Rad2 Lect Final Fx's Flashcards

Humerus
Terms Definitions
Dupuytren's fx
fx of the distal fibula (lateral malleolus) w/ rupture of the distal tibiofibular ligaments, diastasis of the syndesmosis, lateral dislocation of the talus, and displacement of the foot upward and outward
Maisonneuve's fx
fx of the proximal fibular shaft (about 1/3), forceful inversion and external rotation of ankle, talus displaces laterally against fibula - rupture of the inferior tibiofibular syndesmosis, may be overlooked since pts usually complain from pain at the ankle
Tillaux's fx
a fx thru medial malleolus w/ diastasis of the distal tibiofibular syndesmosis - avulsion of the anterior tubercle of the tibia and a fx of the lateral malleolus 6-7 cm proximal to the distal end of the fibula
Toddler's fx
undisplaced spiral fx of the tibia, children 9 mos to 3 yrs; often too young to verbalize pain, fall or child gets a foot caught btwn the slats of the crib and then rolls over, adults form:boot-top fx = BB fx for both bones
Anterior dislocations of ankle
follows a force that results in posterior displacement of the tibia on the fixed foot, all ligamentous and capsular attachments from tibia and fibula to the talus are torn except sometimes the post talofibular ligament, foot is dorsiflexed and appears elongated anteriorly, depressions on either side of the achilles tendon are obliterated, talus is prominent anteriorly, that dorsalis pedis pulse may be absent
Posterior dislocations of ankle
M/C than anterior but still rare, post dislocation of the talus usually follows a blow to the post aspect of the tibia and results in plantar flexion of the ankle w/ apparent shortening of the foot
Complications of ankle fxs: Non-union
frequent w/ medial malleolus (10-15% of pts treated by closed methods), rare w/ fx's of lateral and post malleolus, non-union at level of plafond > symptomatic than below it
Complications of ankle fxs: Traumatic degenerative arthritis
occurs in 20-40% of ankle fx's. regardless of the method of trmt, predisposing factors: inaccurate reduction of the mortise, comminution of the plafond, advanced age
Complications of ankle fxs: ligamentous instability
imp ligaments = lateral collateral, medial (deltoid) collateral, tibiofibular (syndesmosis), M/C = lateral collateral ligament rupture, stress views are useful, but up to 25% will have normal stress radiographs, normal talar tilt 5 to 23 degrees, tilt >er than 10 degrees from side to side = abnormal, MRI is 95% accurate for ligament injuries
Feet fx's
10% of all fx's, direct or indirect trauma
Calcaneal fx's: Compression
compression force from falling, 10% are B/L and 10% are associated w/ T/L junction vertebral body compression fx, the fx may be comminuted, depression of the post facet of the subtalar jt, decreased Boehler's angle from its normal 28-40 degrees and offers a reliable prognostic indicator of the trmt outcome (the smaller the decrease the better the outcome)
Calcaneal fx's: Avulsion
fx's that spare the subtalar jt and involve the anterior process, the sustentaculum tali, the superior portion of the tuberosity, and the medial or lateral surface of the tuberosity, M/C anterior process fx's, a fx of the superior portion of the portion of the tuberosity of the calcaneous = break fx; may be the result of Achilles tendon avulsion
Talar fx's
2nd M/C tarsal bone to fx after calcaneous, usually avulsion fx of anterior surface of the talar neck at the capsular insertion, classified according to anatomic site: body, neck, and head
Talar Body fx's
transverse or oblique plane, osteochondral chip fx's of the talar dome occur either at the medial or lateral margins following forceful inversion or eversion w/ direct contact btwn talus and opposing malleolus
Talar neck fx's
avulsion of the anterior surface of the talar neck are the most frequent, followed by vertical fx's, MOI: impact of the anterior lip of the tibia as it is forced downward into the talar neck, which is being forced upward
Talar head fx's
infrequent and characterized by fx line being well forward of the talar neck
Talar fx's Complications
AVN usually of body after a talar neck fx, more prevalent in children (16% of cases), a neck fx significantly compromises the vascular supply, little to no collateral supply exist because >60% of surface is covered by articular cartilage, the more anterior the neck fx the >er the likelihood for developing AVN, early formation of a linear beneath the coretx of the dome = intact blood supply (Hawkin's sign)
Navicular fx
M/C = avulsion of dorsal surface, acute eversion may also avulse the medial tuberosity from traction of the tibialis posterior tendon, ddx: os tibiale externum
Cuneiform fx's
rare, usually associated with tarsometatarsal dislocations (Lisfranc's injury)
Cuboid fx's
unusual, M/C at lateral margin, bone scan may be required in children, ddx: os peroneum, os versalum
Metatarsal fx's
dropped heavy objects may be the cause, M/C shaft or neck, M/C 2nd and 3rd metatarsal, fx line may be oblique, spiral or trasverse
Jones (Dancer's) fx
base of the 5th metatarsal, M/C injury of the foot, transverse fx at the proximal end of the fifth metatarsal 15-20 mm from its base, traction from the peroneous brevis tendon or lateral cord of the plantar aponeurosis when the foot is forcefully inverted and plantar flexed, ddx: longitudinally oriented apophysis in children, can be overlooked because attn is given more to the ankle mortise, the farther from the base the longer it takes the fx to heal because of poor blood supply
Crush injuries
phalangeal fx's, droppig heavy objects may result in comminuted fx esp of distal phalanx
Bedroom fx
phalangeal fx, striking an object w/ the bare foot esp of first and fifth
Chip fx
phalangeal fx, small fx of the phalangeal articular margins following hyperextension/flexion
Hallux rigidus fx
phalangeal fx, fx of the phalanx may produce a stiffened, painful 1st metatarsophalangeal jt, later degeneration may occur
Sesamoid fx
phalangeal fx, jumping, dancing, running esp w/bare feet, stress fx's or secondary AVN may be seen, medial hallux sesamoid M/C involved, single or multiple fx lines, specialized submetatarsal view, ddx: bipartite sesmoid present in 1/3 of population and bilateral in 85%
Tarsal dislocations
M/C bone in foot to dislocate at 3 possible jts: talotibial , talocalcaneal (subtalar), and the talonavicular, may occur singularly or together, can precipitate AVN of the talus
Midtarsal dislocations
Chopart's, rare injury that separates the foot at the talonavicular and calcaneocuboid jts
Tarsometatarsal fx-dislocation
Lisfranc's, named after a surgeon in Napoleon's army, not for description of the injury, but for his method of foot amputation through the same region (the tarsometatarsal junction), dorsal dislocation of the metatarsal bases in relation to the opposing tarsals, in combination w/ fracture at various location, there may be an associated lateral displacment of the metatarsals, CT is useful, M/C accompanying fx's: base of the 2nd metatarsal and lateral cuboid surface, mat predispose to development of secondary OA, surgical reduction w/ fixation gives a better prognosis when compared to conservative trmt, were common w/ equestrian accidents, now occur more in MVA's and industrial accidents
Phalageal dislocations
frequent and readily recognizable
Fx's of the thorax
uncommon injuries of childhood, incidence increases w/ age esp after 3rd decade, 10% of all traumatic fxs will have an associated rib fx, difficult to visualize (do multiple oblique views), 50% will go indetected on x-ray, US is supto plain film (78% vs 12% identification), bone scan valuable esp in medicolegal purposes
Radiologic features of rib fxs
Fx line: transverse or oblique, ddx: bronchial shadow, cortical offset: sharp step effect when present, rib orientation: sharp deviation, if distal end appears hook-like (costal hook sign) - it may indicate flail segment, Callus formation: local increase in density and bulbous expansion, Pleural effusion: localized hemtoma displaces pleura inward, seen as opaque density conves toward lung
Other fx's
Multiple rib fxs are usually aligned in a linear fashion, Ipsilateral costophrenic recess may be blunted due to sanquinous emphysema, diaphragmatic elevation and splenic laceration
Upper rib fx
Upper 3 ribs rarely fx bcse of supporting mm, Presence suggests severe trauma w/ possible injuries to trachea, aorta, great vessels, brachial plexus or spine, Weightlifters may incur fx of the 2nd rib during heavy bench pressing, Stress fxs of the 1st rib can occur in throwing athletes
Middle rib fx
Ribs 4-9 M/C fxed, MOI: is usually lateral and it makes them difficult to visualize, extrapleural collection of hematoma, Fxs of middle to lower anterior ribs should stimulate close scrutiny of spleen and liver for injury
Flail chest
occurence of 2 fxs of the same rib, isolating a segment of the rib, Usually more ribs are involved, The isolated rib fragments move in opposite directions (paradoxical motion). This reduces ventilation and can be life threatening, X-ray: isolated rib section rotated and exhibits a hook-like distal end on AP view
Golfer's fx
a golfer may inadvertently strike theh ground rather than the ball, Abrupt termination of swing may precipitate rib fx usually at lateral margin
Passion (Bear hug) fx
presence of osteopenia may predispose elderly to these fxs
Lower rib fx
10-12 not likely to fx, but if they do kidney evaluation is necessary, Cough (post-tussive) fx:stress fx of lower (M/C 6th-7th anterior rib
Costal cartilage injuries
not discerned on plain film, Nuclear bone scan adn CT
Sternal fx
Blunt compressive impacts such as from steering wheel or belt, M/C involve the body or manubriosternal junction, Transverse in nature, US is more sensitive than plain film, but radiography remains modality of choice in clinical situations and best demonstrates degree of displacement, Careful evaluation of the T/L spine is necessary, Rule out cardiac complications
Pleural complications: Traumatic pneumothorax
Intrapleural negative pressure functions to maintain lung inflation, When pleura is torn the pressure is lost - lung collapse
Pleural complications: Hemothorax
Accumulation of blood in pleural space, Blunt costophrenic sulci, widening of the paraspinal space, and apical "capping"
Pleural complications: Chylothorax
Accumulation of lymphatic fluid
Pleural complications: Pneumonia
May complicate the immobility of the chest owing to inactivation of the normal lung fluid-clearing mechanism
Other pleural complications
Rupture of spleen, diaphragm, tracheobronchial tree, esophagus, kidney, heart, aorta, lung, thoracic spine, Elderly have a high morbidity from rib fxs due to these complications
Fx's of the clavicle
M/C skeletal injury during birth and childhood, S shape and overlap w/ upper rib cage renders it difficult to evaluate, Do 15 degrees cephalad for optimal visualization, 15% of all fxs; 44% of shoulder fxs, 2/3 of all pts are males, middle clavicle = M/C fxed (75-80%); lateral (15-20%); medial (5%), When middle is fxed the medial fragment displaces superiorly bcse of action of SCM, when lateral is fxed, must evaluate integrity of the coracoclavicular ligament, prior to skeletal maturity fxs of the clavicle are >common than AC injury, but symptoms may be similar
Complications of fx's of the clavicle
heal w/out sequelae in 95%, neurovascular damage: subclavian artery and vein, brachial sympathetic chain, Non-union:5% of cases, malunion: w/ fragment overlap, OA, Post-Traumatic osteolysis: 1-3 mm and never >than 2-3cm; commonly overlooked; apparent 2-3 mos postinjury; possibly bcse of synovial hypertrophy; common in weightlifters, If lack of callus w/in 6 wks and gap>1.5cm = non-union
Fxs of the scapula
Severe trauma, 80% have other associated injuries; need special views such as coracoid (axillary or scapular Y view), lateral (pt rotated to 35 degrees, axillary, Majority involve body and neck (80%), If coracoid or acromion fx it is usually in the midportion or the narrowest region, An avulsion at the triceps insertion of inferior glenoid is seen with anterior humeral dislocation (Bankart lesion)
Fxs proximal to anatomic neck of humerus
Head-splitting fxs, Associated w/ anterior shoulder dislocations = Hill-Sachs defect); optimal projection = internal rotation of the shoulder
Greater tuberosity fx
Flap fx, Avulsion by the connecting tendons, Associated w/ anterior dislocations, Older pts show a smaller separated fragment than younger ones, Optimal view = external rotation of the shoulder, Displacement > 1cm = associated w/ rotator cuff tear
Lesser tuberosity fx
Not vulnerable to isolated fxs, Usually occurs w/ proximal humeral fxs
Surgical neck of humerus fxs
M/C site for humeral fxs, Narrowest point of humerus, Fxs tend to be comminutes involving adjacent tuberosities, Anteromedial displacement of the shaft distal to the fx often occurs bcse of pull of pectoralis muscle, Injury of hte axillary nerve and artery may complicate fx
Anterior dislocation
95% of GH dislocations; subglenoid, subcoracoid (M/C), subclavicular, MOI: forceful abduction and external rotation, in 60% = Hill-Sachs lesions; 15% HAGL lesions (humeral avulsion of the GH ligament); less frequently Bankart lesion, Reoccurence is common in young pts; in pts >40 the reoccurence rate is 4%, 10-20 fold increase in incidence of arthritis
Posterior dislocation
2-4% of GH dislocations, M/C missed traumatic injury in the ER, Follow epileptic convulsion, electric shock, or extreme trauma (triple E), rarely occur B/L (seizure induced), Difficult to identify radiographically, Widened joint space (>6mm - rim sign), double articular surface (trough line sign), lack of humeral head-glenoid fossa overlap, lack of close contact at the anterior jt margin (vacant glenoid sign), cystic appearance of the head (tennis racquet sign), superior displacement, Rarely, avulsion injury of the post labrum may occur
Inferior dislocation
AKA Luxatio erecta, Follows severe hyperabduction where humeral head contact acromion, which acts as a fulcrum to lever humeral head out and displace it inf
Superior dislocation
Rare, Requires considerable force w/ elbow flexed and arm adducted, M/C w/ rotator cuff tendon tear, If acromiohumeral distance measures < 7mm = tear
Rotator cuff tear
Common, incidence increases w/ age, Clinical assessment w/ palpation may be as high as 95% accurate, X-ray: elevated humeral head (unopposed action of the deltoid); narrowing of the acromiohumeral jt space; erosion w/ sclerosis of the undersurface of teh acromion; cysts on greater tuberosity, MRI is most sensitive and depicts tears
SLAP lesions
Superior labrum anterior and posterior, MRI is imaging modality of choice
AC separation: Type I
Mild sprain, AC ligament is stretched by not disrupted, and coracoclavicular ligament is intact, No discernible increase in jt space or altered alignment is visible, Treated conservatively
AC separation: Type II
Moderate sprain, Torn AC ligament and stretched but intact coracoclavicular ligament, X-ray: widened jt space and slight elevation of the clavicle, Treated conservatively w/ brace, but may require surgery, Old injury may manifest as ligament calcifications
AC separation: Type III
Severe sprain, Both AC and coracoclavicular ligaments are disrupted, X-ray: widened jt space; elevation of the distal clavicle and widened coracoclavicular space >5mm than contralateral side, May require jt repair and open fixation, but conservative treatment has also been shown to be beneficial
Sternoclavicular jt dislocation
Exceedingly rare, MOI: severe trauma, Anterior displacement of the clavicle are more frequent than posterior dislocations, The latter can be life threatening, CT: technique of choice
Sternothoracic jt dislocation
Rare, Severe trauma, Aka Locked scapula and Scapulothoracic dissociation
Elbow fx
6% of all fxs, In adults 50% involve radial head and neck; 20% olecranon; 10% the supracondylar region; 15% combinations w/ dislocations, In children 60% involve the supracondylar region; lateral condyle fxs in 15% and separation of the medial epicondyle ossification center in 10%, Unrecognized fxs of elbow can lead to loss of mobility and OA
Supracondylar fx
Fx line extends transversely or obliquely through the distal humerus above the condyles, M/C fx of the elbow in children (60%), Usually fx fragment displaces post, Conservative care, If difficult to visualize do line along anterior cortex of humerus on lateral; it should intersect 40-50% of condyles; if not - fx
Intercondylar fx
Fx line extends btwn medial and lateral condyles and communicates w/ the supracondylar region, T or Y configuration of fx line, 50% of distal humeral fxs in adults, transverse line that passes through both condyles = transcondylar fx, a comminuted fx of distal humerus, usually w/ associated ulnar and radial fxs, may occur if an object is struck w/ the elbow protruding from a car window = sideswipe or baby car fx
Condylar fx
Of single condyle, May be along articular surface of trochlea and capitelum, Convex surface of capitelum is susceptible to compression and breakage from forces transmitted through radial head; can occassionally fx simultaneously, small osteochondral fragment may also be sheared off the capitelum - intraarticular loose body (Kocher's fx)
Epicondylar fx
usually avulsive from common flexor or extensor tendons and collateral ligaments, Separation of the medial epicondyle = common injury of hte throwing sports athletes (Little Leaguer's Elbow)
Olecranon fx
20% of adult elbow fxs (2nd M/C), Direct trauma or avulsion from triceps, Swelling or olecranon bursa = common finding
Coronoid process fx
Avulsion by brachialis muscle, or impaction into trochlea fossa, Uncommon when isolated, Frequently seen w/ posterior elbow dislocation, Oblique view
Radial head fx
Chisel fx; fx line is usually on lateral side; step-off or angulation is common; double cortical sign; 50% of elbow injuries in adults, FOOSH injuries, Positive fat pad; injury may be subtle - do multiple oblique views (absence of fat pad does not exclude possibility of a fx)
Radial neck fx
M/C at junction of head and neck, A comminuted fx of the radial head in combination w/ dislocation of the distal radioulnar jt = Essex-Lopresti fx
Fxs of both radius and ulna
60% (BB fx), M/C in the middle 1/3 of shaft, Almost all fxs of these bones have associated displacement and angulation w/ rotation, Almost always require open surgery and fixation
Nightstick or Parry fx
Distal ulnar shaft, Direct trauma from arm being raised to protect head during an assault w/ club or hard object
Monteggia's fx
Proximal ulnar shaft fx, Associated w/ dislocations of the radial head, In children ulnar component of this lesion is often a greenstick fx
Isolated fxs of the radius
M/C toward the distal shaft, Galleazzi, Piedmont's, or reverse Monteggia's, rare, but serious traumatic injury, Associated w/ dislocation of the distal radioulnar joint, Frequently complicated by non-union and tendency towards dislocation, Early recognition - better prognosis
Dislocations of the elbow
3rd M/C site for dislocation (shoulder and IP joints of fingers), M/C dislocation of children, Classified according to displacement:post, posterolateral, ant, medial, anteromedial
Post and Posterolateral dislocations of the elbow
M/C = 85-90%, In practically all elbow dislocations both the radius and the ulna will be dislocated, >50% will have associated fxs (M/C medial epicondyle and radial head or neck), In children avulsed medial epicondyle may become entrapped in the joint, Small percentage will develop post-traumatic myocitis ossificans at the anterior aspect of the joint (usually in brachialis muscle)
Pulled elbow
Aka nursemaid elbow, Children 2-5, A child is tractioned - radial head slips out from under the annular ligament in the radiohumeral articulation, No x-ray findings, Supination of the hand can reverse changes and provide instance relief
Fxs and dislocations of the wrist
One of M/C sites for fxs, not so much dislocations, Point tenderness and decrease grip strength > 20% - strong indicators for fxs
Colle's fx
Fxs of distal radius 20-35mm proximal to jt, w/ posterior angulation of the distal fragment, > than 60% will have associated fx of ulnar styloid, Fall on extended hand, AKA Dinner fork, Silver fork, Incidence increases w/ age, Osteoporosis is an influencing factor, Abnormal angulation is noted; normally there is 5-15 degrees palmar angulation of the articular surface
Smith's fx
fx of the distal radius w/ ant angulation of the distal radius, fall on hyperflexed wrist, Aka Reversed Collie's
Barton's (Rim) fx
Fx of the distal radius w/ associated proximal dislocation of the carpus, MOI: forceful hyperextension, Fx of anterior rim = Reversed Barton's
Chauffeur's fx
Aka Backfire, Hutchinson, Fx of the radial styloid, Used to be result of backfire occurring when attempting to start engine
Moore's fx
Ulnar styloid fx in association w/ Collie's fx, w/ dislocation of the distal ulna
Torus fx
M/C fx of the wrist in children 6-10 yr, 2-4 cm distal from joint surface, Can occur in any bone
Slipped Radial Epiphysis
Childhood equivalent of Collie's fx, Shearing across growth plate following forceful hyperextension, Displaced metaphyseal fragment (Corner sign) = Salter-Harris Type II
Distal ulnar fxs
Ulnar styloid: isolated fx, Uncommon, usually w/ avulsion of the ulnar collateral ligament, M/C found in combination w/ other injuries
Scaphoid fx
M/C carpal to fx, 15-40 yos, Rare in children, MOI: differs, but usually consists of hyperextension and radial flexion, Often overlooked - high incidence of complications, M/C site for occult fx, although only 30% of fxs initially taken for occult are really of this nature, 70% involve waist; 20% proximal pole: 10% distal pole, Optimum view: ulnar deviation, 90% will have fat strip displacment in the radial compartment of the wrist (navicular fat stripe sign), Healing occurs w/out callus; fx line just disappears, the more distal the fx the faster the healing and vice versa, healing time: 6-20 wks
Scaphoid fx Complications
AVN: 1-15%, Dual blood supply, the proximal pole is the least perfused, Non-union: 30%, surgical screw w/ Herbert screw
Carpal instability: Scapholunate dissocation
(rotary subluxation of the scaphoid), follows acute dorsiflexion, pain, crepitus, weakness, disruption of scapholunate ligament (+ others), scapholunate dissociation (Terry Thomas sign), foreshortening of the scaphoid (ring sign), ddx: wide scapholunate jt in 50% of lunotriquetral coalition, May need to do views different than the standard ones
DISI
Lunate tilts w/ the capitate displaces slightly dorsally to lie posterior to the longitudinal axis of the radius, On lateral view lunate tilts >80 degrees to the radius
VISI
Lunate tilts ventrally w/ the capitate extended or tilted dorsally
Radiocarpal OA
Follows healed scaphoid fx
Triquetrum fxs
2nd M/C carpal to fx, Usually avulsion from the dorsal surface at the attachment of the radiocarpal ligament, Aka Fisher's fx, usually after hyperflexion, Presents as displaced flake of bone on lateral
Pisiform fx
Direct impact, M/C vertical, Reverse oblique wrist projection
Trapezium fx
M/C after hyperabduction at the radial pole
Trapezoid fx
Least commonly fxed carpal
Capitate fx
Uncommon, usually associated with scaphoid or perilunate dislocations, M/C transverse
Hamate fx
Fxes in various locations, Commonly at the hook, Fxs of the dorsal surface often accompanies posterior dislocation or sublucation of the fourth or fifth metacarpal and is seen as an oblong-shaped bone fragment near the articulation, Tangential view w/ the wrist in hyperextension or a 30 degree tilted lateral projection w/ palmar abduction of the thumb, CT: most accurate, Non-union = common
Lunate fx
Uncommon, since it tends to dislocate B4 fx, If fx is seen Kienbock's disease is likely (AVN)
Dislocations
Uncommon, but predictable, 2 patterns: single bone dislocating in relation to rest of carpals, or single bone remaining in place in relation to carpals, Do arc relationships of radiocarpal, carpocarpal and carpometacarpal joints
Lunate dislocation
M/C carpal to dislocate following hyperextension, Best seen on lateral view
Scaphoid dislocation
2nd M/C carpal to dislocate, Complete dislocation = infrequent, It moves laterally and rotates anteriorly, Ring of signet ring sign, May havee scapholunate dissociation
Other carpal dislocation
unusual and require severe trauma
Perilunate dislocation
Dorsal displacement of all carpal bones except lunate, Best seen on lateral, On PA capitate overlies lunate, Numerous complications - open or closed reduction, Complications: chondrolysis, carpal instability and traumatic arthritis
Trans-Scaphoid Dislocation
Same as perilunate dislocation, except that there is an associated fx through waist of scaphoid, Proximal part of scaphoid stays next to lunate, distal part moves w/ other carpal bones
De Quervain's fx-dislocation
Anterior dislocation of the lunate, along w/ the proximal fragment of a fxed scaphoid
Fxes and dislocations of the hand
M/C sites for skeletal injury in entire skeleton, Most can be treated conservatively
Boxer's fx
Transverse fx of the neck of the 2nd or 3rd metacarpal, MOI: straight, jabbing type of blow w/ the fist
Bar room fx
Transverse fx involving the neck of the 4th or 5th metacarpals, MOI: "roundhouse" type of blow from inexperienced fighter, There is usually anterior angulation of the fxed fragment
Shaft fx
involve the 3rd and 4th metacarpals, often simultaneously, Dorsal angulation and displacement across the fx site quite commonly occurs
Bennett's fx
Fx dislocation; avulsion injury at the base of the 1st metacarpal, Follows injury where there is a grip applied to an object such as a ski pole or handle bar, intraarticular fx, usually dorsal and displacement of the shaft
Rolando's fx
aka Comminuted Bennett's, least common of all 1st metacarpal injuries, Difficult to treat
Transverse fx 1st metacarpal
M/C fx through the 1st metacarpal, May be oblique
Distal phalanges fx
Middle finger is M/C, 4 types: transverse, longitudinal, comminuted, chip, Longitudinal may split it in 1/2 and extend all the way to the joint, M/C comminuted; usually distal tip, Chip involve the post or ant corners of bases, A post chip fx inactivates extension of distal IP joint - flexion deformity (mallet or baseball finger)
Middle phalange fx
Most involve the middle and proximal shafts, Infrequently continue into adjacent joint
Turret exostosis
See tumors, Usually on ulnar and dorsal aspect of the base of the proximal or middle phalanx
MTP dislocations
Readily apparent, M/C at index and little fingers
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