Common fractures of the upper limb Flashcards
Describe the appearance of a clavicular fracture
Lump is usually obvious and occasionally threatens the skin. The fracture usually occurs at the middle 1/3. The distal fragment is displaced inferiorly (weight of arm) and the proximal fragment displaced superiorly (sternocleidomastoid muscle).
Name 2 causes of clavicular fractures
Direct trauma to shoulder
Fall on outstretched hand
How is a clavicular fracture managed?
Broad arm sling with follow-up X-ray at 6 weeks
Internal fixation if non-union occurs
Name 3 complications of clavicular fractures
Malunion
Damage to subclavian artery
Damage to brachial plexus
Pneumothorax
Describe the clinical features of acromioclavicular injuries
Tender prominence over acromioclavicular joint
Positive scarfs test: horizontal flexion
Deformity due to raised clavicle
What is the commonest cause of fractures of the proximal humerus?
Osteoporotic fractures in the elderly
What is the commonest cause of fractures of the humeral shaft?
Fall on outstretched hand
Which nerve is at risk of injury following a humeral shaft fracture?
Radial nerve: runs in the radial groove on the posterior aspect of the humerus
May cause wrist drop
What is the commonest fracture of childhood?
Supracondylar fracture: peak between 5-7 years
What is often the cause of a supracondylar fracture?
Child fall on outstretched hand
List the neurovasculature that can be compromised by a supracondylar fracture
Brachial artery
Median nerve: typically anterior interosseous branch
Radial nerve
Ulnar nerve
Name 3 complications of supracondylar fracture
Vascular injury to brachial artery ➔ ischaemic hand
Nerve injury: median nerve damage often temporary
Malunion
What is pulled elbow?
Radial head slip out of the annular ligament, causing slight flexion and internal rotation.
What is a buckle fracture?
Compression of cortex of one side, without disrupting the other side.
What is a greenstick fracture?
Incomplete fracture of cortex of one side, with bending of cortex on the other side.
Define Monteggia fracture
Fracture of the proximal 1/3 of the ulna, with dislocation of proximal head of the radius.
Define Galeazzi fracture
Fracture of distal 1/3 of the radius, with dislocation of the distal radioulnar joint.
Describe the Salter and Harris classification of epiphyseal injury
I. Through growth plate, not involving bone
II. Through metaphysis and most of growth plate (75%)
III. Through some of growth plate and epiphysis
IV. Through metaphysis, growth plate, and epiphysis
V. Crush injury compressing growth plate
Define Colles’ fracture
Transverse fracture of distal radius, with dorsal angulation and displacement. Produces a ‘dinner-fork’ deformity.
What is the commonest cause of Colles’ fracture?
Osteoporotic post-menopausal women who fall on an outstretched hand
Define Smiths’ fracture
Transverse fracture of distal radius with palmar angulation and displacement.
Describe the clinical features of scaphoid fracture
Swelling and tenderness in anatomical snuff box and over scaphoid tubercle.
Pain on wrist movement and longitudinal compression of thumb.
What imaging is used for scaphoid fractures?
Initial x-ray imaging may be negative
Repeat x-ray 2-3 weeks later
MRI: sensitive and cost-effective
Name 3 complications of scaphoid fracture
Avascular necrosis: requires excision
Non-union
Osteoarthritis
Why is avascular necrosis commoner with scaphoid fractures?
Blood supply to the scaphoid is from branches of the radial artery, which run distal ➔ proximal. Proximal pole of scaphoid is at high risk of AVN following fracture.
What is the commonest type of metacarpal fracture?
Boxer’s fracture: transverse fracture of 5th metacarpal +/- 4th metacarpal.
