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RB Y2 MSK Regional Trauma > Arm Fractures > Flashcards

Arm Fractures Flashcards

1
Q

proximal humerus fractures

  • who is it common in
  • displacement
  • which structures are often injured
A

common low energy in osteoperotic bone due to fall onto outstretched hand/directly onto shoulder

most commonly fracture of surgical neck (rather than anatomic neck) with medial displacement of the shaft due to the pull of the pec major muscle

brachial plexus and axillary artery are at risk of injury

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2
Q

where is the anatomical and surgical neck of the humerus

A
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3
Q

treatment of proximal humerus fractures

A

minimally displaced - conservatively in a sling

displaced - wait for muscle spasm to resolve, position might improve

persistently displaced - internal fixation, but stiffness, chronic pain and failure of fixation are common

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4
Q

humeral shaft fractures

A

caused by direct trauma resulting in transverse/comminuted fractures

or by fall with/out twisting injury - obique/spiral fractures

high union rates and due to mobility of joint significant (up to 30º) angulation can be tolerated without loss of function

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5
Q

what nerve is often damaged in humeral shaft fractures

  • how does this manifest
A

radial nerve that runs in radial groove

manifests as wrist drop ( supplies posterior extensor muscles) and loss of sensation in first dorsal web space

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6
Q

treatment of humeral shaft fracture

A

most non-operative with a brace that compresses the fragments into alignment

internal fixation with IM nail or screw may afford quicker recovery

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7
Q

distal humeral fractures

A

usually intra articular and so require ORIF

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8
Q

olecranon fracture

  • treatment
A

usually avulsion - fall onto elbow with triceps contraction

treat with ORIF

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9
Q

what are the attachments of the triceps muscle

A

proximal:

long head - infraglenoid tubercule of scapula

superior (lateral head) and inferior (medial head) to radial groove of humerus

distal:

all 3 heads combine to form triceps tendon, which attaches to olecranon process of the ulna

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10
Q

who are supracondylar fractures common in

A

most common type of elbow fracture in children

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11
Q

what are the two structures commonly injured in supracondylar fractures

A

median nerve and brachial artery

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12
Q

what is often damaged in a medial epicondyle fracture

A

ulnar nerve

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13
Q

radial head fractures

A
  • fall onto outstretched arm
  • OE; marked local tenderness over head of radius, impaired elbow movements and sharp pain at lateral side of elbow at extremes of rotation
  • undisplaced/minimally displaced treated conservatively with sling
  • often patients lose 10-15º extension
  • ORIF if fragment large enough or block to extension
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14
Q

x ray signs of radial head fracture

A
  • pathological posterior fat pad sign
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15
Q

why is the forearm unlikely to only break in one place

A

acts as a ring

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16
Q

nightstick fracture

  • manage
  • rule out?
A

isolated ulnar fracture occurs after direct blow

manage conservatively

rule out Monteggia

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17
Q
A

nightstick fracture

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18
Q

fracture of both bone of forearm

A

ORIF - highly unstable and anatomic reduction to maximise function and prevent deformity

in children, minimally angulated fractures can be treated with plaster only

19
Q

Monteggia fracture

A

fracture ulnar and dislocation of radial head

ORIF even in children

20
Q
A

monteggia

21
Q

Galeazzi fracture

A

fracture radius and dislocate ulnar at distal radioulnar joint

ORIF required

22
Q
A

Galeazzi fracture

23
Q

colles fracture

A

occurs doing FOOSH with wrist extended

distal radius dorsally displaced/angulated

treatment :

  • minimal and stable - POP
  • displaced - MUA
  • comminution - add K wiring
24
Q
A

colles fracture

25
Q

complications of colles fracture

A

median nerve compression, EPL rupture, loss of grip strength and CRPS

26
Q

smiths fracture

A

volarly (palmar) displaced distal radius - falling back onto flexed wrist

v unstable - ORIF

grip strength and extension greatly reduced if there is malunion with excessive volar angulation

27
Q

barton’s fracture

A

intra articular fracture of distal radius involving dorsal/volar rim, where the carpal bones of the wrist sublux into the displaced rim fragment

can be vorsal Bartons (intra-articular Smiths) or dorsal Barton’s (intra-articular Colles)

ORIF

28
Q
A

smiths fracture

29
Q

comminuted intra articular distal radius fracture

A

so comminuted stable fixation isnt possible

external fixator sited across joint, or wires to pin larger fragments

30
Q

scaphoid fracture

  • clinical signs
  • imaging
  • treatment
A
  • usually occurs after FOOSH
  • clinical signs are tenderness in anatomical snuffbox and pain on compressing thumb metacarpal
  • difficult to visualise on x ray - take 4 views if have suspicion. around 5% are only detected when callus forms
  • treatment: undisplaced - plaster cast for 6-12 weeks . displaced - compression screw
31
Q

clinical scaphoid fracture

A

fracture suspected but doesnt show up on x ray

reviews x rays 2 weeks later

32
Q

complications of scaphoid fracture

A

non union due to synovial fluid inhibiting healing

  • CT useful to determine if union has occurred

AVN of proximal pole due to retrograde blood supply from distal branch of radial artery

  • partial/total wrist fusion required
33
Q

penetrating hand injury

A

thorough examination, low threshold for surgical exploration

tendon injuries - surgical repair

digits can function with one digital artery, however, damage to both requires surgical repair

34
Q

extensor tendon injuries

A

divison of more than 50% requires surgical repair with splintage in extension for 6 weeks

35
Q

mallet finger

A

forced flexion of extended DIPJ causes avulsion of extensor tendon from insertion into terminal phalanx

patient presents with pain, dropped DIPJ and inability to extend

treat with mallet splint holding DIPJ in extension for >4 weeks

36
Q

flexor tendon injuries

A

problematic due to tendon sheaths and pulleys - bow stringing

fingers splinted in flexed position, often with elastic traction

37
Q

metacarpal fractures

  • boxers injury
  • fight bite
A

3, 4, 5 treated conservatively

5th - punching injury (boxer’s fracture)/ strap digit to adjacent finger and check rotational alignment

fight bite - laceration on hand from punchee’s tooth. risk of septic arthritis - explore and wash out, dont suture up in A and E

38
Q

Bennett fracture

A

intra articular fracture of base of CMC joint on thumb

39
Q

phalangeal fractures

A

neighbour strapping/splintage

significantly dispalced/angulated - MUA/digital nerve block

unstable - K wiring or fixation with small screws

40
Q

fat pad sign

A

The fat pad sign suggests displacement of one or more bones at the elbow, caused by displacement of the fat pad around the elbow joint.

Anterior fat pad is often normal, posterior is always pathological

41
Q

posterior fat pad sign in adults

A

suggests radial head fracture

42
Q

posterior fat pad sign in children

A

suggest supracondylar fracture

43
Q

clavicle fracture

  • incidence
  • management
A
  • occurs after a fall onto the point of the shoulder eg mountain bike or horse rider
  • managed in a broad arm sling
44
Q
A

RB Y2 MSK Regional Trauma (7 decks)

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