1
Q
What do we see with scapular fractures?
A
- Requires severe trauma
- Radiographs will typically demonstrate other fractures/injuries
2
Q
___% of fractures are seen involving the scapular body and neck
A
80%
Other locations:
- Coracoid
- Acromion
3
Q
Describe a Bankart lesion (Glenoid Rim)
A
- Impaction fracture from an anterior glenohumeral dislocation
- Avulsion fracture from Triceps tendon
4
Q
What is a Bankart fracture?
A
Fracture including the anterior inferior glenoid rim
- May be osseous, soft tissue or both
5
Q
What is a Bankart fracture seen with?
A
Seen with an anterior-inferior glenoid dislocation
6
Q
What is the treatment for a Bankart fracture?
A
- Typically heal without severe complications
- Labral fragment can be sutured back to the glenoid rim
7
Q
What condition can show a Bankart fracture?
A
Can be seen with a Hill-Sachs defect
8
Q
Where is a Hill-Sachs defect commonly found?
A
On the humerus
9
Q
What is the MOI of a Bankart fracture?
A
FOOSH (Fall On Outstretched Hand)
10
Q
Describe a Hill-Sach deformity
A
- Seen with an anterior-inferior shoulder dislocation
- Compression/impaction fracture involves the posterior-lateral aspect of the humeral head on the inferior glenoid rim
11
Q
What imaging should you use for a Hill-Sach deformity?
A
- Best seen on an internal rotation view
- May require MR arthrogram to assess the rotator cuff and labrum
12
Q
How do you manage a Hill-Sach deformity?
A
Deformity will persist for life
- Must consider if the injury is acute or chronic
- Consider injury to the rotator cuff tendons
13
Q
Describe a Flap fracture
A
Greater tuberosity fracture due to avulsion from the supraspinatus tendon
14
Q
What is the MOI of a Flap fracture?
A
Commonly seen following an anterior shoulder dislocation
15
Q
What is the most common Glenohumeral dislocation?
A
Anterior (95%)
16
Q
What is the most common location that the humerus may be found with anterior shoulder dislocations?
A
Subcoracoid
17
Q
What injuries are associated with an anterior shoulder dislocation?
A
Hill-Sach fracture (60%)
Flap fracture (15%)
Bankart lesion
18
Q
Posterior Glenohumeral dislocation: Common or Uncommon?
A
Uncommon
19
Q
What signs and symptoms is a Posterior Glenohumeral dislocation associated with?
A
- Seizures
- Electric shock
- Trauma
20
Q
What injuries is a Posterior Glenohumeral dislocation associated with?
A
- Reverse Hill-Sach deformity
- Reverse Bankart lesion
21
Q
Describe a Proximal Metaphyseal fracture
A
Fracture through the surgical neck of the humerus
22
Q
What do we see radiographically with a Proximal Metaphyseal fracture?
A
Cortical disruption between the anatomical and surgical necks of the humerus
23
Q
What may be damaged with a Proximal Metaphyseal fracture?
A
Axillary nerve may be damaged
24
Q
What is the MOI of a Proximal Metaphyseal fracture?
A
FOOSH (Fall On Outstretched Hand)
25
What is the MOI of a Mid-diaphyseal Humeral fracture?
- Direct blunt force trauma
- Indirect trauma from a fall or twisting action
26
What do we see radiographically with a Mid-diaphyseal Humeral fracture?
Cortical disruption in the middle of the diaphysis of the humerus
27
What may be damaged with a Mid-diaphyseal Humeral fracture?
Radial nerve may be damaged
28
What is the most common elbow fracture in the pediatric patient?
Supracondylar fracture
29
What is the MOI of a Supracondylar fracture?
FOOSH injury with elbow hyperextended
30
What do we see radiographically with a Supracondylar fracture?
Abnormal location of the capitellum in relation to the anterior humeral line and the radio capitellar line
31
What are two important lines used when assessing a Supracondylar fracture?
- Anterior Humeral Line
- Radiocapitellar Line
32
What sign do we see in a Supracondylar fracture?
SAIL Sign
33
Medial Epicondyle fracture: More common in boys or girls?
80% of these avulsion fractures occur in boys
34
What is a Medial Epicondyle fracture associated with?
50% are associated with elbow dislocations
35
What nerve is damaged in a Medial Epicondyle fracture?
Ulnar nerve damage
36
What is the MOI of a Lateral Epicondyle fracture?
Hyperextension injury with extreme valgus stress
37
What do we see radiographically with a Lateral Epicondyle fracture?
Cortical disruption between the lateral epicondyle and the lateral supracondylar ridge
38
What may be associated with a Lateral Epicondyle fracture?
Dislocation or fracture of the radius
39
Head of the radius fracture AKA
Chisel fracture
40
What is the most common elbow fracture in an adult?
Head of the radius (Chisel) fracture
41
Chisel fracture: More common in women or men?
More common in women
- Ages 30-40 years old
42
What is the MOI of a Chisel fracture?
FOOSH
43
What is the MOI of a neck of radius fracture?
FOOSH
44
What do we see radiographically in a neck of radius fracture?
Cortical disruption through the neck of the radius
- Transverse break
45
What is the most frequently dislocated joint in children?
Elbow
46
What is the MOI of an elbow dislocation?
FOOSH with elbow partially flexed
47
Elbow dislocation: Posterior or Anterior more common?
Posterior dislocation most common
48
What do we see radiographically with an elbow dislocation?
Separation of the distal humerus from the proximal ends of the radius and ulna
49
What are some complications seen with elbow dislocations?
- Ulnar nerve injury
- Coronoid process fx.
50
What are the MOIs of an Olecranon fracture?
- Direct trauma in children
- Indirect trauma due to pull of triceps in the elderly
51
What do we see radiographically with an Olecranon fracture?
Cortical disruption through the olecranon
52
What signs will be present with an Olecranon fracture?
- Anterior sail sign
- Posterior fat pad sign
53
What type of fracture is a Coronoid fracture?
Avulsion fracture
54
What is the MOI of a Coronoid fracture?
Excessive pull from the brachialis muscle
55
What do we see radiographically with a Coronoid fracture?
Impaction of the coronoid process into the trochlea fossa of the humerus (posterior elbow dislocation)
56
Describe a Monteggia Ulnar fracture/dislocation
- Proximal radioulnar dislocation
- Proximal ulnar fracture
(need both for true Monteggia ulnar fracture)
57
What is the MOI of a Monteggia Ulnar fracture/dislocation?
FOOSH
58
What do we see radiographically with a Monteggia Ulnar fracture/dislocation?
Cortical disruption through the proximal diaphysis of the ulna
59
Describe a Galeazzi fracture/dislocation
- Distal radial diaphyseal fracture
- Dislocation of the distal radioulnar joint
60
What is the MOI of a Galeazzi fracture/dislocation?
FOOSH
61
What do we see radiographically with a Galeazzi fracture/dislocation?
Positive ulnar variance
62
What are the MOIs of a Nightstick fracture?
- Direct blow to the ulnar
- Forearm often held in defensive position at time of injury
63
What do we see radiographically with a Nightstick fracture?
Cortical disruption through the ulnar diaphysis
64
Describe a Colles fracture
Break through the distal end of the radius
65
What is the MOI of a Colles fracture?
FOOSH
66
What do we see radiographically with a Colles fracture?
Posterior displacement of the distal radial fragment
67
What population has increased risk of Colles fracture?
Older white women with osteoporosis
68
What type of deformity do we see with a Colles fracture?
Dinner fork deformity
69
Describe a Smith fracture
Break in the distal radius with anterior displacement of the distal radial fragment
70
What are common MOIs of a Smith fracture?
- FOOSH with wrist in flexion
- Direct blow to the back of wrist
71
What type of deformity do we see with a Smith fracture?
Garden spade deformity
72
Describe a Barton's (Rim) Fracture
- Intra-articular fracture of the posterior (dorsal) margin of the distal radius
- Proximal displacement of the distal fragment
73
What is the MOI of a Barton's (Rim) fracture?
FOOSH
74
Describe a Reverse Barton's fracture
- Intra-articular fracture of the anterior (volar) margin of the distal radius
- Anterior displacement of the distal fragment
75
What is the MOI of a Reverse Barton's fracture?
FOOSH with wrist in flexion
76
Chauffeur fracture AKA
Hutchinson's or Backfire fracture
77
Describe a Chauffer fracture
Oblique break in the styloid process of the radius
78
What is the MOI of a Chauffeur fracture?
Direct blunt force trauma
79
Describe a Scaphoid fracture
Break through the waist (most common) or poles of the scaphoid bone
80
What is the MOI of a Scaphoid fracture?
FOOSH
81
What is a possible complication of a Scaphoid fracture?
Possible disruption of the blood supply in some proximal pole fractures
82
Scaphoid fracture: In ___% of people, the proximal pole is supplied by a branch from the distal half
11%
83
Describe SNAC?
Scaphoid Non-Union Advanced Collapse
- Capitate migrates proximal via the scaphoid fx. site
84
What is the MOI of a Lunate dislocation?
Hyperextension injury
85
What sign do we see with a Lunate dislocation?
Pie Sign
86
Perilunate dislocation: common or rare?
Extremely rare
87
Perilunate dislocation: lunate bone displaced or not?
Lunate bone is not displaced
88
What is the MOI for a Perilunate dislocation?
FOOSH with hyperextended hand
89
Describe a Scapholunate disassociation
Severe instability of the wrist due to disruption of the scapholunate ligament
90
What sign do we see in Scapholunate disassociation?
Terry Thomas Sign
- widening greater than 4 mm
91
What complications are seen with a Scapholunate disassociation?
Scapholunate Advanced Collapse (SLAC) Wrist
- Proximal migration of the capitate due to the widening of the scapholunate joint
92
Bennet fracture/dislocation: Rare of Common
Extremely rare
93
Describe a Bennet fracture/dislocation
Intra-articular break of the base of the first metacarpal bone with a subluxation of the first carpo-metacarpal joint
94
What is the MOI of a Bennet fracture/dislocation?
Axial loading (bearing weight) on a partially flexed 1st metacarpal bone with forced abduction
95
Describe a Rolando fracture
Comminuted intra-articular fracture through the base of the first metacarpal bone
96
What is the MOI of a Rolando fracture?
- Fall on the radial side of the thumb
- Punching a wall with a closed first with the thumb tucked inside the palm
97
What do we see radiographically with a Rolando fracture?
T-shaped or Y-shaped fracture with more than 3 fragments
98
Worse Prognosis: Bennet or Rolando fracture?
Rolando fracture
99
Describe a Boxer fracture
Break just below the head of the second (or 3rd) metacarpal
100
What is the MOI of a Boxer fracture?
- Punching with the fist
- Axial loading
101
Describe a Bar room fracture
Break just below the head of the fifth (or 4th) metacarpal
102
What is the MOI of a Bar room fracture?
- Punching with the fist
- Oblique or glancing force
103
Mallet finger AKA
Baseball finger
104
What is the MOI of a Mallet finger?
Axial loading causing hyperflexion of the distal interphalangeal joint
105
What is a Mallet finger associated with?
Rupture of one of the extensor digitorum tendons
106
Describe a Chip fracture
Forced flexion involving the attachment of one of the tendons of extensor digitorum
107
What is the MOI of a Chip fracture?
Hyperflexion of the distal interphalangeal joint
108
What can a Chip fracture result in?
Avulsion fracture
109
Gamekeeper fracture AKA
Skier's thumb
110
Describe a Gamekeeper fracture
Avulsed bone is attached to the ulnar collateral ligament
111
What is the MOI of a Gamekeeper fracture?
FOOSH, abducted hyperextended thumb against a ski pole
112
What kind of fracture is a Gamekeeper fracture?
Avulsion fracture
