Fractures of the Upper and Lower Extremities PDF - Diagnosis & Treatment

**FRACTURES OF THE UPPER AND LOWER EXTREMITIES** +-----------------------+-----------------------+-----------------------+ | **Feature** | **Anterior** | **Posterior** | +=======================+=======================+=======================+ | **H&P** | FO...

**FRACTURES OF THE UPPER AND LOWER EXTREMITIES** +-----------------------+-----------------------+-----------------------+ | **Feature** | **Anterior** | **Posterior** | +=======================+=======================+=======================+ | **H&P** | FOOSH, **forced | **Direct blow to | | | abduction & external | front of shoulder**, | | | rotation**, seizure, | seizure, | | | trauma (MVA) | electrocution | +-----------------------+-----------------------+-----------------------+ | **Symptoms** | Arm abducted, | Arm adducted, | | | externally rotated, | internally rotated, | | | loss of deltoid | limited external | | | contour | rotation | +-----------------------+-----------------------+-----------------------+ | **Radiology Finding** | AP → **Medial** & | AP → **Lateral** to | | | **Inferior** to | Glenoid; Widened gap; | | | Glenoid | **Lightbulb sign** | | | | | | | Y → See glenoid; | Y → Glenoid obscured | | | humerus is | slightly; humerus is | | | [closer] | [farther] | | | to ribcage; | from ribcage | | | | | | | | **Axillary** → Just | | | | know would be off of | | | | glenoid | +-----------------------+-----------------------+-----------------------+ | **Associated | Hill-Sachs → | Reverse Hill-Sachs → | | Injuries** | [PosteroLateral]{.und | [AnteroMedial]{.under | | | erline} | line} | | | Humeral head | Humoral Head | | | | | | | Bankart → | Reverse Bankart→ | | | A[nterior]{.underline | P[osterior]{.underlin | | | } | e} | | | glenoid labrum | glenoid labrum | | | | | | | **[axillary | | | | nerve]** | | | | injury | | +-----------------------+-----------------------+-----------------------+ A\) anterior humeral head and anterior glenoid B\) posterior humeral head and anterior glenoid C\) posterior humeral head and posterior glenoid D\) **anterior humeral head and posterior glenoid** 2\) Which of the following features is **NOT **a commonly associated injury in posterior shoulder dislocation? A\) **neurovascular damage** B\) proximal humeral fractures C\) reverse Bankart lesion D\) reverse Hill-Sachs lesion 3\) An impaction fracture of the anteromedial aspect of the humeral head is known as a\... bony Bankart lesion Hill-Sachs lesion **reverse bony Bankart lesion** reverse hill sachs lesion 4\) A fracture of the anteroinferior aspect of the glenoid is known as a\... A\) **bony Bankart lesion** B\) Hill-Sach lesion C\) reverse bony Bankart lesion D\) reverse Hill-Sach lesion 5\) Forced external rotation and abduction of the humerus will most often result in a glenohumeral dislocation in which direction?  A\) **anterior**  B\) inferior C\) intrathoracic  D\) posterior 6\) The \'light bulb sign\' observed on radiographs of posterior shoulder dislocations is due to\... A\) fixed abduction of the humeral head B\) fixed adduction of the humeral head C\) fixed external rotation of the humeral head D\) **fixed internal rotation of the humeral head** 7\) Forced external rotation and abduction of the humerus will most often result in a glenohumeral dislocation in which direction?  A\) **anterior**  B\) inferior C\) intrathoracic  D\) posterior **\ ** **Shoulder** **Feature** **Clavicular Fracture** **Proximal Humeral Fracture** **AC Joint Separation** ------------------------------- ----------------------------------- -------------------------------------------------------- ---------------------------------------------------- **Note** Most **Middle third** of clavicle Prob won't be a picture question **Elevated distal clavicle** **A/W** **Bulge** Adhesive Capsulitis; **Axillary N.** damage; ishchemia **Point tenderness** **Diagnosis/ Classification** **Clavicular X-ray view** **Neer's Classification** **Traction X-ray** of [both] shoulders The majority of clavicular fractures occur at the\... distal shaft inferior shaft medial shaft **mid shaft ** superior shaft Which of the following joints is most frequently dislocated? ankle joint elbow joint **glenohumeral joint** hip joint tibiofemoral joint **Feature** **Humeral Shaft Fracture** ------------------- ------------------------------------------------------ **Etiology** FOOSH, MVA, direct trauma, Consider **Osteoporosis** **Location** Midshaft fracture common **Diagnosis** AP & lateral X-ray → Will Prob ask us to type it **Complications** **Radial N. injury** **Radial N. Sx** ↓Sensation back of hand; **wrist drop**  **GIRAFFES CAN SPIN TOO!**  **Fracture Pattern** **Description** ------------------------------ ------------------------------------------------------------------------------ **G**reenstick One side of bone broken, other side bent (common in children) **I**mpaction (Buckle/Torus) Bone is compressed, causing a buckling effect **R**otated A fragment is rotated in relation to the proximal piece **A**vulsion Tendon or ligament pulls off a piece of bone **F**racture Displacement Fracture with misalignment of joint **F**racture Complete Bone broken all the way through **E**levation (Butterfly) Triangular bone fragment detached from main bone shaft **S**egmental Bone fractured in two places, leaving a floating segment **C**omminuted Fracture with more than two fragments **A**ngulation Fragments form an angle at the fracture site **N**arrowing (Pathologic) Fracture due to weakened bone from disease (e.g., osteoporosis) **S**piral Fracture spirals around the bone, often from twisting force **T**ransverse Fracture line runs straight across the bone **O**blique Fracture line runs diagonally across the bone **O**pen (Compound) Fracture that breaks through the skin or another organ **Elbow** +-------------+-------------+-------------+-------------+-------------+ | **Feature** | **Distal | **Occult | **Proximal | **Elbow | | | Humerus | Fracture of | Ulnar / | Fracture- | | | Fracture** | the Radial | Olecranon | Dislocation | | | | Head** | Fracture** | ** | +=============+=============+=============+=============+=============+ | **Symptoms* | Pain, | Lateral | **Cubital | Obvious | | * | swelling, | elbow pain, | Tunnel/Ulna | deformity | | | limited | limited | r | | | | motion | supination/ | Claw Hand** | | | | | pronation | → Grip W + | | | | | | ↓sens | | | | | | **5^th^ | | | | | | finger + ½ | | | | | | ring** | | +-------------+-------------+-------------+-------------+-------------+ | **Location* | 1) | Suspect if | Olecranon | **Posterior | | * | Supracondyl | no | process: | dislocation | | | ar | Dislocation | | ** | | | | on question | 1) | MC | | | 2) | → **Look at | Displaced | | | | Transcondyl | Fat Pads!** | | **Terrible | | | ar | | 2) | triad**: | | | | | Non-displac | coronoid, | | | 3) | | ed | radial | | | Intercondyl | | | head, | | | ar | | | dislocation | +-------------+-------------+-------------+-------------+-------------+ | **Diagnosis | anterior | Posterior | X-ray | AP & | | ** | and | fat pad | lateral | lateral | | | posterior | sign | view with | X-ray | | | fat pad | | Posterior | | | | | | Fat Pad. | | | | | | Will be | | | | | | obvious | | +-------------+-------------+-------------+-------------+-------------+ | **Complicat | | | **Ulnar N** | | | ions** | | | | | +-------------+-------------+-------------+-------------+-------------+ **CRITOE -- 1, 3, 5, 7, 9, 11** **Which structure does the olecranon articulate with?** Coronoid process Radial head **Trochlea** Capitulum **Which bony structure does the radial head articulate with to form the elbow joint?** Scaphoid Trochlea of humerus **Capitulum of humerus** Ulnar styloid process In which age group are supracondylar fractures most common in? **5-7 years old** 12-16 years old 20-24 years old 35-40 years old **Forearm** +-----------------------+-----------------------+-----------------------+ | **Feature** | **Monteggia | **Galeazzi Fracture** | | | Fracture** | | +=======================+=======================+=======================+ | **H&P** | Children; Protecting | Foosh | | | self | | | | | | | | PIN Palsy → cant | | | | extend thumb & wrist | | +-----------------------+-----------------------+-----------------------+ | **Fracture at** | Ulna | Distal Radius | +-----------------------+-----------------------+-----------------------+ | **Dislocation of** | Radial Head | DRUJ | +-----------------------+-----------------------+-----------------------+ | **Diagnosis** | Will give **Elbow** | Will give **Wrist** | | | xray | Xray | +-----------------------+-----------------------+-----------------------+ | **Complications** | Ass. Posterior | | | | interosseous N. | | | | (**PIN**) | | +-----------------------+-----------------------+-----------------------+ **Wrist** **Colles\' Fracture** **Smith's Fracture** **Barton's Dorsal** **Barton's Volar** ------------------------- ----------------------- ------------------------ --------------------- -------------------- **Fx of Distal Radius** Metaphysis Metaphysis Intra-articular Intra-articular **Displacement** Dorsal Volar Dorsal Volar **A/W** Dinner fork deformity Garden spade deformity **Complications** **Ulnar Styloid** **Which one of the following best describes a Smith's fracture?** Intra-articular fracture of distal radius with Dorsal Displacement **Extra-articular fracture of distal radius with Volar Displacement** Extra-articular fracture of distal radius with Dorsal Displacement Intra-articular fracture of distal radius with Volar Displacement **While working in her garden, a 78 year old lady falls backward on the dorsum of her hand with a flexed wrist. She develops severe wrist pain. Given the mechanism of the injury, what is the most likely fracture caused by this fall?** Colles\' fracture **Smith\'s fracture** Humeral fracture Bankart fracture **Which of the following fractures is the most common type of distal wrist fracture?** Smith\'s fracture **Colles\' fracture** Rolando fracture Barton\'s fracture **An extra-articular distal radius fracture with dorsal angulation is also known as a\...** Barton fracture  chauffeur fracture **Colles fracture** die-punch fracture Smith fracture +-----------------------+-----------------------+-----------------------+ | | FOOSH, wrist | | | | in **extension & | | | | ulnar deviation** | | +=======================+=======================+=======================+ | | **Perilunate | **Lunate | | | Dislocation** | Dislocation** | +-----------------------+-----------------------+-----------------------+ | **Dislocation** | **Dorsal** | **Volate** | +-----------------------+-----------------------+-----------------------+ | **What is | **Capitate** | **Lunate** | | Dislocated** | | | +-----------------------+-----------------------+-----------------------+ | **Sign** | **\"Cup Empty | **\"Spilled Teacup | | | Sign\"** | Sign\"** | +-----------------------+-----------------------+-----------------------+ | **Diagnosis** | Honestly so trickly | PA → Lunate | | | IDT she'll ask... | Triangular rather | | | | than quadrilateral | | | | | | | | Lateral → Lunate | | | | displaced anteriorly | +-----------------------+-----------------------+-----------------------+ | **Complications** | **Median nerve | | | | injury**, Radial & | | | | Ulnar Styloid | | +-----------------------+-----------------------+-----------------------+ **A patient with a suspected scaphoid fracture had 2 inconclusive plain film radiographs two weeks apart. What is the most definitive investigation that needs to be requested at this stage?** Repeat plain film radiograph in 2 weeks time **MRI scan** Physiotherapy for early mobilisation CT angiogram to exclude arterial injury **Which of the following complications following a scaphoid fracture is the most common?** Non-union **Avascular necrosis** Delayed union Myositis **A perilunate dislocation can be described as\...** dislocation of the capitate from the lunate, and subluxation of the lunate from the radius **dorsal dislocation of the capitate and carpus relative to the anatomically aligned lunate** dorsal dislocation of the lunate, no longer articulating with the capitate or radius volar dislocation of the lunate, no longer articulating with the capitate or radi **Hand** **1^st^ MC** **4^th^/5^th^ MC** --------------------------- --------------------------------------------------------------- --------------------------------------- -------------------------------------------------------------------------------- **Feature** **Bennett's Fracture** **Rolando's Fracture** **Boxer's Fracture** Base Base Neck Intra-articular Intra-articular Transverse **Definition** Partial -- 2 Fragments Comminuted Fracture of 4th/5th metacarpal neck **Radiographic Findings** Displacement dorsally & radially T-shaped or Y-shaped fracture pattern Honestly it's the only 5^th^ MC Fx we know... **Treatment** Requires ORIF Requires ORIF  **Ulnar gutter splint** **Complications** [Fragment] dislocated by abductor pollicis longus **Risk of compartment syndrome** [Distal finger/fragment] angulated dorsally and externally rotated **A transverse fracture of the 5th metacarpal as a result of** **axial loading is most often angulated in which direction?** dorsal radial ulnar **volar** **Phalangeal Fractures** **Feature** **Skier's Thumb (Gamekeeper's)** **Mallet Finger (Only in Bony Mallet)** ------------------- ---------------------------------------------- -- ------------------------------------------- **Fracture** Base of Proximal phalanx of 1^st^ digit (Possible) Proximal dorsal distal phalynx **Disruption of** Ulnar collateral ligament (UCL) Avulsion of extensor tendon **Key Feature** Laxity & pain on valgus stress test for PIP Patient unable to extend DIP joint **Treatment** **Thumb spica splint** **Complications** Can lead to chronic instability if untreated Honestly its easy to spot lol What is the name for a three-part or comminuted intra-articular fracture-dislocation of the base of the thumb? Bennett fracture epibasal fracture Jones fracture  **Rolando fracture** Seymour fracture **Hip** **Feature** **Anterior Hip Dislocation** **Posterior Hip Dislocation** **Subcapital & Subchondral Hip Fracture** **Intertrochanteric Hip Fracture** **Subtrochanteric Hip Fracture** ----------------------- ----------------------------------------------------------------------- ---------------------------------------------------------------------------- -------------------------------------------- ---------------------------------------------- --------------------------------------------------------------- **Etiology** Forced **hip abduction**, impact on knee (football, race car driving) Contact with flexed knee (MVA dashboard) Fall in elderly, MVA in young Low-energy fall in elderly, MVA in young Low-energy fall in elderly, MVA in young **Shortened?** No Yes Yes Yes Yes **Rotation** External Internal External External Internal/External **Hip (Fl/Ex/Ab/Ad)** Flexed Adducted Flex **Diagnosis** Femoral Head displaced **Inframedially** Femoral Head displaced **Superolaterally** Crescent Sign (Hypointense) See if Fx passes through b/w the trochanters Transverse, Spiral, or Oblique fx **Below** Lesser Trochanter **Treatment** Reduction & immobilization Reduction & immobilization ORIF or hip replacement **ORIF required** **Surgical fixation required** **Complications** Risk of sciatic nerve injury, vascular damage Often associated with **[posterior] acetabular rim fractures** High risk of avascular necrosis → Want MRI Often **comminution** of Lesser → Want MRI Risk of **delayed healing, malunion** Which of the following types of neck of femur fractures typically occurs at the femoral head/neck junction and is considered an intracapsular fracture? basicervical intertrochanteric **subcapital** transcervical trochanteric **\ ** **Femur** **Feature** **Femoral Shaft Fracture** ------------------- ------------------------------------------------- **Etiology** High-energy trauma (GSW, MVA, fall from height) **Symptoms** Fat embolism → AMS & Petechial Rash **Diagnosis** Honestly Easy... **Complications** Risk of **fat embolism, compartment syndrome** **Knee** +-----------------+-----------------+-----------------+-----------------+ | **Feature** | **Knee | **Patellar | **Tibial | | | Dislocation** | Fracture** | Plateau | | | | | Fracture** | +=================+=================+=================+=================+ | **Etiology** | Direct force, | Direct trauma, | High-energy | | | quadriceps | sudden | axial loading | | | contraction | quadriceps | (fall, MVA) | | | | contraction | | +-----------------+-----------------+-----------------+-----------------+ | **Symptoms** | Obvious | Swelling, | Inability to | | | deformity, | bruising, | bear weight, | | | numbness, | inability to | knee effusion | | | decreased | straighten knee | | | | pulses | | | +-----------------+-----------------+-----------------+-----------------+ | **Diagnosis** | Knee X-ray AP, | X-ray AP, | X-ray AP, | | | lateral, MRI | lateral, | lateral, cross | | | | skyline view | table lateral | | | Look at Patella | | | | | | Patella will | | | | | "fit" together | | | | | w/ NO gaps | | +-----------------+-----------------+-----------------+-----------------+ | **Complications | | Distinguish | | | ** | | from **bipartit | | | | | e | | | | | patella** | | +-----------------+-----------------+-----------------+-----------------+ +-----------------------------------+-----------------------------------+ | | **Tibial/Fibular Fracture** | +===================================+===================================+ | **Etiology** | Falls, MVA, twisting injury | | | (sports) | +-----------------------------------+-----------------------------------+ | **Symptoms** | Inability to walk, limp, numbness | | | in foot, **Tenting** | +-----------------------------------+-----------------------------------+ | **Diagnosis** | X-ray PA & lateral, MRI for | | | stress fractures | +-----------------------------------+-----------------------------------+ | **Types** | Spiral → MC | | | | | | Butterfly Fragment → Comminuted | +-----------------------------------+-----------------------------------+ | **Complications** | Risk of compartment syndrome | +-----------------------------------+-----------------------------------+ **Ankle** **Feature** **Tibial Plafond (Pilon) Fracture** **Maisonneuve Fracture** ------------------- ---------------------------------------- ----------------------------------------------- **Location** Distal Tibia Proximal Fibula **Etiology** High-impact trauma (fall, MVA, skiing) External rotation force on foot **Symptoms** Considerable bruising and blistering +Squeeze test **Diagnosis** X-ray AP, lateral, mortise view Ankle X-ray, tib-fib X-ray, MRI for ligaments **Treatment** ORIF required Surgical fixation required **Complications** Risk of compartment syndrome Risk of peroneal nerve injury **Foot** +-----------------+-----------------+-----------------+-----------------+ | **Feature** | **Lover's | **March | **Jones | | | Fracture** | Fracture** | Fracture** | +=================+=================+=================+=================+ | **Bone** | Calcaneus | 2^nd^ | 5^th^ | | | | Metatarsal (MC) | Metatarsal | +-----------------+-----------------+-----------------+-----------------+ | **Etiology** | Axial loading | Repeated trauma | Plantar flexion | | | (fall from | (ballet, | & ankle | | | height) -- MC | athletes, | inversion | | | Tarsal fx | soldiers) | (athletes) | +-----------------+-----------------+-----------------+-----------------+ | **Symptoms** | Heel pain, | **Midfoot pain, | **Pain at base | | | ecchymosis**, | localized | of 5th | | | skin tenting** | tenderness** | metatarsal** | +-----------------+-----------------+-----------------+-----------------+ | **Diagnosis** | **Calcaneal | X-ray AP, | X-ray AP, | | | Series** -- AP, | lateral, MRI | lateral, | | | Lat, Harris, | | oblique view | | | Oblique | AP -- | | | | | Periosteal | | | | **Lat** - | thickening | | | | **Boehler's | | | | | angle \