E1 Ortho- Fx, Casting, Splinting

What is the hard layer of bone?

Cortex

What is the softer inner layer of bone?

Cancellous bone

What is the inner lining of the cancellous bone?

Endosteum

What is the thick layer of bone that covers cortex and contains vessels, nerve endings, cells for fracture repair?

Periosteum

What part of the bone provides bony growth?

Physis

What part of the bone that consists of spongy cancellous bone, where fractures most commonly occur?

Metaphysis

What is the thick cortical bone that provides structure?

Diaphysis

What is the most distal end of a long bone?

Epiphysis

How many views should you order on an Xray?

2 views, 90 degrees to each other (AP & lateral)

*can add 3rd (oblique)

Which fracture?

comminuted

Which fracture?

transverse, undisplaced

Which fracture?

oblique, undisplaced

Which fracture?

spiral

Which fracture?

segmental

What type of Salter Harris fracture is the following:

Fx through the Physis plate

Type I

What type of Salter Harris fracture is the following:

fx of Physis plate w/ Metaphysis fragment

*MC

Type II

What type of Salter Harris fracture is the following:

Fx through Physis w/ Epiphysis fragment

Type III

What type of Salter Harris fracture is the following:

Fx through distal Metaphysis, Physis & Epiphysis

Type IV

What type of Salter Harris fracture is the following:

Crush or impaction of the Physis plate

Type V

What fractures are MC missed?

scaphoid, talar neck, radial head, tibial plateau

Which nerve injury is associated with/ closed fx, dislocation, or blunt trauma?

Contusion (neuropraxic) & crush (axonotmesis)

What type of nerve injury is associated with/ open fx?

Transection (neurotmesis)

If a patient has a wrist drop, this would indicate injury to what nerve? What fracture could be related?

Radial nerve injury- Spiral fracture of humerus

If a patient has a foot drop, this would indicate injury to what nerve? What fracture could be related?

Peroneal nerve injury- Tibial plateau fracture

How long does it take for a Type1 nerve injury to recover?

2-3 months, except knee

How long does it take for a Type 2 nerve injury to recover?

1-2 cm per month (95% recover by 6 mo, may take 12 months)

What fx MUST go to an orthopedic surgeon?

any open fx, displaced intraarticular fx, all femur fx, fx of both bones in lower leg

What factors delay bone healing?

smoking, elderly, DM, malnutrition

What is the benefit of a closed reduction?

less risk of infxn

How is an epiphyseal fx fixed in a closed reduction?

distal fx “pushed” back into place

How is a transverse fx fixed during a closed reduction?

reduced by simple traction

How is an oblique “toggle” type fx fixed during a closed reduction?

more complex manipulation

What age range should a rotational deformity be completely corrected at?

should ALWAYS be fully corrected

When should angular deformities be completely corrected in adults?

always

When do angular deformities in children not need correction?

when they are close to a joint & in the same plane of motion (will correct itself)

What is the advantage of a plaster cast?

easier to apply; warmer the water the faster it sets

What is the advantage of a fiberglass cast?

lighter weight, waterproof is an option

What are signs a pt is developing compartment syndrome?

paresthesia, sensory loss, tenseness, pain on stretching the muscle in that compartment

What are complications to watch for after casting a pt?

compartment syndrome, Volkmann’s ischemic contracture, tissue necrosis

How long does PT typically last?

4-6 weeks

How long does a fx take to heal?

6-12 weeks

Guidelines for splinting/casting an arm:

should not extend beyond the distal palmar

MCP should be able to flex

pt should be able to fan their fingers

elbow casts should = 90 degrees

Guidelines when splinting/casting a leg:

foot/ankle at 90 degrees

always extend under metatarsals heads

toes MUST be exposed

50% overlap each turn → do a figure 8

What are the most common fractures seen with child abuse?

Long bone fracture: Shaft (eg. humerus)

What fxs might suggest child abuse?

long bone fx -especially displaced, rib fx, vertebral body compression fx, multiple different fxs at other sites/stages of healing

What are S&S of senior abuse?

hand fxs, unset broken bones, repeat fall injuries