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Orthopedics 2


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What is the most commonly fractured carpal bone, and how is it treated?
Scaphoid fracture. Treat with thumb spica.
What is the most commonly broken bone in children and how is it treated?
clavicle fracture, treated with sling and swath or figure of 8 dressing.
What does the descriptive term Salter-Harris III mean?
Fracture through the epiphysis into the physis not involving the diaphysis. Accounts for 6% of long bone pediatric fractures.
Are all fat pads in the elbow pathologic?
No. A small anterior fat pad may be seen in a normal elbow.
A child presents with elbow pain after a fall and has a posterior fat pad but no visualized fracture. What is the injury?
Usually this represents a nondisplaced supracondylar fracture.
An adult presents with elbow pain after a fall and has a posterior fat pad but no visualized fracture. What is the injury?
Usually this represents a nondisplaced radial head fracture.
What artery and nerve may be injured in an elbow dislocation?
Brachial artery, Ulnar nerve involvement in 10-20%.
What artery may be injured in a shoulder dislocation?
Axillary artery, usually presenting with an axillary hematoma.
What is the feared complication of a scaphoid fracture?
Avascular necrosis of the proximal fracture segment.
What is the feared complication of supracondylar fractures?
Volkmann's ischemic contracture. This is why these injuries should all be admitted and preferably not reduced by the ED staff.
what is the most common bone broken in children?
A 25-year-old patient presents with a swollen, painful elbow. She can't range it without significant pain. She also has a nontender maculopapular rash on her trunk, arms, and legs. She does not have a fever. What diagnosis should you consider, and how is
You should consider gonococcal arthritis, and it may be diagnosed by vaginal swab. The organism is not recovered in the joint fluid.
What is the most common septic joint in children?
A patient presents with septic sternoclavicular joints as well as evidence of sacroiliac involvement. What does the patient do for fun?
The patient is likely an IV drug user.
Who is at risk for polyarticular septic arthritis?
IVDA as well as anyone with multiple abnormal joints, such as those with RA or severe psoriatic arthritis. These can be difficult to diagnose because the course can be more indolent and the patient may lack fever.

Identify the bones of the wrist.

As shown

Which bone is the scaphoid?

as labelled
What is the normal volar tilt of the wrist?

11 degrees. When reducing a wrist, you want to restore the volar tilt to 0 degrees to 11 degrees to preserve function.
In reducing a wrist, what is most important to restoring function?
Restoring radial length.

What is the usual ulnar inclination of the wrist?

22 degrees. This is part of the rule of 11. The radial styloid is 11mm tall. The wrist has 11 degrees of volar tilt and 22 degrees of ulnar inclination.

What is this injury?

Scapholunate dissociation. Note the wide space between the scaphoid and lunate, also known as the terry thomas sign. on a lateral film, the scapholunate angle will be increased to greater than 60 degrees.

What is the complication of this injury?
This is a supracondylar fracture, and the feared complication is Volkmanns ischemic contracture of the forearm.
what is the difference between a comminuted fracture and a segmental fracture?
a segmental fracture means multiple transverse fractures and a free segment of long bone. comminuted is shattered.
you have a patient with pain in the elbow, and you diagnose her with lateral epicondylitis. how do you treat her?
with a WRIST splint.
which midshaft humerus fracture is more likely to require operative repair, and why, oblique or transverse?
transverse, because it has less surface area of injury to heal to the other bone segment.
which elbow fat pad is always abnormal, anterior or posterior?

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