Arm Injury Flashcards
1
Q
Learning Outcome:
A
- Fracture of proximal humerus
- Fracture of humeral shaft
- Fracture of distal humerus
- Supracondylar fracture
- Fracture of capitulum
- Head of radius fracture
- Olecranon fracture
- Elbow dislocation
- Radial head dislocation
2
Q
Fracture of proximal humerus pathology
A
- Epids:
- more common in elderly, middle aged, osteoporotic - Mechanism of injury:
- low energy: elderly fall on out-stretched arm. loss of protective mechanism
- high energy: young,
may also cause dislocation, neurovascular injury - Proximal humerus part
- articular segment
- greater tuberosity
- lesser tuberosity
- shaft/surgical neck - Neer’s Classification
*Neer displacement: displacement of segment more than 1 cm or 45 degreel
I - no neer displacement (one-part fracture)
II - 1 neer displacement (two-part fracture)
III - 2 near displacement (three-part fracture)
IV - all segment displaced (four part fracture)
V - fracture dislocation - Displacement after fracture
- shaft: anteriomedially due to pecs major pull
- greater tuberosity: externally rotated due to supraspinatus, infraspinatus, teres minor
- articular segment/head: internally rotated due to subscapularis - Predictors of humeral head ischaemia
- medial calcar length less than 8mm
- disrupted medial hinge
- basic fracture - Associated injury
- axillary nerve
- brachial plexus
- arterial injury (if at level of surgical neck) - Neck-shaft angle: 135 degree
- Blood supply to humeral head
i. Ascending branch -> anterior humeral@ circumflex -> axillary
ii. Arcuate -> anterior humeral circumflex -> axillary
iii. posterior humeral circumflex-> axillary
3
Q
Fracture of proximal humerus diagnosis
A
Hx
- trauma: fall on outstreched arm
- bruises upper part of arm
- tro axillary nerve injury
- tro lower brachial plexus injury (same mechanism)
- tro dislocation
X-Ray
- Axillary view
- Scapular Y view
- AP view (Grashey)
4
Q
Fracture of humeral shaft pathology
A
- Mechanism of injury:
- fall on hand (twisting)
- fall on elbow with abducted arm (bending)
- direct blow (transverse or comminuted)
- pathological: bone mets - Fracture displacement
- fracture above deltoid insertion: proximal segment adducted (pecs major)
- fracture below deltoid insertion: proximal fragment abducted (deltoid) - Associate injury
- radial nerve injury - Radial nerve:
- along spiral groove
- 14 cm proximal to lateral epicondyle
- 20 cm proximal to medial epicondyle - Classification
- fracture location: proximal, middle, distal (Holsten Lewis fracture)
- fracture pattern: spiral, transverse, comminuted - Acceptable alignment:
- <20 anterior angulation
- <30 varus or valgus
- <3 cm shortening
5
Q
Fracture of humeral shaft diagnosis
A
Hx
- trauma:
- fall on hand (twisting)
- fall on elbow with abducted arm (bending)
- direct blow (transverse or comminuted)
- pain, extensive bruise, swelling
- assess radial nerve injury
Pe
- radial nerve injury (wrist drop, finger drop)
- shortening
- varus
X-Ray
- AP, Lateral
6
Q
Fracture of distal humerus pathology
A
- Classification
I. supracondylar fracture:
- extension (95%): Gartland Classification
- flexion (5%)
II. single column fracture: Milch Classification (medial or lateraly condyle)
- Type 1: lateral trochlear ridge intact
- Type 2: through lateral trochlear ridge
III. bicolumnar fracture: Jupiter Classification
- High T (above olecranon fossa)
- Low T (above trochlea)
- Y
- H (trochlea as free fragment)
- Medial/Lateral lambda
- Multiplane T
IV. Capitulum fracture - Epidemiology: young male, older females
- Mechanism of injury:
- axial loading
- direct blow - Associated injury
- elbow dislocation
- terrible triad injury
- floating elbow
- forearm compartment syndrome (volkmann contracture)
7
Q
Supracondylar fracture of humerus pathology
A
- Displacement
- Extension (95%)
- Flexion (5%) - Epidemiology
- young children age (5-7)
- male - Mechanism of injury
- fall on outstretched hand - Association injury
I. Neuropraxia
- anterior interosseus nerve (median): most common
- radial nerve: 2nd most common
- ulnar nerve: flexion type, medial condyle
II. Vascular - Classification: Gartland
I. undisplaced
II. displaced with intact posterior periosteum
III. completely displaced (in 2 or 3 planes)
IV. complete periosteal disruption with instability (flexion and extension)
*beware of minute media comminution (leads to Gunstock deformity)
8
Q
Supracondylar fracture of humerus diagnosis
A
Hx
- trauma: fall on outstretched hand
- pain, swelling, bruises, deformity
- TRO AIN, radial, ulnar nerve injury
- TRO vascular injury
X-Ray
- Lateral view:
- Posterior fat pad sign “lucency along posterior distal humerus and olecranon fossa - fat pushed by haematoma
- displacement of anterior humeral line (should intersect middle third of capitalum) - AP view:
- Baumann’s angle (70-75 degree) *angle between longlitudinal axis and line along lateral condylar physis
9
Q
Fracture of capitulum pathology
A
- Epidemiology: rare, occur only in adults
- Mechanism of injury: fall on outstretched hand with straight elbow
3. Bryan and Morrey Classification I - Complete fracture II - Cartilaginous shell III - Comminuted fracture IV - Includes trochlea
- Associatied injury:
- radial head fracture
- LUCL injury
10
Q
Fracture of capitulum diagnosis
A
Hx
- trauma: fall on outstretchedhand with straight/semi-flexed elbow
Pe
- fullness in front of elbow
- tender on lateral elbow
- restricted flexion
X-Ray
- Lateral: Capitulum displaced anterior to humerus, Radial head not pointing towards capitulum
11
Q
Head of radius fracture pathology
A
- Epidemiology: common in adult (rare in children because cartilaginous).
- Mechanism of injury
- fall on oustretched hand with extended, pronated elbow
3. Mason Classification I - undisplaced vertical split II - displaced III - comminuted IV - with elbow dislocation
- Associated injury
- LCL
- MCL
- DRUJ
- Terrible triad: elbow dislocation, radial head fracture, coronoid fracture
- Scaphoid fracture
12
Q
Head of radius fracture diagnosis
A
Hx
- trauma: fall on outstretchedhand with extended elbow
Pe
- tenderness of radial head (lateral aspect of elbow)
- restricted supination and pronation
- TRO elbow instability (valgus test)
- TRO DRUJ instability (wrist tenderness)
- TRO longlitudinal instability (radius pull test)
X-Ray
- AP, Lateral: fat pad sign (occult fracture)
- Greenspan/Radiocapitellar view (no coronoid overlapping allow easier visualization of head of radius)
13
Q
Neck of radius fracture pathology
A
- Epidemiology: common in children
- Mechanism of injury: fall on outstretched hand, extended and pronated elbow
- O’Brien Classification
I- less than 30 degree
II - 30-60 degree
III - more than 60 degree
4. Elbow ossification around elbow joint Capitulum - 1 yr Radius - 3 yrs Internal epicondyle - 5 yrs Trochlea - 7 yrs Olecranon - 9 yrs External epicondyle - 11 yrs
- Associated injury: same as radial head
14
Q
Olecranon fracture pathology
A
- Mechanism of injury:
- fall on elbow (comminuted)
- fall on hand with triceps contracted (transverse)
2. Mayo Classification I - Undisplaced II - Displaced a - non-comminuted b - comminuted III - Unstable
- Associated injury
- tricep tendon rupture
- anconeus tendon rupture
15
Q
Olecranon fracture diagnosis
A
Hx
- trauma: fall on elbow
- pain posterior elbow
Pe
- tenderness of olecranon
- inability to extend elbow
X-Ray
- Lateral
