670 Upper and lower ext. trauma

B in BOLTS

breaks in cortical surface

O in BOLTS

opacities

L in BOLTS

lucencies

T in BOLTS

trabeculae disruption

S in BOLTS

soft tissue abnormality

displacement is described in terms of

distal fragment at fracture site

angle is described in terms of

distal fragment at most distal end

soft tissue signs

soft tissue emphysema, fat pads, fat-fluid levels

When to look for fat fluid levels

cross table lateral knees

soft tissue emphysema

air in soft tissue

sail sign

anterior fat pad of the elbow visible

why are fat pads visible in fx elbows

blood pushes the fat pads out

hemoarthrosis

blood in the joint from fracture or dislocation

subluxation

partial loss of normal joint alignment, bones remain partially intact

bones can _____ and joints cannot

displace

joints can ____ and bones cannot

dislocate

diastasis

abnormal widening of a fibrous joint

name the pediatric fractures

greenstick, buckle, bowing, torus, salter harris

what type of fracture affects the physis only

Salter Harris 1

what type of fracture affects the ohysis and metaphysis

salter harris 2

what type of fracture affects the physis and epiphysis

salter harris 3

What type of fracture affects the physis, metaphysis, and epiphysis

salter harris 4

What type of fracture crushes the physis

salter harris 5

Step one of fracture healing

hematoma → granulation of tissue

step two of fracture healing

soft callus

What happens in the granulation of tissue phase of a fracture?

fibroblast and new vessels form

step three of the fracture healing process is

hard callus

whats step 4 of a healing fracture

remodeling and replacing

the remodeling phase takes

months to years

factors that delay healing

poor blood supply, infection, motion/overuse, age, smoking

non-union

fracture doesn’t heal

mal-union

The fracture heals, but not within clinical alignment standards

Fx of the distal 2.5 inches of the radius with dorsal displacement or angulation (often accompanied by ulnar styloid fx)

Colles

Fx of the distal 2.5 inches of the radius with anterior displacement or angulation

smith AKA reverse colles

Fracture of the distal radius with radioulnar joint disruption

Galezzi

important note for Galezzi fx

do the radius and ulna remain aligned?

Fx of the proximal ulna with radiocapitellar dislocation

Monteggia

oblique intra-articular fx at the base of the thumb metacarpal and extends to trapezium joint

Bennet

Oblique intraarticular comminuted fx at the base of the thumb metacarpal and extends to trapezium joint

Rolando

fx of the distal end of the 5th metacarpal (typically transverse and angulated anteriorly)

Boxers

injury to the ulnar side of the thumb MCP involving ulnar collateral ligament

Game keepers

injury of the anteroinferior portion of the glenoid labrum

Bankart

usual cause of bankart injurues

anteroinferior glenohumeral dislocation

fx of the superiolateral portion of the humeral head

Hills-sachs

common cause of hills-sachs injuris

humeral head impacted on anteroinferior portion of glenoid

complication of bankart

predisposes to frequent injury

injury at tarsometatarsal junction of midfoot (can be fx of metatarsal bases, adjacent cunieforms, and cuboids, can be multiple joint disruption of MTs)

Lisfranc

Transverse fx of the 5th MT base

Jones

Transverse intra-articular fx of the 5th MT base

dancer

ankle injury with proximal fibula fracture

Maisonneuve

common causes of Colles, Smith, scaphoid, and carpal fractures

FOOSH

Ring Trauma

rings of bone will always have a second injury site

common places for ring of bone injuries

pelvis, tib fib, radius ulna

often creates comminuted, displaced, severly angled, open fractures

direct blow injuries

common causes of spiral and oblique fractures

twisting or rotational forces

insufficient injuries

fracture of weakened bone

stress fractures

injuries of normal bone due to abnormal repetitive stress

FOOSH on the extended wrist (palm of hand hts the ground)

Colles

FOOSH on flexed wrist (back of hand hits ground)

Smith

common causes of direct blow injuries

MVA, fall from height, sports collision

lower extremity axial loading injuries

calcaneus and tibial plateau

Dashboard injury aka

posterior force on flexed knee (MVC)

common dashboard injuries

posterior hip dislocation, acetabulum and femoral head fx

associated complication of pelvis injuries

bladder/urethra injurymajor vascular injury, pelvic hematoma

Ankle Inversion

foot turns medially putting pressure on lateral ankle

Ankle inversion common injuries

lateral malleolus and other lateral structure fx

Ankle Eversion

foot turned laterally putting pressure on medial ankle

Ankle Eversion injuries

medial malleolus fx, fibular fracture