MSK ER
Anterior/Posterior Shoulder Dislocation Anterior: fall on an outstretched hand (sports or elder) Posterior: Muscle spasm/contraction (seizure, electricity) Sx: Shoulder pain, unable to move shoulder Anterior: external rotation Posterior: internal rotation Caution: axillary nerve injury (anterior) Dx: Hill sachs lesion (anterior) dent humoral head Bankart lesion (Anterior): glenoid labrum injury Light bulb sign: (posterior) need y view | Acromioclavicular Separation Type I: AC ligament sprained, CC lig & AC J intact Type II: AC lig torn, CC lig sprained, AC J subluxed Type III: AC & CC lig torn, AC J completely dislocated Type IV: clavicle posteriorly displaced Type V: clavicle superiorly displaced Type VI: clavicle inferiorly displaced | Humeral Fractures Location: Proximal (MC), shaft, Supracondylar --Proximal: axillary a/n (deltoid, paresthesia) injury --Shaft: Radial nerve injury (wrist drop) --Supracondylar: MC pediatric Medial Nerve Injury: hand of benediction Brachial Artery Injury: Claw like deformity | clavicle fractures About: MC birth trauma Grade: 1) midshaft 2) lateral 3) medial Sx: Swelling, deformity clavicle, tenting skin Caution: May involve supraspinatus tear
Tx: Grade 1 + Grade 3: sling Grade 2: refer to ortho | ||||
Subluxation Radial Head (nursemaid’s elbow) About: head slip out of annular ligament Sx: slight flexion of elbow and pronate, avoid moving Tx: closed manual reduction (supination flexion) | Colle’s Fracture About: distal radial fx by landing on palm Dx: Xray: radius fx angulated posterior Caution: EPL tendon rupture Smith Fractures About: distal radial fx landing back hand Dx: Xray: volar (anterior) angulation Caution: Median nerve injury Tx: Sugar tong splint or cast, ORIF: >20degree | Radial Fracture Radial head: MC, px w/ rotation + can’t fully extend Sling, Long arm splint, ORIF: 60 < Elbow dislocation: posterior MC | Fracture and Dislocation 1) Monteggia: --proximal ulnar shaft fx + radial head dislocation --Caution: radial nerve injury --Tx: ORIF 2) Galeazzi: --Distal radial shaft fx + distal radioulnar dislocation --Tx: double sugar tong splint
| Scaphoid (Navicular) fracture About: MC carpal bone fx Caution: AVN + Scaphoid compression test + Anatomical snuffbox tenderness Tx: Thumb spica | ORIF: >1mm | |||
Ulnar Collateral Ligament (UCL) Gamekeepers thumb --Chronic hyperabduction injury --Sx: spain/welling base thumb over styloid --PE: worse w/ extension and gripping --Dx: Finkelstein test Skiers Thumb --acute --Sx: laxity/pain w/ valgus stress --PE: (weak pinch grasp) --Xray --Tx: thumb spica, Nsaid, CSI PT ortho | mallet finger About: Finger tip: avulsion extensor digit tendon Sx: unable to extend DIP Tx: splint, surgical fixation
Boutonniere deformity About: Jammed finger Dx: elson test Tx: pip splint (hand surgeon) | metacarpal fractures (Boxer’s) 1) boxer Fracture --about Fracture 5th neck --Tx: ulnar gutter splint 60 degree flex 2) intraarticular metacarpal fracture ---A: bennett’s fracture/dislocation (one part fracture) ---B: Rolando fracture (3 part fracture) ---Dx: Robert view ---Thumb spica if unstable ORIF | |||||
Malleolar fractures Weber fracture: A-C (fibular fracture) --A: bellow ligament --B: within the groove in the ligament --C: above the ligament (widen Talofib. Joint) | Fifth metatarsal (Jones) Jones: --About: traverse fx of the proximal metadiaphyseal junction 5th --Sx: pain over lat border of foot --Complication: high rate of nonunion (AVN) --Tx: >2m to heal, NWB cast or surgery Pseudo-Jones: --About: evulsion fracture of 5th --Tx: conservative | Lisfranc Injury About: Tarsometatarsal fracture, 2nd MT fx Sx: Swelling of midfoot, ecchymosis of plantar midfoot Dx: Fx: base of 2nd metatarsal + tarsometatarsal joint disruption Tx: ORIF, if no surgery NWB >6wks | Slipped Capital femoral epiphysis
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Femur fracture Intracapsular (femoral neck) MC Extracapsular (Intertrochanteric) MC Sx: hip/groin, buttock, thigh pain PE: leg shorten & externally rotated Caused: by log roll maneuver Tx: Surgery w/in 24-48hrs
| Legg-d-Perthes | Tibial Fractures About: proximal tib w/ extension of joint MC lateral plateau CAUTION: peroneal nerve injury (foot drop) Tx: nondisplaced: NWB hing knee brace Displaced: ORIF | patella fracture/dislocation About: dislocation—trochlear groove displaced (MC Lateral) Dx: apprehensive test: lat force patella cause pain Tx: reduction: Medial force patella while extending, immobilize, PT  | ||||