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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
Q

what happens to the AC ligaments in a subluxation and dislocations

A

subluxation- ruptured

dislocation- disrupted along with the conoid and trapezoid ligaments

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26
Q

how are the majorities of ACJ injuries managed

A

conservative- sling, physio

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27
Q

when do you get surgery for ACJ injuries

A

(reconstruction of coracoclavicular ligaments)
chronic pain
athletes (controversial)

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28
Q

do humeral shaft fractures heal well

A

yes- 90% union rate

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29
Q

what can cause humeral shaft fractures

A

direct trauma resulting in transverse or comminuted fractures, or by fall with or without twisting injury resulting in oblique or spiral fractures.

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30
Q

how much angulation can be accepted in humeral shaft fractures

A

30 degrees

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31
Q

what present with wrist drop and loss of sensation in the first dorsal web space

A

radial nerve in the spiral groove injury - often in humeral shaft fractures

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32
Q

how are humeral shaft fractures treated

A

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

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33
Q

how gets supracondylar fractures

A

children

34
Q

what causes an olecranon fracture

A

fall onto the point of an elbow with contraction of the triceps muscle

35
Q

what is the treatment for an olecranon fracture

A

most undergo ORIF- to restore triceps function and articular surface

comminuted fractures require ORIF with plates and screws

36
Q

how can a simple transverse olecranon avulsion fracture be fixed

A

with tension band wiring

37
Q

how do the bones of the forearm act as a ring

A

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
Q

what is a nighstick fracture

A

am isolated fracture of the ulnar shaft

39
Q

how are fractures of the ulnar shaft treated

A

most conservatively

ORIF might mean quicker recover

40
Q

how is a fracture of both forearm bones treated

A

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
Q

what is a monteggia fracture dislocation

A

when the ulnar fractures and the radial head dislocates at the elbow

42
Q

how are monteggia fractures managed

A

ORIF- even for kids

43
Q

what is a galeazzi fracture dislocation

A

fracture of the radius with dislocation of the ulnar a the distal radioulnar joint

44
Q

how are galeazzi fracture dislocations treated

A

ORIF

45
Q

why in forearm radioulnar fracture dislocations do you need two xrays

A

Forearm xrays may not easily demonstrate the incongruence of the radiocapitallar joint

46
Q

how do you get distal radial fractures

A

FOOSH

47
Q

what is a colles fracture

A

extra articular fracture of the distal radius within an inch of the articular surface + dorsal displacement or angulation

48
Q

what causes a colles fracture

A

FOOSH

49
Q

what fracture is often associated with a colles fracture

A

fracture of the ulnar styloid

50
Q

what colles fractures have best outcomes

A

those that heal with less angulation and shortening - have less pain and better pain, grip, ROM, function

51
Q

how are colles fractures treated

A

minimally displaced/ angulated= splintage

angulation past neutral= manipulation, plastercast/ percutaneous wires or ORIF with plates and screws if unstable after reudction

52
Q

what nerve damage may accompany a colles fracture

A

median nerve compression from stretch of the nerve/ bleed into the carpal tunnel

53
Q

what is the specific late complication of a colles fracture

A

rupture of the extensor pollicis longus tendon

54
Q

what is a smiths fracture

A

volarly displaced or angulated extra‐articular fracture of the distal radius which usually occurs after falling onto the back of a flexed wrist.

55
Q

what is the treatment for smiths fracture

A

all should undergo ORIF using plate and screws as are highly unstable

56
Q

what are bartons fractures

A

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
Q

what are the types of bartons fracture

A

volar- an intra-articular Smith’s fracture

dorsal- an intra-articular Colles’ fracture

58
Q

how are bartons fractures fixed

A

ORIF

59
Q

how do you restore the shortening in comminuted intra-articular distal radius fractures

A

an external fixator +/- supplementary wires

60
Q

what do penetrating volar injuries risk

A

damage to flexor tendons, digital nerves and digital arteries

61
Q

what do dorsal penetrating injuries risk

A

damage to the extensor tendons

62
Q

what is the treatment for complete or significant partial hand tendon injuries

A

surgical repair

63
Q

what do digital nerve injuries proximal to the DIPJ need

A

repair

64
Q

what does an arterial injury to a digit cause

A

injury to the adjacent digital nerve

circulation may also be lost

65
Q

how are extensor tendon injuries treated

A

usually surgery with splintage in extension for 6 weeks as any flexion within this period may cause failure of the repair

66
Q

what is mallet finger

A

avulsion of the extensor tendon from its insertion into the terminal phalanx

67
Q

what causes mallet finger

A

forced flexion of the extended DIPJ- e.g. ball at sport

68
Q

how does a mallet finger present

A

pain, drooped DIPJ, inability to extend at DIPJ

69
Q

what is the treatment for mallet finger

A

mallet splint, holds DIPJ extended for 4 weeks

70
Q

what are hand tendon pulleys

A

thickenings of the tendon sheaths which hold the tendon to the finger

71
Q

what else is at risk in flexor tendon injuries

A

digital nerves and arteries

72
Q

what are the two types of hand flexor tendons

A

superficial and deep (distal to superficial)

73
Q

why are pulley important

A

prevent bowstringing of the tendon

74
Q

how are flexor tendon injuries of the hand treated

A

may require surgery

splinted in flexed position- often with elastic traction to allow early movement and prevent stiffness and adhesions

75
Q

what do penetrating injuries in the volar forearm risk

A

injury to the wrist flexors (FCU & FCR) as well as the long flexors to the fingers and thumb (requiring repair)

76
Q

what metacarpal fracture are usually treated conservatively- why

A

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
Q

what often causes a fracture of the 5th metacarpal

A

punching injury

78
Q

how much angulation in a 5th metacarpal fracture can be tolerated

A

45 degrees

79
Q

what is the treatment for a 5th metacarpal fracture

A

neighbour strapping
early motion
possible K wire stabilisation

80
Q

what is a fight bite injury and what are the risks of it

A

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
Q

what is the treatment for phalangeal fractures

A

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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