T&O - Fractures Of The Distal Radius and Shoulder Dislocations Flashcards Preview

Year 3- Surgery > T&O - Fractures Of The Distal Radius and Shoulder Dislocations > Flashcards

Flashcards in T&O - Fractures Of The Distal Radius and Shoulder Dislocations Deck (21)
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1
Q

What is a Colles fracture?

A

• Colles: extra-articular fracture of distal radius (within an inch and half of joint) with dorsal displacement and radial shift of distal fragment + in rotational injuries, ulna styloid may also get pulled off by its attachment to the triangular fibrocartilagenous disc (MOI = FOOSH)

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2
Q

Colles fracture: Mx and Rx

A

◦ Assess neurovascular function: median nerve and radial artery lie very close to radius
◦ If displaced: correct deformity (manipulation) under either local (haematoma block), regional (Bier’s block) or GA
◦ Colles plaster: elbow to metarcaropophalangeal joints + thumb metacarpal

3
Q

Colles fracture: complications

A

malunion, median nerve problems, stiff/frozen shoulder, tendon rupture, Sudek’s atrophy, carpal tunnel syndrome

4
Q

What is a Smith’s Fracture?

A
  • Increased volar tilt (>11 degrees) of distal fragments
  • Fracture of distal radius with volar displacement and angulation of distal fragment

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5
Q

What is a Barton fracture?

A
  • Fracture dislocation where distal radial fracture is oblique and extends into wrist joint (intra articular fracture)
  • Can get either volar or dorsal Barton

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6
Q

Which distal radius fracture require operative intervention?

A
  • Intra-articular
  • Volar fragments (smith’s)
  • Dorsal fragments with inadequate reduction of comminution
7
Q

What three radiological features to you look for when interpreting wrist fractures?

A

Features of adequate reduction: 11mm radial height, 22 degrees radial inclination and 11 degrees of volar tilt

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8
Q

Scaphoid fractures: clinical features

A

FOOSH, Pain in anatomical snuffbox, pain on telescoping thumb.

9
Q

Scaphoid fractures: specific Mx

A
  • If clinical Hx and exam suggest scaphoid fracture, treat as such even if X-ray is normal
  • Place wrist is scaphoid plaster (beer glass position)
  • If initial X-ray is -ve, return pt in 10 days for re X-ray
  • Must be in plaster for 6 weeks, if mal-united, can do further 6 weeks or ORIF (single screw) + bone graft
10
Q

What are the borders (in anatomical position) and contents of the anatomical snuffbox

A
  • Medial border: extensor pollicis Longus
  • Lateral border: extensor pollicis brevis and abductor pollicis Longus
  • Contents: superficial branch of radial nerve and radial artery

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11
Q

Scaphoid fractures: specific complications

A

-AVN: blood supply enters bone distally - proximal fragments at risk of AVN (esp if displaced fracture) - pt has pain and wrist stiffness

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12
Q

Supracondylar fractures of the humerus: presentation

A

◦ Most common in children, esp after FOOSH - elbow swollen and semi flexed in position
◦ Distal fragment: usually displaces backwards + proximal numeral edge may compress the brachial artery or median nerve.

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13
Q

Supracondylar fracture: what is key in Mx?

A

Check for neurovascular damage (check radial pulse and median nerve territory)
-Ulnar nerve and radial can also be damaged if the fragments displace weirdly

14
Q

Supracondylar fracture: Rx for displaced and undisplaced

A

◦ Undisplaced: collar and cuff (with very flexed arm) or back slab - 3 week immobilisation
◦ Displaced: needs manipulation under GA (MUA- manipulation under anaesthesia) +position held in place by K wires + Collar and cuff or back slab applied with arm fully flexed

15
Q

Supracondylar fracture: risks associated with the injury

A

◦ compartment syndrome (check for pain on passive extension), angular deformities
◦ Neurovascular injury: brachial artery, radial nerve, median nerve (esp anterior interosseus branch- which supplies FPL, lat half of FDP and pronator quadratus)
◦ Gun stock deformity: valgus, varus and rotational deformities in the coronal place that do not remodel and lead to cubital varus

16
Q

Shoulder dislocation: why does it dislocate? What are the muscles of the rotator cuff? Which dislocations are most common?

A
  • Most mobile of all joints
  • Rotator cuff muscles: supraspinatus, infraspinatus, teres minor and subscapularis
  • 95% are anterior dislocations: direct trauma, falling on hand where humerus is driven forward teaching capsule of joint.
17
Q

Shoulder dislocation: general presentation

A

◦ Shoulder contour lost - appears square
◦ Bulge in infraclavicular fossa: humeral head
◦ Arm supported in opposite hand
◦ Severe pain

18
Q

Shoulder dislocation - specific Mx

A

◦ Check for neurovascular deficit: axillary nerve - regimental badge area
◦ Do AP and trans-scapular view to see direction of humeral head

19
Q

Shoulder dislocation: Rx

A
  • Reduce and rest in sling for 3-4 weeks, then rehabilitate with physio
  • Avoid abduction and external rotation (eg throwing baseball)
20
Q

Which is which?

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A

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21
Q

What is the aetiology of posterior dislocation?

A

Caused by direct trauma, epilepsy and electrocution: will show light bulb sign b/c greater tuberosity isn’t seen - must be reduced by specialist

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