Common fractures of the upper limb

Question 1

Describe the appearance of a clavicular fracture

Answer 1

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).

Question 2

Name 2 causes of clavicular fractures

Answer 2

Direct trauma to shoulder

Fall on outstretched hand

Question 3

How is a clavicular fracture managed?

Answer 3

Broad arm sling with follow-up X-ray at 6 weeks

Internal fixation if non-union occurs

Question 4

Name 3 complications of clavicular fractures

Answer 4

Malunion
Damage to subclavian artery
Damage to brachial plexus
Pneumothorax

Question 5

Describe the clinical features of acromioclavicular injuries

Answer 5

Tender prominence over acromioclavicular joint
Positive scarfs test: horizontal flexion
Deformity due to raised clavicle

Question 6

What is the commonest cause of fractures of the proximal humerus?

Answer 6

Osteoporotic fractures in the elderly

Question 7

What is the commonest cause of fractures of the humeral shaft?

Answer 7

Fall on outstretched hand

Question 8

Which nerve is at risk of injury following a humeral shaft fracture?

Answer 8

Radial nerve: runs in the radial groove on the posterior aspect of the humerus

May cause wrist drop

Question 9

What is the commonest fracture of childhood?

Answer 9

Supracondylar fracture: peak between 5-7 years

Question 10

What is often the cause of a supracondylar fracture?

Answer 10

Child fall on outstretched hand

Question 11

List the neurovasculature that can be compromised by a supracondylar fracture

Answer 11

Brachial artery
Median nerve: typically anterior interosseous branch
Radial nerve
Ulnar nerve

Question 12

Name 3 complications of supracondylar fracture

Answer 12

Vascular injury to brachial artery ➔ ischaemic hand
Nerve injury: median nerve damage often temporary
Malunion

Question 13

What is pulled elbow?

Answer 13

Radial head slip out of the annular ligament, causing slight flexion and internal rotation.

Question 14

What is a buckle fracture?

Answer 14

Compression of cortex of one side, without disrupting the other side.

Question 15

What is a greenstick fracture?

Answer 15

Incomplete fracture of cortex of one side, with bending of cortex on the other side.

Question 16

Define Monteggia fracture

Answer 16

Fracture of the proximal 1/3 of the ulna, with dislocation of proximal head of the radius.

Question 17

Define Galeazzi fracture

Answer 17

Fracture of distal 1/3 of the radius, with dislocation of the distal radioulnar joint.

Question 18

Describe the Salter and Harris classification of epiphyseal injury

Answer 18

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

Question 19

Define Colles’ fracture

Answer 19

Transverse fracture of distal radius, with dorsal angulation and displacement. Produces a ‘dinner-fork’ deformity.

Question 20

What is the commonest cause of Colles’ fracture?

Answer 20

Osteoporotic post-menopausal women who fall on an outstretched hand

Question 21

Define Smiths’ fracture

Answer 21

Transverse fracture of distal radius with palmar angulation and displacement.

Question 22

Describe the clinical features of scaphoid fracture

Answer 22

Swelling and tenderness in anatomical snuff box and over scaphoid tubercle.
Pain on wrist movement and longitudinal compression of thumb.

Question 23

What imaging is used for scaphoid fractures?

Answer 23

Initial x-ray imaging may be negative
Repeat x-ray 2-3 weeks later
MRI: sensitive and cost-effective

Question 24

Name 3 complications of scaphoid fracture

Answer 24

Avascular necrosis: requires excision
Non-union
Osteoarthritis

Question 25

Why is avascular necrosis commoner with scaphoid fractures?

Answer 25

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.

Question 26

What is the commonest type of metacarpal fracture?

Answer 26

Boxer’s fracture: transverse fracture of 5th metacarpal +/- 4th metacarpal.