Orthopedic Fracture Management Quiz

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Questions and Answers

What is the recommended immobilization period for a Type I radial head fracture?

4 weeks

3 weeks (correct)

2 weeks

1 week

Which treatment is appropriate for a Type II radial head fracture?

Physical therapy only

ORIF and immobilization in plaster cast for 2 weeks (correct)

ORIF and immobilization for 1 week

Excision of radial head

What is the primary characteristic of a Monteggia fracture?

Fracture of the distal radius with proximal ulna dislocation

Complete articular fracture with comminution

Fracture associated with single bone involvement

Fracture of the upper third of the ulna with radius dislocation (correct)

For a Galeazzi fracture, what type of fracture occurs?

Distal third of the radius with inferior radioulnar joint dislocation Signup and view all the answers

Which phase of rehabilitation focus on active and active-assisted ROM for the elbow and forearm?

Phase II Signup and view all the answers

What should not be done for at least 14 to 21 days after a radial head fracture treatment to lower the risk of myositis ossificans?

Passive movement to the elbow Signup and view all the answers

What is a common complication associated with fractures of the radial head?

10º to 15º limit to ROM Signup and view all the answers

What immediate action is taken for both Monteggia and Galeazzi fractures to prevent redisplacement?

Surgical ORIF Signup and view all the answers

What is the primary focus of physical therapy in the early rehabilitation of CRPS?

Limiting pain and reducing edema Signup and view all the answers

Which treatment method uses visual feedback to aid recovery in CRPS?

Mirror therapy Signup and view all the answers

What characterizes Type 1 Complex Regional Pain Syndrome (CRPS 1)?

Out of proportion pain and vasomotor dysfunction Signup and view all the answers

Which of the following is NOT a common symptom of CRPS 1?

Spontaneous bone fractures Signup and view all the answers

What defines the mechanism thought to contribute to the pathophysiology of CRPS?

Both peripheral and central mechanisms Signup and view all the answers

What is the role of desensitization in treating CRPS?

To provide sensory exposure through varied stimuli Signup and view all the answers

Which type of fracture may sometimes require closed reduction as part of its treatment?

A mild angulation and displaced fracture Signup and view all the answers

How long after a fracture is mobilization of the wrist typically indicated?

7-8 weeks Signup and view all the answers

What is the typical deformity associated with a Colles fracture?

Dinner Fork Signup and view all the answers

Which complication of a Colles fracture is categorized as an early complication?

Carpal tunnel syndrome Signup and view all the answers

What population is primarily affected by Colles fractures due to osteoporosis?

Women over 50 Signup and view all the answers

What causes the distal fragment to displace radially in a Colles fracture?

Momentum of body weight during a fall Signup and view all the answers

Which of the following best describes malunion in a Colles fracture?

Healed fracture with residual malalignment Signup and view all the answers

Which ligament may be sprained due to the momentum resulting in radial displacement during a Colles fracture?

Ulnar collateral ligament Signup and view all the answers

What type of fracture is characterized by the major fracture line running transversely across the distal radius?

Colles fracture Signup and view all the answers

Which of the following is not considered a late complication of a Colles fracture?

Radial artery injury Signup and view all the answers

What is the primary focus during the next phase of rehabilitation after surgery for a wrist fracture?

Increasing range of motion and beginning strengthening exercises Signup and view all the answers

Which of the following best describes a Smith fracture?

A transverse fracture at the lower end of the radius with palmar displacement Signup and view all the answers

What is a common mechanism of injury for a Smith fracture?

A fall on a palm flexed wrist Signup and view all the answers

During wrist rehabilitation, if a patient cannot tolerate a prolonged stretch, how should they proceed?

Perform shorter stretches of 10 seconds for 10 repetitions Signup and view all the answers

What differentiates a Barton fracture from a Smith fracture?

Barton fracture is an intra-articular fracture with volar displacement Signup and view all the answers

What is the most common cause of scaphoid fractures?

A fall on an outstretched hand with a radially deviated wrist Signup and view all the answers

How long after surgery can early mobilization for wrist fractures typically begin?

Approximately 1 week Signup and view all the answers

Which statement regarding radial styloid fractures (Chauffeur fractures) is true?

These fractures are primarily treated with immobilization in a cast Signup and view all the answers

What is the primary reason for avascular necrosis of the scaphoid bone?

Lack of adequate blood supply to the proximal pole Signup and view all the answers

Which treatment method is recommended for an undisplaced scaphoid fracture?

Cast immobilization Signup and view all the answers

What indicates a potentially serious complication following a scaphoid fracture?

Tenderness in the lunate fossa Signup and view all the answers

How long is immobilization generally required for fractures of the waist and proximal pole of the scaphoid?

8 to 12 weeks Signup and view all the answers

What is the most common consequence of untreated scaphoid fractures?

Osteoarthritis due to missed fracture union Signup and view all the answers

When treating a lunate fracture that is clinically suspected, what is the initial recommended approach?

Short arm thumb spica splint Signup and view all the answers

What symptom should raise suspicion for Kienbock’s disease in a patient with a lunate fracture?

Tenderness while palpating the lunate fossa Signup and view all the answers

What is a typical feature of a Bennett's fracture?

Oblique intra-articular fracture at the base of the 1st metacarpal Signup and view all the answers

What defines a Rolando's fracture?

A T or Y-shaped fracture of the thumb Signup and view all the answers

What is the recommended treatment for a stable Bennett's fracture?

Thumb spica splint Signup and view all the answers

Which of the following best describes a Boxer's fracture?

Fracture of the distal 4th or 5th metacarpal Signup and view all the answers

What is the primary focus of Greer’s principles of splinting regarding immobilization duration?

Fractures should not be immobilized for more than 3 weeks Signup and view all the answers

What is the purpose of ‘Buddy-taping’ in the treatment of Boxer’s fractures?

To immobilize the injured finger effectively Signup and view all the answers

Which position should the metacarpophalangeal joints be maintained in during splinting of fractures?

Flexion to avoid extension contractures Signup and view all the answers

What is the correct method for managing unstable Boxer’s fractures?

Perform open reduction and internal fixation (ORIF) Signup and view all the answers

Which principle emphasizes the importance of early active tendon gliding in splinting?

E: Early active tendon gliding is encouraged Signup and view all the answers

Study Notes

Fractures & Dislocations Of The Upper Limb

Elbow dislocations constitute 10% to 25% of elbow injuries. Among upper extremity injuries in adults, elbow dislocation ranks second only to shoulder dislocation.
Elbow dislocations are categorized into simple and complex patterns.
Simple dislocations involve only ligamentous injury without any fractures. They can be anterior or posterior.
Posterior dislocations are the most common type and are further classified based on the direction of the dislocated ulna (posterior, posteromedial, posterolateral, direct lateral).
Complex dislocations include associated fractures, such as of the radial head, coronoid process of the ulna, and the olecranon. The "terrible triad" represents a dislocation with injuries to the coronoid process, radial head, and the posterior lateral dislocation of the elbow joint. This may be associated with nerve or vascular injury (e.g., ulnar/median neuropraxia, brachial artery injury). Ulnar collateral ligament tears can also occur.
In children under 10 years, posterior dislocations (PEDs) are the most common type of joint dislocation, often caused by falling on an outstretched hand.
Elbow dislocations may lead to dislocations caused by axial compression, valgus stress, arm abduction, and forearm supination. Anterior dislocations originate from direct force to the posterior forearm with the elbow flexed, which is less common.

Treatment

Simple posterior dislocations are treated via closed reduction under sedation, followed by fixation in a plaster cast or posterior splint with the elbow at 90 degrees for 2-3 weeks. Early active range of motion exercises are crucial.
Complex or unstable dislocations, severe soft tissue injuries, or bony entrapment require open reduction with or without internal fixation. Ulnar collateral ligament repair is often necessary.

Reduction of Posterior Elbow Dislocation

The palm-palm technique involves grasping the patient's hand with palms together and fingers interlocked. The examiner's elbow is placed in the patient's antecubital fossa. The examiner then pushes downward on the patient's distal humerus with their elbow, assisting the dislocated elbow back into its anatomical position.

Rehabilitation Considerations

Extended casting and prolonged immobilization should be avoided to prevent post-traumatic stiffness in simple elbow dislocations.
Early active range of motion (ROM) is key for successful outcome.
Elbow splinting for 5-7 days allows for soft tissue rest while compressive dressings and ice help control swelling.
Starting at day 5-7, a hinged elbow brace (30-90 degrees) is used and active ROM begins.
Active ROM promotes muscle activation, assists with elbow stability, and increases cross-joint compression. Increasing the brace's range of motion by 10-15 degrees per week is standard.
The 2 week period following the injury should avoid passive ROM, valgus stress, abduction and external rotation, and forced terminal extension to avoid disrupting MCL healing which could lead to instability or recurrent dislocations.
Strengthening and resistive exercises are avoided during this time. Training can resume after 6-8 weeks and elbow flexion returns before extension. Full flexion can be expected in 6-12 weeks and extension might take 3-5 months.

Radial Head Fracture

Radial head fractures often originate from a fall on an outstretched arm (minimal/moderate flexion), which results in a valgus pronation stress that pushes the radius against the capitulum of the humerus. A direct blow to the elbow can less frequently cause this.
Most common complication is limited ROM (10-15 degrees). Mason classification of radial head and neck fractures, depending on fracture displacement: Type I (undisplaced), Type II (marginally displaced), Type III (comminuted), Type IV (associated with dislocation).
Treatment depends on the fracture type:
Type I: immobilization in a cast for 3 weeks
Type II: ORIF and cast immobilization for 2 weeks
Type III: ORIF or radial head excision, 2-week cast immobilization
Type IV: radial head resection or replacement.

Forearm Bone Shaft Fracture

Monteggia fracture dislocation: Fracture of the upper third of the ulna with anterior displacement of the upper ulnar fragment causing anterior dislocation of the radius and associated superior radio-ulnar joint dislocation. ORIF is necessary, or the dislocation will likely reappear.
Galeazzi fracture dislocation: Fracture of the distal 1/3rd radius resulting from rotational force and associated inferior radioulnar joint dislocation. Conservative treatment may cause redisplacement and is thus usually followed by ORIF.

Distal Radial Fractures

Colles' fracture: Extra-articular fracture of the distal radius, typically resulting from a fall onto an outstretched dorsiflexed (extended) hand. It is common in elderly people (osteoporosis), presenting with a 'dinner fork' deformity (dorsal displacement).
Smith's fracture: Also known as a reverse Colles' fracture, occurs from a fall and palmer-flexed wrist, resulting in palmer displacement. The management is analogous to Colles' fracture, except a focus on regaining wrist flexion.
Barton's fracture: Intra-articular distal radius fracture with volar (palmer) or dorsal displacement. Managed with ORIF.
Radial Styloid fracture (Chauffeur fracture): Compression of the scaphoid against the styloid. Non-displaced cases are treated with casting; displaced cases require surgical fixation.
Carpal bone fractures: The majority are scaphoid fractures (50-80%), often caused by falling on an outstretched hand with a deviated wrist, resulting in an extreme dorsiflexion and radial compression to the hand. Scaphoid fracture of the distal pole heals in 2-3 weeks, while those of the waist and proximal pole may need 8 to 12 weeks of immobilization and the lack of direct blood flow (radial artery) makes the proximal pole vulnerable to necrosis.
Lunate fractures: Frequently caused by FOOSH mechanism, with the blood supply entering the distal/proximal ends. High risk of avascular necrosis. Treatment: Non-displaced cases typically receive short arm casts; displaced fractures typically require surgical fixation.
Metacarpal fractures: Type I: Bennett's fracture (oblique base of 1st metacarpal, dislocation/subluxation of the carpometacarpal joint). Sometimes described as a "T" or "Y" shaped fracture, called a Rolando’s fracture requiring surgical fixation if unstable. Type II: Boxer fracture (neck fracture of the 4th or 5th metacarpal, closed fist impact). This type of fracture is typically treated with immobilization (buddy taping, casting, splinting).

Complications

Malunion: Colles fracture can heal with some malalignment (radius foreshortened and dorsally displaced), leading to limitations in full wrist flexion and ulnar deviation/pronation.
Avascular necrosis is a complication that can occur after a fracture, especially in the scaphoid and lunate bones. The avascular necrosis arises because there is an interruption in the blood supply.
Reflex sympathetic dystrophy (RSD): Chronic pain, swelling, vasomotor issues in an extremity, often after injury. Early identification of RSD is crucial and requires prompt medical intervention. Physical therapy that focuses on limiting pain, edema and regaining range of motion is typically part of the treatment.

Treatment and Rehabilitation Protocols

Treatment and rehabilitation protocols vary based on the specific fracture/dislocation type. Many involve immobilization (e.g., casts, splints) for varying durations, specific exercises, and possible surgical interventions.

General

Active range of motion exercises are generally encouraged in many protocols.
Avoiding passive movements for at least 14-21 days, and valgus stress, abduction, and external rotation for certain conditions is generally recommended.
Maintaining good communication with the treating surgeon about recovery milestones, weight lifting restrictions, and the recovery timeline, throughout the healing process is crucial.

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Description

Test your knowledge on the management and rehabilitation of various fractures, including radial head, Monteggia, and Galeazzi fractures. This quiz also explores Complex Regional Pain Syndrome (CRPS) and its treatment methods. Suitable for students and professionals in orthopedic and rehabilitation fields.