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Posterior fat is never normal.
Normal anterior fat pad is right up against bone. |
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Normal Apophysis
• Growth centers on long bones where no joint space is involved |
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Radial Fracture
• Due to fall on outstretched hand
- Trivial trauma
• PE: tenderness over radial head or pain with passive rotation of the forearm
• X-ray
- Positive fat pad
• Treatment
- Sling support
- ROM exercises |
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Term
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Definition
Humeral Shaft Fracture
• Mechanism
- Healthy adults
- Blow to shoulder or fall on outstretched hand
• Pain, tenderness, deformity
• PE: watch for radial nerve injury
- Check wrist extension
• Treatment
- Sugar tong splint of upper arm
How is the radial nerve injured? |
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Definition
Radial Nerve Injury
Radial nerve palsy occurs in 8.5% to 12% of humeral shaft fractures. Middle and middle-distal fractures have a higher association with radial nerve palsy, as do transverse and spiral patterns of fracture. |
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Definition
Nightstick Fracture
• Single fracture through midportion of the ulna
• Due to raising arm when being hit by a stick |
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Definition
Monteggia’s Fracture
• Ulna fracture usually in the proximal third, and radial head dislocation
- Radius and radial head should point toward the capitulum of the distal humerus
• Due to forced pronation of the forearm or direct blow over posterior aspect of the ulna
-need lateral, hard to determine dislocation on AP view |
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Definition
• Radius fracture usually located at the junction of the middle and distal thirds and dislocation of the ulnar head from the wrist joint
• Due to direct blow on the dorsolateral wrist or from a fall on a outstretched hand |
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Definition
• GRIMUS is a mnemonic for the difference between a Galeazzi and Monteggia fracture- dislocation.
• Galeazzi = Radius, Inferior • Monteggia = Ulna, Superior
• GRIMUS helps one to remember which forearm bone is fractured—and whether the distal (“inferior”) or proximal (“superior”) part of the bone is involved. |
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Subluxation of Radial Head
• Nursemaid’s elbow
• Children age 1–3
• Tender over radial head • Child refusal to use arm
• Treatment: reduction |
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Definition
Greenstick Fracture
• Seen in the young • Bones very flexible
• Due to direct trauma
• One side broken and
the other side bent
• Treatment: reduction and cast for 6 weeks |
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[image]
Some Lovers Try Positions That They Can’t Handle
S – Scaphoid
L – Lunate
T – Triquetral
P – Pisiform
T – Trapezium
T – Trapezoid
C – Capitate
H – Hamate |
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Definition
Colle’s Fracture
• Fracture of the distal radius
• Results from fall on the outstretched arm
• Transverse fracture of the distal radial metaphysis with dorsal displacement of the distal fragment
• X-ray: Fracture through radial metaphysis
• Exam: “Dinner fork” deformity of the wrist
• Treatment: Reduction and immobilization with sugar tong splint
- Place elbow at 90 degrees of flexion and wrist in fairly marked flexion
- Splint for 6 weeks |
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Definition
• Fracture of distal radius with volar displacement
• Fall on outstretched hand
• Reverse Colles’ fracture
• Treatment
- Volar wrist splint |
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Definition
Hutchinson’s Fracture
• Radial styloid fracture
- Chauffeur’s fracture
• Mechanism: fall on outstretched hand with force transmitted up the scaphoid
• Treatment
- Nondisplaced with short arm
splint
- Watch for ligament damage— ortho referral |
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Definition
Boxer’s Fracture
• Fracture at distal end of 5th metacarpal with apex dorsal angulation
• Result from direct blow of the closed fist against another object
• Increased angulation (>25–30%) may result in malunion
• Malunion leads to permanent hyperextension deformity
• Treatment: splint, surgery (pinning)
-fifth metacarpal fracture |
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Definition
Scaphoid Fracture
• Most common carpal bone fracture, seen in young adults
• Mechanism
- Fall on outstretched hand
• Physical exam
- Point tender anatomical
snuffbox
- Limited ROM of wrist and thumb
• X-ray: may need to repeat in 2 weeks to detect
• Treatment
- Spica splint |
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Definition
Gamekeeper’s Thumb
• Due to thumb being pulled backward
• Avulsion fracture at base of proximal phalanx |
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Definition
Finger Dislocation
• Result from direct blow
• Obvious deformity seen
• Pain and limited mobility
• Treatment: reduction
- May need digital block |
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