4 stages of perilunate instabilty:

I - disruption of scapholunate articulation


2 - capitlounate separation


3 - triquetrolunate joint separation


4 - complete lunate dislocation

radiographic findings of perilunate d/l:

seen BEST on lateral view:


- disuprtion of 3 C's


- capitate displaced dorsal to lunate and lunate retains contact w/ radius


- PA view, obliteration of the normal smooth arcs w/ bones overlapping;

radiographic apperance of lunate dislocation:

- PA view: piece of pie triangular shape of lunate


- lateral: lunate pushed off the radius into the palm "spilled teacup" sign and capitate rebounds back

perilunate and lunate d/l require followup or emergent ortho consult?

emergent

what is considered an unstable scaphoid fracture:

oblique


1mm of displacement


rotation or comminution


carpal instablity pattern is present

non-displaced or clinically suspected scaphoid fractures are treated how? what about unstable fractures?

short arm thumb spica splint in dorsiflexion and radial deviation to compress the fracture fragments


unstable - LONG arm thumb spica splint and should have prompt ortho f/u



2nd most common carpal fx:

triquentral fractures

mech of triquentral fx and exam findings

mech - twisting of hand against resistance or hyperextension


exam - tenderness at dorsum of wrist , distal to ulnar styloid

best way to see a triquentral fracutre:

lateral radiograph and oblique view in partial pronation - tiny flake of bone on lateral view is how it typically appearce

tx of triqunetral dorsal avulsion fracture:

wrist splint for 1-2 weeks

major complication of lunate fx:

avascular necrosis (so a thumb spica should be applied if clinical suspision is present

what trapezium fractures require surgery, and how do you treat in the meantime?

displaced fx >1mm or diastasis >2mm require surgery


treat - thumb spica

when is ossification of the pisiform complete?

by age 12

treatment of pisiform:

splint with 30 degrees of flexion, ulnar deviation to relax tension of flexor carpi ulnaris

what forms the walls of the guyon canal? why is it important to know this?

pisiform and hook and hamate; they form the canal that the ulnar nerve and art run, so it is important to exclude fracture

classic mechanism of hamate hook fx:

interrupted swing w/ golf club, bat, or racquet where the handle impacts the hypothenar immenence and compresses the bone

best view for hook of hamate fracture, and treatment

carpal tunnel


tx - compression dressing or splint

capitate fx are rarely seen alone, and usually a/w what other bone fx?

scaphoid

radiographic appearnce of colles fx (4 things)

1) dorsal angulation of the plane of distal radius


2) distal radius fragment is displaced proximally and dorsally


3) radial displacement of the carpus


4) ulnar styoid may be fx

radiographic signs of colles fx instability that may complicate reduction or arthritis down the road

1) >20 degrees of angulation


2) intra-articular involvement


3) marked comminution


3) >1cm shortening

how to reduce a colles fracture

1) apply good local anesthesia


2) place fingers in traps for traction


3) push fracture fragment distal and palmar while holding forearm firmly


GOAL - restore the normal volar tilt, radial inclination, and proper length to radius


4) place in sugar tong splint

splint for post-reduction of colles fx

sugar tong

the classic description of a smith fracture

garden-spade deformity

what does smith fracture look like on plain film?

- volar angulation of the plane of distal radius


- distal radius fragment is displaced proximally and volarly


- radial displacement of carpus


- the fracture line extends obliquely from dosral surface to the volar surface


it's the reverse colles

radiographic apperance of barton's frx

volar and proximal displacement of large frag of radial articular surface


volar displacement of the carpus


radial styloid may be fx

tx of barton's frx

1) minimally displaced - sugar tong


2) unstable involving >50% of radial articular surface or those a/w carpal subluxation need open reduction and internal fixation

radial styloid fx are often a/w what?

lunate d/l

radial styloid frx are significant how?

b/c the major carpal ligaments insert on the radial styloid and fx can produce instability; displaced >3mm fx often require ORIF

tx of radial styloid frx

- place in short arm splint w/ wrist in mild flexion and ulnar deviation

radiographic apperance of radioulanr joint disruption

on lateral view, the ulna is not overlapping the centered over the radius, but deviated either volar or dorsal