Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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 |