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MSK > Cortex- Upper limb and Hands Trauma > Flashcards

Cortex- Upper limb and Hands Trauma Flashcards

1
Q

how do you break your proximal humerus

A

FOOH, fall directly onto shoulder

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2
Q

what is the most common pattern of proximal humerus fracture

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

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3
Q

what happens to the greater and lesser tuberosities in a proximal humerus fracture

A

may be avulsed with the attachments of Supraspinatus, Infraspinatus and teres minor for the greater tuberosity and subscapularis for the lesser tuberosity

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4
Q

what is the treatment for displaced proximal humerus fractures

A

minimally displaced= conservative- sling

persistently displaced- internal fixation

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5
Q

can you get AVN in humeral head

A

yes- can be seen in comminuted proximal humerus fractures

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6
Q

when might shoulder replacement be needed in humeral neck fractures

A

head splitting fractures, comminuted fractures

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7
Q

which direction of shoulder dislocation is most common

A

anterior

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8
Q

what causes anterior shoulder dislocation

A

excessive external rotation force/ fall onto the back of the shoulder
can occur due to seizure

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9
Q

what is a nankart lesion

A

when an anterior shoulder dislocation results in detachment of the anterior glenoid labrum and capsule

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10
Q

what is a hill sachs lesion

A

when the posterior humeral head impacts on the anterior glenoid causing an impaction fracture on the posterior humeral head

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11
Q

what nerve can be stretched in an anterior shoulder dislocation

A

axillary nerve as it passes through the quadrangle space + other nerves of the brachial plexus

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12
Q

what artery can be damaged by an anterior shoulder dislocation

A

axillary artery

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13
Q

what is the sign of axillary nerve injury

A

loss of feeling in the regimental badge area

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14
Q

what is the management for an anterior shoulder dislocation

A

closed reduction (sedated/ anaesthetic)
neurovascular assessment
sling for 2-3 weeks to allow detached capsule to heal
physio

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15
Q

when is open reduction required for anterior shoulder dislocation

A

is delayed presentations- alcoholics

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16
Q

what is the usual treatment for shoulder fracture disocations

A

surgery- ORIF

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17
Q

does the risk of recurrent dislocations increase or decrease with age

A

decreases with age

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18
Q

how can recurrent dislocations be stabilised

A

bankart repair with reattachment of the torn labrum and capsule

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19
Q

what can cause ligamentous laxity

A

idiopathic, hypermobility, CTD- ehlers-danlos syndrome, marfans syndrome

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20
Q

what is the mainstay of treatment for shoulder dislocations due to instability

A

physio to build up rotator cuff muscles

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21
Q

what causes a posterior shoulder dislocation

A

posterior force on the adducted and internally rotated arm

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22
Q

what is the lightbulb sign

A

AP x ray sign of posterior shoulder dislocation

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23
Q

what causes an ACJ injury

A

fall onto the point of the shoudler

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24
Q

what can happen to the AC joint

A

sprained, subluxed, dislocated

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25
what happens to the AC ligaments in a subluxation and dislocations
subluxation- ruptured | dislocation- disrupted along with the conoid and trapezoid ligaments
26
how are the majorities of ACJ injuries managed
conservative- sling, physio
27
when do you get surgery for ACJ injuries
(reconstruction of coracoclavicular ligaments) chronic pain athletes (controversial)
28
do humeral shaft fractures heal well
yes- 90% union rate
29
what can cause humeral shaft fractures
direct trauma resulting in transverse or comminuted fractures, or by fall with or without twisting injury resulting in oblique or spiral fractures.
30
how much angulation can be accepted in humeral shaft fractures
30 degrees
31
what present with wrist drop and loss of sensation in the first dorsal web space
radial nerve in the spiral groove injury - often in humeral shaft fractures
32
how are humeral shaft fractures treated
Most cases are treated non-operatively with a functional humeral brace which compresses the fragments into acceptable alignment and provides some stability internal fixation in polytrauma and plating and bone grafting in non unions
33
how gets supracondylar fractures
children
34
what causes an olecranon fracture
fall onto the point of an elbow with contraction of the triceps muscle
35
what is the treatment for an olecranon fracture
most undergo ORIF- to restore triceps function and articular surface comminuted fractures require ORIF with plates and screws
36
how can a simple transverse olecranon avulsion fracture be fixed
with tension band wiring
37
how do the bones of the forearm act as a ring
radius and ulnar bones plus the ligaments around the proximal and distal radio ulnar joints act as a ring- break in one will likely cause break or dislocation in the other
38
what is a nighstick fracture
am isolated fracture of the ulnar shaft
39
how are fractures of the ulnar shaft treated
most conservatively | ORIF might mean quicker recover
40
how is a fracture of both forearm bones treated
usually ORIF with plates and screws children (minimally angulated) can be treated with plaster as will remodel as the child grows if intact periosteum can b treated with MUA and plaster
41
what is a monteggia fracture dislocation
when the ulnar fractures and the radial head dislocates at the elbow
42
how are monteggia fractures managed
ORIF- even for kids
43
what is a galeazzi fracture dislocation
fracture of the radius with dislocation of the ulnar a the distal radioulnar joint
44
how are galeazzi fracture dislocations treated
ORIF
45
why in forearm radioulnar fracture dislocations do you need two xrays
Forearm xrays may not easily demonstrate the incongruence of the radiocapitallar joint
46
how do you get distal radial fractures
FOOSH
47
what is a colles fracture
extra articular fracture of the distal radius within an inch of the articular surface + dorsal displacement or angulation
48
what causes a colles fracture
FOOSH
49
what fracture is often associated with a colles fracture
fracture of the ulnar styloid
50
what colles fractures have best outcomes
those that heal with less angulation and shortening - have less pain and better pain, grip, ROM, function
51
how are colles fractures treated
minimally displaced/ angulated= splintage angulation past neutral= manipulation, plastercast/ percutaneous wires or ORIF with plates and screws if unstable after reudction
52
what nerve damage may accompany a colles fracture
median nerve compression from stretch of the nerve/ bleed into the carpal tunnel
53
what is the specific late complication of a colles fracture
rupture of the extensor pollicis longus tendon
54
what is a smiths fracture
volarly displaced or angulated extra‐articular fracture of the distal radius which usually occurs after falling onto the back of a flexed wrist.
55
what is the treatment for smiths fracture
all should undergo ORIF using plate and screws as are highly unstable
56
what are bartons fractures
intra‐articular fractures of the distal radius involving the dorsal or volar rim, where the carpal bones of the wrist joint sublux with the displaced rim fragment
57
what are the types of bartons fracture
volar- an intra-articular Smith's fracture | dorsal- an intra-articular Colles' fracture
58
how are bartons fractures fixed
ORIF
59
how do you restore the shortening in comminuted intra-articular distal radius fractures
an external fixator +/- supplementary wires
60
what do penetrating volar injuries risk
damage to flexor tendons, digital nerves and digital arteries
61
what do dorsal penetrating injuries risk
damage to the extensor tendons
62
what is the treatment for complete or significant partial hand tendon injuries
surgical repair
63
what do digital nerve injuries proximal to the DIPJ need
repair
64
what does an arterial injury to a digit cause
injury to the adjacent digital nerve | circulation may also be lost
65
how are extensor tendon injuries treated
usually surgery with splintage in extension for 6 weeks as any flexion within this period may cause failure of the repair
66
what is mallet finger
avulsion of the extensor tendon from its insertion into the terminal phalanx
67
what causes mallet finger
forced flexion of the extended DIPJ- e.g. ball at sport
68
how does a mallet finger present
pain, drooped DIPJ, inability to extend at DIPJ
69
what is the treatment for mallet finger
mallet splint, holds DIPJ extended for 4 weeks
70
what are hand tendon pulleys
thickenings of the tendon sheaths which hold the tendon to the finger
71
what else is at risk in flexor tendon injuries
digital nerves and arteries
72
what are the two types of hand flexor tendons
superficial and deep (distal to superficial)
73
why are pulley important
prevent bowstringing of the tendon
74
how are flexor tendon injuries of the hand treated
may require surgery | splinted in flexed position- often with elastic traction to allow early movement and prevent stiffness and adhesions
75
what do penetrating injuries in the volar forearm risk
injury to the wrist flexors (FCU & FCR) as well as the long flexors to the fingers and thumb (requiring repair)
76
what metacarpal fracture are usually treated conservatively- why
3rd, 4th and 5th 3rd and 4th metacarpals have strong intermetacarpal ligaments proximally and distally giving stability to these fractures and usually minimal displacement
77
what often causes a fracture of the 5th metacarpal
punching injury
78
how much angulation in a 5th metacarpal fracture can be tolerated
45 degrees
79
what is the treatment for a 5th metacarpal fracture
neighbour strapping early motion possible K wire stabilisation
80
what is a fight bite injury and what are the risks of it
laceration sustained to the puncher's hand from the punchee's tooth could potentially penetrate the MCP joint and or disrupt the extensor tendon Intra‐oral organisms may cause an aggressive infection leading to septic arthritis- needs to be washed out in theatre
81
what is the treatment for phalangeal fractures
neighbour strapping or splintage. Significantly displaced or angulated fractures may require manipulation under anaesthetic or digital nerve block (ring block) and unstable fractures may require K‐wiring or fixation with small screws. Intra‐articular fractures may be fixed with k‐wires or small screws.

MSK (71 decks)

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