DI II - Extremity Trauma TQs - MJ

What kind of trauma results in transverse fractures?

Angulation and tension

What kind of trauma results in a spiral fracture?

Rotation

What kind of fracture runs at a right angle to the long axis?

What fracture runs 45 degrees to long axis?

Right angle - transverse

45 degrees - oblique

What term describes the ANGULATION of the distal fragment at the fracture site?

Alignment

What term describes the CLOSENESS of the bony contact at the fracture site?

Apposition

How is alignment and apposition described

Displacement/position of the distal fragment relative to proximal fragment.

When can you see the first visualization of a callus?

14 days

What are complications of fracture healing?

Non-union

Delayed union

Arrest/stimulation of growth

What type of Salter fx involves wide growth plate and ST swelling?

Type I

What type of Salter fx goes through the physis and metaphysis?

Type II

What type of Salter fx is MC?

Type II

What is the sign associated with Salter Type II?

‘Thurston-Holland’ sign → metaphyseal fragment

What type of Salter fx goes through the physis and epiphysis?

Type III

What type of Salter fx involves the physis, metaphysis, and epiphysis?

Type IV

What type of AC joint injury involves slight widening between acromion and clavicle with NO elevation?

Type I

What type of AC injury involves a completely torn AC ligament but an intact coracoclavicular ligament?

Type II

What is the normal width of the AC joint?

>5 mm

What is the normal distance between the coracoid and clavicle?

11-13 mm

Where in the clavicle is a fx MC?

Middle 1/3

What is the MC fx during birth?

Clavicle fx

What deformity can occur after a transverse mid-clavicle fx?

Overriding/Bayonet deformity

In what direction is a shoulder dislocation MC?

Anterior direction

What type of anterior shoulder dislocation is MC?

Anterior subcoracoid dislocation

What are the 3 associated findings with a GH dislocation?

Bankart Lesion → fx thru anterior-inferior labrum

Hill-Sachs Defect (hatchet deformity) → impaction fx of humeral head & glenoid fossa

What sign is associated with posterior shoulder dislocations?

Rim sign - widening of joint space >6 mm

What rotator cuff muscle is MC damaged?

Supraspinatus

Where are the RC muscles MC damaged?

Critical zone → decreased vascular supply

What is the gold standard for RC muscle injury diagnosis?

MRI imaging

How do RC injuries appear on MRI?

Damage → hyperintense (white) on T1

Note: normally dark when healthy in MRI

What is the MC elbow fx in kids?

Supracondylar

What is the MC elbow fx in adults?

Radial head/neck

What line do you look at to find radial dislocations?

Radio-capetellar line

When looking at the radio-capetellar line or anterior humeral line, where should the line intersect in the capitulum?

Middle 1/3

What line is most important in the elbow in kids?

Anterior humeral line

What kind of fracture is indicated with an anterior humeral line that doesn’t intersect in the middle 1/3 of the capitulum?

Supracondylar (FOOSH mechanism MC)

What is another name for a radial head fracture?

Chisel fracture

What is the order of the ossification centers in the elbow?

CRITOE!

Capitellum

Radial head

Internal/medial epicondyle

Trochlea

Olecranon

External/lateral epicondyle

What direction of elbow dislocation is MC?

Posterior/posterolateral

What bone is MC fxed in a nightstick/parry injury?

Ulna

What is the name for a fx of ulna and anterior dislocation of radius at proximal radio-ulnar articulation?

Monteggia fx

What is the name for a fracture of distal radius with slight dislocation at distal radio-ulnar articulation?

Galeazzi fx

What is the MC forearm fx in kids age 6-10?

Torus/buckle fx

What bone is often involved in a torus/buckle fx?

Radius - posterior surface

What angle of radius tilt is normal?

10-15 anterior tilt

In what direction is a Colles fracture?

Posterior/dorsal displacement

What deformity is commonly associated with a Colles fx?

Dinner fork deformity

In what direction is a Smith’s fracture?

Volar/palmar/anterior angulation of distal fragment

What is the name for a fx of the posterior rim of the radius with carpal dislocation?

Barton’s fracture

What is the name for a fracture of the radial styloid?

Hutchinson’s fracture

What carpal is MC fractured?

Scaphoid

Where is the MC site for an occult fx?

Scaphoid (broke but you cannot see it)

What complication is often associated with a fx of the proximal pole of the scaphoid?

Avascular necrosis

Where on the scaphoid is a fx MC?

Waist

remember to name location of fx on test!

What is the procedure for a suspected occult scaphoid fx?

1. Immobilize

2. Repeat films 7-10 days post-injury

What carpal is the 2nd MC fxed?

Triquetral

What sign is associated with a triquetral fx?

Note: this is best seen on lateral wrist view!

Pooping duck sign

What carpal is 3rd MC fxed?

Hamate

What is the MC carpal dislocation?

Posterior perilunate dislocation

What sign is associatEd with a lunate dislocation on the PA view?

Pie sign

What sign is associated with a rotatory subluxation of the scaphoid?

Terry Thomas Sign → 4 mm gap

Foreshortened appearnace

Signet ring sign

What diagnosis demonstrates the Terry Thomas or Signet Ring sign?

Scaphoid rotatory subluxation

What is a boxer’s fx?

Fx of the neck of 5th or 4ht metacarpal

What is the difference between a Bennett’s or Rolando’s fracture?

Bennett’s → oblique fx of base of 1st metacarpal with dorsal subluxation

Rolando’s → comminuted fx of base of 1st metacarpal with radial displacement

What is a Bennett’s fx?

Intra-articular oblique fx of 1st metacarpal base

Dorsal subluxation

What is the name for a partial/complete disruption of the UCL of 1st MCP articulation?

Gamekeeper’s Thumb

AKA Skier’s Thumb

What direction is the hand MC dislocated?

Dorsal

In what direction is the hip MC dislocated?

Posterior

What fx is frequent with a posterior hip dislocation?

Posterior acetabular rim fracture

In what dislocation is the leg superior to the acetabulum?

Posterior hip dislocation

What exam is needed with a (posterior) hip dislocation?

CT exam

What is the dislocation called when the femur head goes inferior and medial?

Anterior hip dislocation

What hip fx is MC associated with AVN?

Intracapsular

What intracapsular hip fx is MC?

Subcapital

Remember to name location of hip fx!

Where is a tension fx located in the hip?

Outside side of femoral neck

Note: high risk of complicated healing!

What kind of stress fracture involves abnormal stress/torque to a bone with normal elastic resistance?

Fatigue fx

What kind of stress fracture involves normal stress placed on a bone with deficient elastic resistance?

Insufficiency fx

What kind of stress fx is suspected in the following case:

17 year old, pain from running

Fatigue fracture

What kind of stress fx is suspected in the following case:

85 year old, pain from walking in mall

Insufficiency fracture

What is the MC form of a femoral shaft fx?

Transverse fx of mid-shaft

What sign is seen in a knee and indicates a fx even if one is NOT seen?

FBI → fat-blood interface sign

What does density in Hoffa’s fat pad indicate?

Joint effusion

How large should the suprapatellar bursa be?

No more than 5 mm

On what film is the FBI sign seen?

Cross table lateral x-ray

If the line between lateral femoral condyle and medial cortex of proximal figular shaft is >5 mm, what is indicated?

Split/depression fx of proximal tibia

What is the MC fx of patella?

Transverse

What diagnosis is associated with bowing of the PC and “kissing contusions'“ of the LFC and lateral tibial plateau?

ACL tear

What is the name for tears of the ACL, MCL, and medial meniscus?

Unhappy Triad

What accompanies a meniscal tear?

Articular disruption

What kind of fx is MC in distal 1/3 of lower leg?

Delayed or non-union

What kind of fx is common in proximal 1/3 of lower leg?

Stress fx

What is the name for a fragment arising from lateral margin of lateral tibial plateau?

Segond’s fx

What is a Segond’s fx associated with?

ACL tears

What are the 3 parts of the ring of the ankle joint?

Tibia, fibula, talus

How many breaks in the ankle ring make a stable fx?

Unstable?

Single break → stable

2 breaks → unstable

What is the MOI for a fx of the medial malleolus?

Eversion

What is the MOI for a fx of the lateral malleolus?

Inversion

What is the name for a transverse fx of medial malleolus and widening of the tibiofibular syndesmosis and oblique fx of proximal fibula?

Maisonneuve Fracture

What is the MOI for a Maisonneuve fx?

Eversion

What are the radiographic features of an ankle stress view?

>16° of talar dome angulation

Asymmetrical lateral mortise spacing

>3 mm anterior translation on anterior draw stress

What is the MC fractured tarsal bone?

Calcaneus