Cortex - Adult trauma (upper limb) 1 Flashcards
How do the majority of proximal humerus fractures occur ?
Majority being low energy injuries in osteoprotic bone due to a fall onto the outstretched hand or directly onto the shoulder.
What is the most common pattern for the appearance of proximal humerus fractures ?
Is a fracture of the surgical neck (rather than the anatomic neck) with medial displacement of the humeral shaft due to pull of the pectoralis major muscle.
What is the treatment of proximal humerus fractures ?
- Minimally displaced - conservative treatment with a sling and gradual mobilisation
- Persistently displaced (usually displacement settles) - internal fixation
During anterior dislocation of the shoulder which nerve is at risk of injury and if it is injured how does it characteristically present ?
- Axillary nerve is at risk
- Prinicple sign is loss of sensation in the regimental badge area
What are the two different lesions that anterior dislocation of the shoulder can cause?
- Bankart lesion - detachment of the anterior glenoid labrum and capsule
- Hill-sachs lesion - posterior humeral head can impact on the anterior glenoid producing an impaction fracture of the posterior head
Upon clinical assessment of the shoulder what would indict a shoulder dislocation ?
- Loss of symmetry with a loss of roundness of the affected shoulder
- Arm held in an adducted position with the other arm supporting it
How are shoulder dislocations diagnosed ?
X-ray
What is the mainstay of treatment for all shoulder dislocations ?
- Closed reduction
- Immobilisation
- Followed by physio
When do injuries to the acromioclavicular joint usually occur ?
After a fall onto the point of the shoulder
What are the 3 levels of injury to the acromioclavicualr joint ?
- Sprained
- Subluxed
- Dislocated
Describe, sprained, subluxed and dislocated acromioclavicular joints
- Sprained (diagram 1)
- Subluxed - the acromioclavicular ligaments are ruptured (diagram 2)
- Dislocated - the acromioclavicular and coracoclavicular ligaments are ruptured (diagram 3)
What is the treatment of ACJ injuries ?
Conservative management:
- 1st line - Sling followed by physio
- 2nd line - Surgery (reconstruction of the coracoclavicular ligaments) for those with chronic pain
Humeral shaft fractures have 2 main mechanisms of injury which produce different types of fractures - match them below:
- Trauma,
- Fall with or without twisting injury
Oblique or spiral fractures, Transverse or comminuted fractures
- Trauma - Transverse or comminuated fractures
- Fall with or without twisiting injury - Oblique or spiral fractures (this one more twisting remember)
Which nerve is susceptible to injury following a humeral shaft fracture ?
Radial - presents with wrist drop and loss of sensation in the first dorsal web space.
How are most cases of humeral shaft fractures treated ?
A functional humeral brace which compresses the fragments into acceptable alignment
What is an olecranon fracture and how do they occur ?
- Fracture of the olecranon in the elbow
- Occur due to a fall onto the point of the elbow with contraction of the triceps muscle.
What is a nightstick fracture and what do you need to make sure its not?
- It is a fracture of just the ulnar which can occur after a direct blow to it
- Need to make sure its not a monteggia fracture dislocation
What type of fracture is shown ?
A diaphyseal fracture of both bones of the forearm
What is a monteggia fracture dislocation ?
Where a fracture of the ulna occurs with dislocation of the radial head at the elbow.
What is a Galeazzi fracture dislocation?
A fracture of the radius with dislocation of the ulna at the distal radioulnar joint
