11.5 Fractures

Question 1

Outline the treatment algorithm for an upper arm fracture (5 steps)

Answer 1

1. Establish correct diagnosis
2. Rule out neurovascular compromise
3. Stabilise fracture
4. Prevent further injury
5. Refer to specialist

Question 2

What is a HAGL injury?

Answer 2

Humeral avulsion of glenohumeral ligament injury (think abt what this is)

Question 3

A patient has a fractured humerus and a laceration on the back of their forearm. Is this a compound fracture?

Answer 3

Not unless the bone is sticking out and the injuries are related.

Question 4

Where does blood supply to the humeral head come from? How does this affect the chance of avascular necrosis?

Answer 4

• Blood supply comes from tendons and from humeral shaft
• If tuberosities and shaft are broken, increased risk of avascular necrosis

Question 5

What is a reverse shoulder replacement? When is it indicated in terms of musculature, and why?

Answer 5

• Replace ball/socket with socket/ball respectively (swap)
• Conventional requires intact rotator cuff; if this is not true, then the deltoid can take over in the setting of a reverse replacement

Question 6

Tendinitis vs tendinosus

Answer 6

Tendinitis = inflammation of tendon
Tendinosis = non-inflammatory tendon pathology

Question 7

Explain how differing levels of force can cause different types of orthopaedic injuries

Answer 7

• Once forces exceed the elastic range of stretch and enter the plastic range, injury occurs
• In lower forces, this can be contusion, tendinits, bursitis, tendinosis, sprains, and strains
• Later, this can be ligamentous injury, fracture, and dislocation

Question 8

What is popeye’s sign? What does it indicate?

Answer 8

• Distal bicep bulge
• Indicates distal bicep tendon rupture

Question 9

What is a CEO tear? Where is it? Which tendon is most commonly affected?

Answer 9

• Tear of ligaments at common extensor origin on lateral elbow
• ECRB is most common affected tendon

(CEO plays tennis; active and restless)

Question 10

What is a CFO tear? Where is it? Which tendon is most commonly affected?

Answer 10

• Tear of ligaments at common extensor origin on medial elbow

(CFO plays golf; rich and relaxed)

Question 11

What is a disadvantage of an arm sling?

Answer 11

Can lead to stiffness of elbow joint; only use if necessary

Question 12

Describe the anatomical course of the radial nerve + roots

Answer 12

Travels from axilla, from medial to lateral through the radial groove o the humerus, and enters forearm anterior to lateral epicondyle of humerus

(C5-T1)

Question 13

Describe the anatomical course of the median nerve + roots

Answer 13

Travels lateral to brachial artery superiorly, before crossing over and travelling through the cubital fossa into the forearm

(C6-T1)

Question 14

Describe the anatomical course of the ulnar nerve + roots

Answer 14

Travels down medial arm, and crosses into posterior compartment at the mid point of the arm.

(C8-T1)