Hill Sachs deformity -compression fx of posterolateral humeral head from anterior rim of glenoid -50% of anterior dislocations -may infer damage to cartilagenous and/or osseous portions of the glenoid but does not change mgmt -associated with recurrent dislocations -only requires repair when associated with significant shoulder instability
79yo F s/p fall from standing, c/o hip pain. Name fracture, be specific
Intertrochanteric hip fracture <ul><li>results from falls, generally in elderly </li></ul><ul><li>Most common hip fx </li></ul><ul><li>leg will be shortened, externally rotated (dislocation will be shortened internally rotated) </li></ul><ul><li>Bucks traction </li></ul><ul><li>admit for ORIF/hemiarthroplasty </li></ul>
16yo M w/ Rt elbow pain s/p fall onto right arm. Name the fracture and tell-tale sign seen here.
Answer: Supracondylar fracture w/ Posterior fat pad sign
Supracondylar fracture -make up 60% of fx of elbow -Type I: non displaced (posterior fat pad, sail sign, radiocapitellar line) - splint, ortho f/u Type II: partial displacement but retains cortical contact; III: posteromedial or posterolateral displacement w/o cortical contact -II and III admit for closed reduction, pin fixation, possible ORIF; -Volkmann's contracture: swelling incr’d forearm pressure muscle necrosis, fibrosis, contracture
25yo M w/ hip pain s/p fall from dorm loft. Give fracture and mgmt.
Femoral neck fracture -intracapsular meaning higher risk for vascular compromise due to tearing of vessels or compression by hemarthrosis -admit all for ORIF but need emergent orthopedic consultation if young 2/2 high risk of AVN (w/ older pt they'll just do hemiarthroplasty)
29 y/o M slipped while playing soccer. Name the bony abnormality. Your Text Here
Perilunate dislocation -Results from forceful dorsiflexion (FOOSH) -Midcarpal ligament disruption -With enough force the ligaments are stripped away and the capitate is displaced posterior to the lunate producing posterior dislocation -Lunate maintains contact with the radius -Emergent orthopedic consultation
22yo “profressional skateboarder” w/ wrist pain s/p gnarly ollie. Name the Fx.
Colle’s Fracture -FOOSH distal radius metaphyseal fracture just proximal to radiocarpal joint with dorsal angulation of fracture fragment "dinner fork deformity” -may include fracture of ulnar styloid, disruption of DRUJ - check median nerve on exam -if non-displaced - sugartong w/ palmar flexion/ulnar deviation -if more than moderate angulation/displacement - reduce in ED w/ finger traps - may require OR but can d/c w/ ortho f/u
22yo M w/ Rt hand pain s/p altercation. Lacerations over knucles. Give Fx and mgmt.
Boxer’s fracture -Fracture through neck of 5th metacarpal 2/2 closed fist hitting solid object; -if >40degrees of angulation, should attempt reduction in ED -ulnar gutter splint w/ wrist at 30 degree extension and MCP at 90 -early hand sx f/u -beware the fight bite – ppx antibiotics
25yo F c/o Rt wrist pain s/p drunken fall. Name this injury.
Scaphoid fracture -Scaphoid transmits force from hand to forearm making it most common carpal bone fx (triquetrum=2, lunate=3) -Result from FOOSH or axial load on thumb -TTP over snuffbox - examine with wrist in ulnar deviation, and check for pain w/ axial loading of thumb -negative plain films in 10% - repeat in 2 weeks and splint if high degree of suspicion -non-displaced fx = thumb spica splint and non-emergent ortho referral, if displaced may need ORIF -risk of AVN and non-union if not treated appropriately
20yo snowboarder c/o L wrist pain s/p fall onto clenched fist.
Smith’s fracture -aka "reverse Colle’s = fracture of distal radius with VOLAR angulation of distal fragment "garden spade deformity" -result of fall on flexed wrist -tx same as colles, although volar angulation makes reduction difficult, if angulation not severe/tenting skin, just splint.
55yo M w/ wrist pain s/p fall. Name the injury and tell-tale sign
Scapholunate dissociation -Pt c/o pain on radial side of wrist and clicking sensation -PE - scaphoid shift test w/ radial deviation and examiner pressing over volar aspect of scaphoid -widening of scapholunate joint space >3mm -may also get rotation of scaphoid "signet ring sign” -usually require surgical repair -radial gutter or short arm splint w/ early ortho f/u -complications: early severe degenerative arthritis
Trimalleolar ankle fracture -Fracture involves lateral malleolus, medial malleolus and posterior aspect of distal tibia (posterior malleolus – misnomer) -If there is asymmetry in gap between the talar dome and 2 malleoli on mortise view, the injury is presumed to be unstable -Emergent ortho consult – may d/c w/ early o/p f/u if able to tolerate crutches
27yo M w/ lateral foot pain s/p rolling ankle during basketball game. Name the injury.
Jones Fracture -transverse fx through base of 5th MT 2/2 inversion injury -several definitions: -fx of 5 th MT distal to JCT of metaphysis and diaphysis -10-20mm distal to proximal part of MT -fx distal to distal edge of neighboring cuboid -complicated by nonunion/malunion -conservative mgmt: ortho surgical boot, NWB for 6 weeks
50yo M w/ lateral knee pain s/p jumping off top rung of ladder.
Tibial plateau fracture -MOA: strong varus/valgus force w/ axial loading, ie fall from height -lateral = 55-70% -commonly associated with ligamentous injury -non-displaced fx of one plateau - knee immobilizer, NWB, crutches, f/u ortho w/in a few days, possible o/p MRI -if depressed articular surface - early ortho consult and ORIF;
20yo M w/ lateral foot pain s/p twisting ankle.
Salter-Harris II fracture -SH classication used to classify fractures involving epiphyseal (growth) plate in children -SH II is most common type (75%) w/ good prognosis -fracture involves physis and metaphysis -generally conservative management is appropriate -ORIF is often required for type III and IV
Salter-Harris Classification S – I – Slip A – II – Above L – III – Lower T – IV – Through R – V – Rammed
Lisfranc injury -6 bone tarsometatarsal complex = Lisfranc joint, separates midfoot from forefoot - 20 percent of injuries are missed in ED -Fx of base of 2nd MT is pathognomonic for disruption of Lisfranc ligamentous complex -look for loss of alignment of 2nd through 4th MT w/ associated tarsal bones; -MOA ranges from minor rotational force to high speed MVA -frequently require ORIF -May be complicated by DP damage and severe DJD
Monteggia Fracture -ulnar shaft fracture w/ proximal radial head dislocation -easy to miss radial head dislocation so be sure to image the elbow -be sure to check posterior interosseous nerve (finger/wrist extension) fxn b/c it wraps around proximal radius; -requires ORIF - call ortho
22yo M c/o pain at base of Lt thumb after punching wall
Bennet’s fracture -intraarticular fx at base of thumb -MOA: axial load to flexed/adducted thumb as in punch with closed fist -unstable fx - requires thumb spica and hand sx referral -complications include malunion, severe DJD
Maisonneuve Fracture -proximal fibular fracture assoc w/ rupture of deltoid ligament or fracture of medial malleolus (disruption of tibiofibular syndesmosis) -when you get ankle fracture, especially isolated medial malleolus fx, be sure to examine knee -requires immediate ortho consultation in ED -most require surgical repair of ankle fx/syndesmotic injury but may also be tx'ed conservatively w/ cast immobilization for 6-8 wks
22yo F w/ foot pain s/p jump from 2 nd floor fire.
Calcaneus fracture -MOA:fall from height onto foot -if high degree of suspicion but no obvious cortical disruption, check Boehler angle: <20 suggests depressed fracture -emergent ortho consult - tx varies: orthopods usually use CT to determine plan but most non-displaced fx can be managed conservatively -high incidence of compartment syndrome w/ comminuted fractures -check lumbar spine -
25yo M unrestrained driver w/ wrist pain s/p MVA
Barton’s fracture -Fx of distal radial metaphysis w/ either volar or dorsal angulation (Colles/Smith) and intra-articular involvement and some carpal displacement – high force mech. -minimally displaced fx tx w/ splint and o/p ortho -unstable fx involving 50% of articular surface or associated carpal subluxation require ORIF - talk to ortho prior to d/c
32yo M tree cutter, new onset quad s/p tree branch to head.
Jefferson fracture -fracture of C1 resulting from significant axial load to top of the head -4 part fracture involving both anterior and posterior arches -associated SCI common -treatment depends on integrity of transverse ligament intact ligament: tx w/ hard collar; disrupted ligament halo or surgery
Lunate dislocation -similar to perilunate dislocation radiographically -triangular shape of lunate on AP view = "piece of pie" sign, lateral view shows lunate displaced volarly from radius = "spilled teacup" sign -unstable emergent ortho consultation, most require OR -complications = early DJD, malunion/nonunion, AVN, median nerve compression
45yo M high speed MVA w/ low back pain, ankle pain