Trauma - upper extremities

Radial head fx treatment by Mason classification?

1 Rest in a cuff and color sling for 3 weeks 2 Open reduction and internal fixation with headless screws 3 Radial head excision with or without prosthetic replacement 4 Repair of capsule-ligamentous structure and ORIF of associated fractures.

Rockwood (RW) classification of acromioclavicular (AC) joint disruption: type 1? 2? 3?

1. Strain to the acromioclavicular ligament, no significant instability is present. 2. Complete tear of the acromioclavicular ligaments, but the coracoclavicular ligaments remain intact. 3. Both sets of ligaments (AC and CC) are disrupted. A Type III occurs when the distal clavicle is completely displaced. With up to 100% translation of clavicle relative to the acromion.

Acromioclavicular joint disruption management: Rockwood 1/2? 3? 4/5/6?

1/2 managed conservatively by rest in a sling and analgesics 3 should be individualized (surgical for athletes and high demanding) 4/5/6 managed by surgical reconstruction.

Rockwood (RW) classification of acromioclavicular (AC) joint disruption: type 4? 5? 6?

4.Both sets of ligaments (AC and CC) are disrupted and posterior displacement of the clavicle through the trapezius muscle. 5. Both sets of ligaments are disrupted with gross displacement (often between 100% and 300% of the CC distance) of clavicle. 6. Both sets of ligaments are disrupted and the distal clavicle displaces inferiorly into a subacromial or sub- coracoid position.

Supracondylar fx - what artery might get compressed?

Brachial artery

There are six ossification centers around elbow which appear in a predictable sequence what are they and at which age?

CRITOE C—Capitellum at 1 years R—Radial head at 3 years I—Internal (medial) epicondyle at 5 years T—Trochlea at 7 years O—Olecranon at 9 years E—External (lateral) epicondyle at 11 years.

What is the most common fracture?

Clavicle is the most common fractured bone overall. 4-10% of skeletal trauma presenting to orthopedic emergency

shoulder dislocation tests? (2)

Duga's test: In dislocated shoulder hand cannot be taken to opposite shoulder Hamilton ruler test: In dislocated shoulder a straight ruler can touch the acromion process and lateral epicondyle of the humerus at the same time. In normal shoulder this is not possible due to deltoid bulge which is lost in dislocated shoulder.

Supracondylar fx Classification?

Gartland Classification Type I: Nondisplaced Type II: At least one cortex is intact such that there is only angulation but no displacement Type III: Completely displaced with both cortices fractured.

Lateral condyle fracture classification? treatment in non displaced fx? in displaced fx?

Milch Classification fractures can be managed by immobilization in above elbow cast in 90° of flexion and internal rotation for 4 weeks However, most of these fractures are displaced owing to pull of the common extensor origin and such fractures require open reduction and internal fixation with K wires

Acromioclavicular joint disruption, Xray views? (3)

Shoulder anteroposterior, axillary lateral view and Zanca view (10° cephalic tilt anteroposterior view).

Proximal humerus fracture complications? (3)

Shoulder stiffness Axillary nerve injury fracture nonunion

Mason classification of radial head fracture? (4)

1 Nondisplaced fracture 2 Displaced fracture (fragment involving more than 30% of articular surface that is displaced more than 2 mm) 3 Comminuted fracture 4 Fracture associated with elbow dislocation

most commonly associated fracture with supracondylar humerus fracture?

Ipsilateral radius fracture

Supracondylar humerus fracture is common in? what is the most common type of Supracondylar fx?

It is the commonest fracture seen in children between 3-10 years of age when there is a history of fall on outstretched hand. Extension type supracondylar fracture: Most common type. Here the distal fragment is pulled posteriorly by the triceps (like in the x-ray)

What is This is a common fracture in children between 5 to 10 years? mechanism?

Lateral condyle fracture It causes impaction of the radial head into lateral condyle causing fracture (push off theory). It may also be caused by pull of the common extensor origin (pull off theory

Proximal humerus fracture classification? Displacement is defined as?

Neer: one part. two part, 3 or 4 parts. Displacement is defined as separation between fragments >1cm angulation of more than 45 degree

Indication for operative fixation of clavicle fx? (5)

Open fractures associated neurovascular deficit, polytrauma patient, displacement and shortening greater than 2 cm displaced fracture of lateral end clavicle. Skin about to rapture

SC joint injuries x-ray view?

Serendipity

Supracondylar fx treatment by Gartland type?

Type 1 : elbow cast immobilization for 3 weeks with elbow in 90° flexion, 2/3: require reduction. Majority of the fractures are reduced by close manipulation under C-arm image intensifier

OLECRANON FRACTURE other name? classification? treatment?

also called as Javelin thrower's fracture classified into undisplaced, displaced and comminuted fractures. Undisplaced fractures require above elbow cast immobilization in 90° elbow flexion for 3-4 weeks. Simple transverse displaced fractures require open reduction and internal fixation with tension band wiring Comminuted fractures require open reduction and plate fixation.

PULLED ELBOW common age?

between 1 year and 4 years

After clavicle fracture the medial fragment is _______ by ________ and the distal fragment is displaced __________________ by pull of ________________

medial fragment is elevated by unopposed pull of SCM muscle and the distal fragment is displaced inferiorly and medially by pull of deltoid and pectoralis major muscles

Proximal humerus fracture treatment for one part>? 2? 3/4?

one part - sling. 2 part- Close reduction and immobilization in an arm sling 3/4 parts- fixation with intramedullary nailing or plating.

humerus shaft fx Operative Indications? (3)

shortening > 3 cm, angulation > 20° rotation > 30° וכל הרגילים... שבר פתוח, פוליטראומה ושבר פתולוגי...

The most common neurological injury in clavicle fx?

To the lower trunk of the brachial plexus

The clavicle is connected to coracoid process and acromion by ______ ligament and __________ ligement

by coracoclavicular (CC) ligaments and acromioclavicular ligament

What is a Holstein-Lewis fracture? common complication?

is a special variant of humerus fractures that occurs at the junction of upper two third and lower one third. In this region the radial nerve is adherent to the lateral inter-muscular septum as the nerve crosses from posterior to lateral compartment. Hence this fracture gets very commonly complicated by radial nerve palsy, mostly *transient*