Cortex - Adult trauma (upper limb) 2

Question 1

What is the common mechanism of injury for distal radial fractures ?

Answer 1

A common injury sustained following a fall into an outstretched hand (FOOSH).

Question 2

What is a colles fracture ?

Answer 2

An extra-articular fracture of the distal radius within an inch of the articular surface with dorsal displacement or angulation

Question 3

What nerve is at risk of injury following a colles fracture ?

Answer 3

• The median nerve
• Note - this shows the link of how a colles fracture can result in carpal tunnel syndrome

Question 4

What is a smiths fracture ?

Answer 4

It is a volarly displaced or angulated extra-articualr fracture of the distal radius

Question 5

Colles and smiths fractures are similar how do they differ in the mechanism of injury ?

Answer 5

• Differ as colles fracture is due to FOOSH (fall onto an outstretched hand)
• Whereas it is falling onto the back of a flexed wrist

Question 6

What is a bartons fracture ?

Answer 6

• They are intra-articular fractures of the distal radius involving the dorsal or volar rim, the carpal bones of the wrist joint sublux.
• Hence bartons fractures can be classified as volar (an intra-articular smiths fracture) or dorsal (an intra-articular colles fracture) bartons fractures

Question 7

What is the treatment of colles fractures ?

Answer 7

Depends on the degree of displacement or angulation:

• Minimally displaced - splintage
• Fracture may be treated with plaster cast alone but if dorsal communion or particularly unstable - then percutaneous wires or ORIF with plate or screws

Question 8

What is the treatment for all smith fractures and why ?

Answer 8

ORIF using plate and screws - as they are highly unstable fractures

Question 9

What is the treatment of bartons fractures ?

Answer 9

ORIF (as with most intra-articular fractures)

Question 10

For Comminuted intra‐articular distal radius fracture what can be done to treat it ?

Answer 10

An external fixator and supplementary wires may be used for larger fragments

Question 11

What is the typical presentation of a scaphoid fracture ?

Answer 11

Usually occur after a FOOSH. Clinical signs include tenderness in the anatomic snuff box and pain on compressing the thumb metacarpal

Question 12

How are scaphoid fractures diagnosed ?

Answer 12

X-ray but 4 views done when suspected as it is hard to see (AP, lateral and 2 oblique views)

Question 13

What is the treatment of scaphoid fractures ?

Answer 13

• Undisplaced - plaster cast
• Displaced - special compression screw

Question 14

What are some of the common complications of scaphoid fractures ?

Answer 14

• Non-union
• AVN

Question 15

Penetrating injuries to the hand are common - what structures are at risk of damage due to these type of injuries ?

Answer 15

• Volar injuries risk damage to the flexor tendons, digital nerves and digital arteries.
• Dorsal injuries risk damage to the extensor tendons.

Question 16

How are complete or significant partial tendon injuries treated ?

Answer 16

Surgical repair

Question 17

Describe what mallet finger is and what it looks like

Answer 17

• An injury due to avulsion of the extensor tendon from its insertion into the terminal phalanx caused by forced flexion of the DIPJ of the extended DIPJ, often from a ball at sport
• Presents as a drooped DIDJ of affected finger and inability to extend at the DIPJ

Question 18

What is the treatment of mallet finger ?

Answer 18

Mallet splint holding the DIPJ extended

Question 19

How are flexor tendon injuries of the hand treated ?

Answer 19

Surgical repair with special sutures

Question 20

How are fractures of the metacarpals treated ?

Answer 20

3rd and 4th and 5th are treated conservatively using splintage/plaster cast

Question 21

What is a fracture to the 5th metacarpal known as ?

Answer 21

Boxers fracture

Question 22

How are phalangeal fractures treated ?

Answer 22

With strapping or slintage