Extremity Trauma

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#CC9900" TEXT="#080000" bgproperties="fixed" background="044005a0dwnjzk.png"> <div> <A HREF="index.htm" TARGET="_top" TITLE="TRAUMA SURGERY"><U><B>home</B></U></A><B>     | </B><B> </B><B> </B><B>  </B><FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>TRAUMA SURGERY</B></FONT></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="compartment syndrome"><U><B>compartment syndrome</B></U></A><B>   |   </B><A HREF="id27.htm" TARGET="_top" TITLE="fasciotomy"><U><B>fasciotomy</B></U></A><B>   |   </B><A HREF="id28.htm" TARGET="_top" TITLE="Heel Spur Syndrome"><U><B>Heel Spur Syndrome</B></U></A><B>   |   </B><A HREF="id21.htm" TARGET="_top" TITLE="trauma management"><U><B>trauma management</B></U></A><B>   |   </B><A HREF="id22.htm" TARGET="_top" TITLE="Neck Trauma"><U><B>Neck Trauma</B></U></A><B>   |   </B><A HREF="id23.htm" TARGET="_top" TITLE="Chest Trauma"><U><B>Chest Trauma</B></U></A><B>   |   </B><A HREF="id24.htm" TARGET="_top" TITLE="Abdominal Trauma in the Major Trauma Vic"><U><B>Abdominal Trauma in the Major Trauma Victim</B></U></A><B>   |   </B><B>Extremity Trauma</B><B>   |   </B><A HREF="id26.htm" TARGET="_top" TITLE="Airway Management and Rapid Sequence Int"><U><B>Airway Management and Rapid Sequence Intubation (RSI)</B></U></A><B>   |   </B><A HREF="id20.htm" TARGET="_top" TITLE="pelvic fracture surgery"><U><B>pelvic fracture surgery</B></U></A><B>   |   </B><A HREF="id18.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A><B>   |   </B><A HREF="id17.htm" TARGET="_top" TITLE="Related Links"><U><B>Related Links</B></U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Extremity Trauma</div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="compartment syndrome"><U><B>compartment syndrome</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="fasciotomy"><U><B>fasciotomy</B></U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="Heel Spur Syndrome"><U><B>Heel Spur Syndrome</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="trauma management"><U><B>trauma management</B></U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="Neck Trauma"><U><B>Neck Trauma</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="Chest Trauma"><U><B>Chest Trauma</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="Abdominal Trauma in the Major Trauma Vic"><U><B>Abdominal Trauma in the Major Trauma Victim</B></U></A></div> <div> <B>Extremity Trauma</B></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="Airway Management and Rapid Sequence Int"><U><B>Airway Management and Rapid Sequence Intubation (RSI)</B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="pelvic fracture surgery"><U><B>pelvic fracture surgery</B></U></A></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Related Links"><U><B>Related Links</B></U></A></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Arterial Injury</B> </div> <div> Can be caused by blunt or sharp injury. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Blunt may be more dangerous because less obvious. </div> <div> <B>Absolute indications for arteriogram.</B> Pain, pallor, paralysis, paresthesia, pulselessness, hemorrhage, expanding hematoma, bruits. </div> <div> Penetrating trauma in proximity to a vessel is not necessarily an indication for arteriogram. </div> <div> <B>Arterial pressure index</B> (arterial pressure in injured limb divided by arterial pressure in unaffected limb). Good screening: if >0.90, can safely observe in the absence of other indications for arteriography. </div> <div> <B>Shotgun injuries</B> are a high-risk category and should be studied with arteriography. </div> <div> <B>Compartment Syndrome</B> </div> <div> <B>Caused especially by</B> crush injuries, electrical burns, circumferential scars, tight casts, hematoma in compartment, snake bites, and anything else that can increase pressure in a compartment. </div> <div> Can result in muscle, nerve, and vessel necrosis from hypoperfusion. </div> <div> <B>Clinical presentation.</B> </div> <div> Severe, constant pain in affected limb. </div> <div> Pain on muscle palpation, passive stretch, active contraction. </div> <div> Paresthesia and loss of distal pulses are late signs and herald poor outcome. </div> <div> Compartment may be tense, but a normal turgor does not rule out compartment syndrome. Can diagnose by manometry: </div> <div> Normal tissue pressure less than 10 mg Hg. </div> <div> Capillary blood flow compromised at 20 mm Hg. </div> <div> At risk ischemic necrosis above 30 mm Hg. </div> <div> <B>Treatment</B> is by fasciotomy and requires surgical consultation immediately. </div> <div> <B>Amputations</B> </div> <div> Control bleeding with direct pressure. Avoid clamping vessels. </div> <div> Place severed part in saline-soaked gauze, place in plastic bag, and put in cooler with ice. <B>Avoid freezing part.</B> </div> <div> Refer to plastic or orthopedic surgery. </div> <div> Fractures</div> <div> <B>Types</B> </div> <div> <B>Closed fracture.</B> Fracture that does not communicate with the outside. </div> <div> <B>Open fracture.</B> Fracture that communicates with the external environment. </div> <div> <B>Comminuted fracture.</B> Consisting of three or more fragments. </div> <div> <B>Avulsion fracture.</B> Fragment of bone pulled from its normal position by a muscular contraction or resistance of a ligament. </div> <div> <B>Greenstick fracture.</B> Incomplete angulated fracture of a long bone, particularly in children. </div> <div> <B>Torus fracture.</B> Compression of the bone without cortical disruption. Seen especially in the forearms of children. </div> <div> <B>Epiphyseal Plate Fractures</B></div> <div> Described using the Salter and Harris classification (<FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Fig. 6-3</U></FONT>). </div> <div> <B>Salter I (approximately 6%).</B> </div> <div> Separation of the epiphysis from the metaphysis without evidence of a metaphyseal fragment. </div> <div> Usually the result of a shearing force, can be associated with birth injury. </div> <div> Most common in infants and young children. </div> <div> High index of suspicion is necessary because spontaneous reduction can occur. </div> <div> Prognosis is excellent because epiphyseal blood supply is usually intact and growing cells of epiphyseal plate are undisturbed. </div> <div> <B>Salter II (approximately 75%).</B> </div> <div> Fracture extends transversely through the epiphyseal plate and then out through the metaphysis on the side opposite the fracture initiation resulting in a triangular metaphyseal fragment. </div> <div> Most frequent in children over 10 years of age. </div> <div> Usually treated with closed reduction. </div> <div> Prognosis is excellent because the blood supply is almost always intact. </div> <div> <B>Salter III (8%).</B> </div> <div> Intra-articular fracture that extends from the joint surface across the epiphysis to the epiphyseal plate and out to the periphery. </div> <div> Commonly involves the lower tibial epiphysis. </div> <div> Caused by an intra-articular shearing force. </div> <div> Often requires open reduction. </div> <div> Prognosis is good if the blood supply is intact and reduction is maintained. </div> <div> <B>Salter IV (10%).</B> </div> <div> Intra-articular fracture consisting of a vertical fracture through the epiphysis that crosses the epiphyseal plate and leaves through a portion of the metaphysis. </div> <div> Frequently involves lateral condyle of humerus. </div> <div> Treated with anatomic reduction and internal fixation. </div> <div> Prognosis is poor unless reduction is maintained. </div> <div> <B>Salter V (1%).</B> </div> <div> Results from a crush injury through the epiphysis to a portion of the epiphyseal plate. </div> <div> Usually occurs in a joint that has only one plane of movement. </div> <div> Most commonly seen in the knee and ankle. </div> <div> Initial radiographs tend to be normal and so must suspect this fracture from the mechanism of injury. </div> <div> Results are poor with premature cessation of growth. </div> <div> Nontraumatic events causing a Salter V type of injury are metaphyseal osteomyelitis and epiphyseal aseptic necrosis. </div> <div> Salter V can occur in conjunction with Salter I, II, and III fractures and not be recognized until growth arrest occurs. </div> <div> Treat with 3 weeks of no weight bearing. </div> <div> <B>Repair</B></div> <div> A good rule of thumb is that most bones join in 6 to 8 weeks; lower limb bones may take longer; fractures in children may take less time. </div> <div> <B>Complications</B> </div> <div> <B>Immediate complications,</B> within the first few hours, include hemorrhage, damage to arteries, and damage to surrounding soft tissues. </div> <div> <B>Early complications,</B> within the first few weeks, include wound infection, fat embolism, shock lung, chest infection, DIC, and exacerbation of general illness. May also have <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>compartment syndrome</U></FONT> from casting. </div> <div> <B>Late complications,</B> months and years later, include deformity, osteoarthritis of adjacent or distant joints, aseptic necrosis, traumatic chondromalacia, and reflex sympathetic dystrophy. </div> <div> <B>Management of Some Specific Fractures</B> </div> <div> <B>Fracture of radial head.</B> Usually caused by a fall onto an outstretched hand. Patients are reluctant to pronate the hand or to flex the elbow beyond 90 degrees. The only roentogenographic evidence may be an anterior or posterior fat pad sign. The posterior fat pad is more specific but less sensitive. Management of nondisplaced fractures includes a sling and posterior elbow splint for 1 to 2 weeks with range-of-motion exercises after 1 week. Continue in sling for another week and do follow-up radiograph to document that no displacement has occurred with mobilization. Displacement of the head should be referred to an orthopedist for operative repair. </div> <div> <B>Radial fractures.</B> </div> <div> In children, the most common injury is the torus (buckle) fracture, which occurs with a fall onto an outstretched hand. Radiographic findings may show only a slight cortical disruption on the lateral film. Treatment is a short arm cast for 3 weeks. </div> <div> In adults, the most common radial fracture is the Colles' fracture, which is extra-articular and occurs 2.5 to 3 cm proximal to the articular surface of the distal radius. This fracture occurs with the hand dorsiflexed; the distal fracture segment is angulated dorsally and causes a "silver-fork" deformity. Reduction by traction and manipulation can be performed. After reducing the fracture, a plaster short-arm cast is applied for 5 to 8 weeks. If nondisplaced, casting for 6 weeks without reduction is indicated. </div> <div> <B>Metacarpal fractures.</B> A boxer's fracture is a fracture of the distal neck of the fifth metacarpal and is generally the result of punching something with a closed fist (generally a wall or refrigerator). Tenderness is localized to the injured metacarpal bone. Radiographs reveal a fracture of the involved metacarpal or subluxation at the carpometacarpal joint. Nondisplaced fractures of the base of the metacarpals are treated with immobilization in a short arm cast. Displaced fractures are reduced by traction with local pressure over the prominent proximal end of the distal metacarpal fracture. A follow-up radiograph is necessary within 7 days. If any instability is noted after reduction or the fracture is comminuted, the patient should be referred to an orthopedist for open reduction and internal fixation. </div> <div> <B>Fracture of a finger.</B> </div> <div> <B>Distal tip fractures</B> are usually crush injuries to the tip of the finger. Protective splinting of the tip for several weeks is usually satisfactory. </div> <div> <B>Middle and proximal phalangeal fractures</B> should be examined for evidence of angulation (by roentgenography) or rotation (by clinical examination), which require reduction. Nondisplaced extra-articular fractures can be managed by 1 to 2 weeks of immobilization followed by dynamic splinting with buddy taping to the adjacent finger. Large intra-articular or displaced fractures are usually unstable and require orthopedic referral. </div> <div> <B>Small (<25%) avulsion fractures of the middle phalangeal base</B> occur with a hyperextension injury. These injuries are managed by 2 to 3 weeks of immobilization with up to 15 degrees of flexion at the PIP joint, followed by buddy taping for 3 to 6 weeks. </div> <div> <IMG SRC="04e54f40.gif" border=0 width="340" height="500" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">Salter-Harris classification of epiphyseal fractures. </div> <bR> <div>  <A NAME="73"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Open Fractures:</div> <bR> <div> <B>- See: - </B><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Open Tibia Fractures</U></FONT> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Open Fractures of Femur</U></FONT> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Open Joint Injuries</U></FONT> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Gustillo Classification</U></FONT>: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Gun Shot Wounds</U></FONT>: <B>- Discussion:</B> - treat all open fractures as an emergency; - perform thorough initial eval to dx other life-threatening injuries: (see <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>trauma management</U></FONT>); - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B><U>antibiotics</U></B></FONT><B>:</B> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>antibiotic prophylaxis</U></FONT> - begin appropriate antibiotic therapy in the emergency room & continue for two or three days only; - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>tetanus prophylaxis</U></FONT> - reference: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>The use of antibiotics in open fractures.</U></FONT> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Duration of preventive antibiotic administration for open extremity frx;</U></FONT> - <B>debridement and irrigation:</B> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>debridement of open tibial fractures</U></FONT>: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>skin preparation</U></FONT>: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>topical antimicrobials</U></FONT>: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>pressure irrigation</U></FONT>; - immediately debride the wound using copious irrigation (9 lit) and, for <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>type-II</U></FONT> and <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>type-III fractures</U></FONT>, repeat the debridement in 24 to 72 hours; - note that wounds contaminated by dirt (vs grease, asphault ect) need aggressive repeated debridement inorder to avoid <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>infection</U></FONT> and subsequent <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>osteomyeltis</U></FONT>); - references: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Comparison of isotonic saline, distilled water and boiled water</U></FONT> in irrigation of open fractures. - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>The use of bacitracin irrigation to prevent infection in postoperative</U></FONT> skeletal wounds. An experimental study. - <B>stabilize the fracture:</B> - references: - The role of early internal fixation in the management of open fractures. Chapman MW, Mahoney M: COOR: 138: 120-131, 1979; - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Immediate internal fixation of open fractures of the diaphysis of the</U></FONT> forearm. - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>The influence of skeletal implants on incidence of infection.</U></FONT> Experiments in a canine model. - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B><U>soft tissue coverage:</U></B></FONT> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B><U>bone grafting</U></B></FONT>: - it is controversial as to whether bone grafting should be performed in open fractures; - in the study by Chapman et al (JBJS 1997) 31% of open fractures were treated w/ bone graft substitutes and 28% of open fractures were treated w/ autogenous bone grafts; - in this same study, infection at the fracture site occured in 5% of patients in which bone graft substitutes were used versus 13% of fractures in which autogenous grafts were used; - <B>wound closure:</B> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>wound management</U></FONT>: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>drains and closure of wounds</U></FONT> - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>wound dressings</U></FONT>: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>contaminated wound care</U></FONT>: - in most cases, a delayed primary closure is performed for open wounds, but surgical incisions made during the case can be closed primarily; - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>antibiotic bead</U></FONT> pouch is a useful method of covering the wound; - second look debridement can be performed at 48 hours w/ wound closure; - references: - <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Local antibiotic therapy for severe open fractures. A review of 1085</U></FONT> consecutive cases. </div> <bR> <bR> <div> <U>Acetabular Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Ankle Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > Barton's Fracture: </FONT><U>Dorsal Barton's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Volar Barton's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Bennet's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Both Bone Forearm Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Boxer's Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Burst Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (of spine) </FONT><U>Calcaneus, Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Capitulum Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Chauffeur's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Chance Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Clavicle Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Colles Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Compression Frx (Spinal)</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B><U>Condylar Fractures</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (of elbow) </FONT><U>Coronoid Process Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Cuboid Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Den's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B><U>Distal Radius Fx</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" >: </FONT><U>Distal Femoral Physeal Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Epiphyseal Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Essex Lopresti Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" >: </FONT><U>Extension Teardrop Fracture of C2</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Femoral Head Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Femoral Neck Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B><U>Femoral Shaft Fracture</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (Menu) </FONT><U>Flexion Tear Drop Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Foot Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Galeazzi's Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Greater Tuberosity Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Greenstick Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Hangman's Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Hamate Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Hip Fx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Hip Frx Dislocation</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Humeral Physeal Injuries</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B><U>Humeral Fractures</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (menu) </FONT><U>Intercondylar Eminence Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Intertrochanteric Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Jefferson Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Jones Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Lateral Condyle Frx, Pediatric</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Lateral Talar Process Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" >: </FONT><U>Lisfranc's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Maisonneuve Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Mallet Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Malgaigne Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Medial Epicondyle Frx of the Humerus</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B><U>Metacarpal Frx / Disloc</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Monteggia's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Navicular</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Odontoid Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Olecranon Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Patellar Frx:</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Pathologic Fracture: Diff dx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B><U>Pelvic Fracture</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B><U>Phalangeal Fractures</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Pilon Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Posterior Process Talus Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" >: </FONT><U>Proximal Humeral Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B><U>Radius Fracture</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Rolando's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Sacral Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Scaphoid Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Scapular Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Sesamoid Bones of the Foot:</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Smith's Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Spine: T/L/S Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Spinous Process Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Stress Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Subtrochanteric frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Supracondylar Femoral Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Supracondylar Humeral Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (adult) </FONT><U>Supracondylar Frx of Humerus</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (pediatric) </FONT><U>Syndesmotic Injury</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Talus Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Thumb Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Tibial Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Tibial Plafond Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Tibial Plateau Fractures</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Tibial Tubercle Frx:</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Tillaux Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Trimalleolar Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Triplane Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Torus Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Frx of the Lesser and Greater Trochanter:</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Ulnar Shaft Fracture</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><U>Ulnar Styloid Process Frx</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> </td> </tr></table></body>