INSTRUCTIONS Surgical options for proximal humerus fractures
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Surgical options for proximal humerus fractures
GENERAL PURPOSE: To provide nurses with information, indications, and techniques for surgical repair of proximal humerus fractures. LEARNING OBJECTIVES: After reading the preceding article and taking this test, you should be able to: 1. Identify indications for specific proximal humerus fracture repair procedures. 2. Discuss techniques and equipment needed for proximal humerus fracture surgeries. 3. List implications for postoperative monitoring and care of patients undergoing humerus fracture repair.
1. Neer classification system determines displacement by assessing all except
a. the affected segments of the humerus.
b. vascular isolation in the area of the fracture.
c. the separation and angulation of the separated fragments.
d. the number of fragments present.
2. Arthroplastic surgery for a proximal humerus fracture may be the best choice for
a. patients younger than 70 who have a fracture older than 4 weeks.
b. comminuted fractures.
c. patients over age 70 who have osteoporosis.
d. fractures that can't be medically managed.
3. The CRPP procedure is a good option for treating proximal humerus fractures if
a. there's healthy bone quality and minimal comminution.
b. the patient is older than 70 and can't actively participate in rehabilitation.
c. the patient has significant osteoporosis.
d. there's significant comminution.
4. The CRPP procedure often results in
a. decreased risk of AVN.
b. significant internal scarring.
c. a distorted postoperative appearance.
d. poor quality bone healing.
5. During a CRPP, a post may be placed between the arm and the chest to
a. prevent vascular compromise of the humerus.
b. allow shaft lateralization.
c. allow better visualization of the operative area.
d. facilitate fluoroscopy.
6. Pins placed during a CRPP should be cut
a. 3 cm outside the surface of the skin.
b. 1 cm outside the surface of the skin.
c. flush with the skin surface.
d. below the surface of the skin.
7. Patient education following a CRPP should include
a. biweekly X-rays.
b. use of a sling with total immobility.
c. active range of motion (ROM) only after all pins are removed.
d. strengthening exercises after 8 weeks.
8. Intramedullary nailing can only be used to repair a proximal humerus fracture if
a. the head of the humerus has a good blood supply.
b. there's a risk of decreased vascularity to the head of the humerus.
c. the patient has significant osteoporosis.
d. the humeral head is stable in relation to the shaft.
9. The nail implant procedure may involve all of the following except
a. a laminar spreader to compress the head to the shaft.
b. a bone tamp to reduce the head.
c. K wires for temporary fixation.
d. a drill to make the initial hole.
10. A longer nail and interlocking screws are used to perform a nail implant if the
a. vascular supply to the head of the humerus is compromised.
b. displacement of the fracture is more than 5 mm.
c. shaft of the humerus is fractured and comminuted.
d. bone shaft can't be reamed.
11. Immediately postoperatively, how is proper intramedullary nail fixation often determined?
a. ROM under fluoroscopy
b. standard radiographs
c. bilateral arm measurements to assure equal lengths
d. proper fixation can't be determined for 2 to 3 weeks
12. A locking plate is useful for patients with osteoporosis because the plate
a. has minimal effect on the vascular supply of the bone.
b. doesn't need to be attached at multiple points.
c. can easily be moved if placed incorrectly.
d. has a fixed angle and multiple screws that attach a large amount of bone.
13. Which of the following may be required during a locking plate procedure?
a. 7 to 9 screws
b. a bone graft
c. cement to attach the plate
d. a humeral component
14. Fluoroscopy must be used for a locking plate procedure to
a. ensure proper positioning of the plate.
b. ensure that the screws penetrate the joint space.
c. determine correct positioning of the screws.
d. measure the distance from the bone graft to the plate.
15. A primary hemiarthroplasty requires
a. permanent sutures for tuberosity repair.
b. three bone graft wedges.
c. a universal prosthetic stem.
d. a single bone graft wedge.
16. During a primary hemiarthroplasty, the medullary canal is initially fitted with
a. a preselected implant.
b. a bone graft.
c. cement and a nail.
d. trial implants.
17. Following reverse total shoulder arthroplasty, patients should be instructed to begin active motion exercises in about
a. 1 week.
b. 2 weeks.
c. 4 weeks.
d. 7 weeks.
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