Cortex- Upper limb and Hands Trauma Flashcards
how do you break your proximal humerus
FOOH, fall directly onto shoulder
what is the most common pattern of proximal humerus fracture
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 happens to the greater and lesser tuberosities in a proximal humerus fracture
may be avulsed with the attachments of Supraspinatus, Infraspinatus and teres minor for the greater tuberosity and subscapularis for the lesser tuberosity
what is the treatment for displaced proximal humerus fractures
minimally displaced= conservative- sling
persistently displaced- internal fixation
can you get AVN in humeral head
yes- can be seen in comminuted proximal humerus fractures
when might shoulder replacement be needed in humeral neck fractures
head splitting fractures, comminuted fractures
which direction of shoulder dislocation is most common
anterior
what causes anterior shoulder dislocation
excessive external rotation force/ fall onto the back of the shoulder
can occur due to seizure
what is a nankart lesion
when an anterior shoulder dislocation results in detachment of the anterior glenoid labrum and capsule
what is a hill sachs lesion
when the posterior humeral head impacts on the anterior glenoid causing an impaction fracture on the posterior humeral head
what nerve can be stretched in an anterior shoulder dislocation
axillary nerve as it passes through the quadrangle space + other nerves of the brachial plexus
what artery can be damaged by an anterior shoulder dislocation
axillary artery
what is the sign of axillary nerve injury
loss of feeling in the regimental badge area
what is the management for an anterior shoulder dislocation
closed reduction (sedated/ anaesthetic)
neurovascular assessment
sling for 2-3 weeks to allow detached capsule to heal
physio
when is open reduction required for anterior shoulder dislocation
is delayed presentations- alcoholics
what is the usual treatment for shoulder fracture disocations
surgery- ORIF
does the risk of recurrent dislocations increase or decrease with age
decreases with age
how can recurrent dislocations be stabilised
bankart repair with reattachment of the torn labrum and capsule
what can cause ligamentous laxity
idiopathic, hypermobility, CTD- ehlers-danlos syndrome, marfans syndrome
what is the mainstay of treatment for shoulder dislocations due to instability
physio to build up rotator cuff muscles
what causes a posterior shoulder dislocation
posterior force on the adducted and internally rotated arm
what is the lightbulb sign
AP x ray sign of posterior shoulder dislocation
what causes an ACJ injury
fall onto the point of the shoudler
what can happen to the AC joint
sprained, subluxed, dislocated
what happens to the AC ligaments in a subluxation and dislocations
subluxation- ruptured
dislocation- disrupted along with the conoid and trapezoid ligaments
how are the majorities of ACJ injuries managed
conservative- sling, physio
when do you get surgery for ACJ injuries
(reconstruction of coracoclavicular ligaments)
chronic pain
athletes (controversial)
do humeral shaft fractures heal well
yes- 90% union rate
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.
how much angulation can be accepted in humeral shaft fractures
30 degrees
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
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
how gets supracondylar fractures
children
what causes an olecranon fracture
fall onto the point of an elbow with contraction of the triceps muscle
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
how can a simple transverse olecranon avulsion fracture be fixed
with tension band wiring
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
what is a nighstick fracture
am isolated fracture of the ulnar shaft
how are fractures of the ulnar shaft treated
most conservatively
ORIF might mean quicker recover
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
what is a monteggia fracture dislocation
when the ulnar fractures and the radial head dislocates at the elbow
how are monteggia fractures managed
ORIF- even for kids
what is a galeazzi fracture dislocation
fracture of the radius with dislocation of the ulnar a the distal radioulnar joint
how are galeazzi fracture dislocations treated
ORIF
why in forearm radioulnar fracture dislocations do you need two xrays
Forearm xrays may not easily demonstrate the incongruence of the radiocapitallar joint
how do you get distal radial fractures
FOOSH
what is a colles fracture
extra articular fracture of the distal radius within an inch of the articular surface + dorsal displacement or angulation
what causes a colles fracture
FOOSH
what fracture is often associated with a colles fracture
fracture of the ulnar styloid
what colles fractures have best outcomes
those that heal with less angulation and shortening - have less pain and better pain, grip, ROM, function
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
what nerve damage may accompany a colles fracture
median nerve compression from stretch of the nerve/ bleed into the carpal tunnel
what is the specific late complication of a colles fracture
rupture of the extensor pollicis longus tendon
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.
what is the treatment for smiths fracture
all should undergo ORIF using plate and screws as are highly unstable
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
what are the types of bartons fracture
volar- an intra-articular Smith’s fracture
dorsal- an intra-articular Colles’ fracture
how are bartons fractures fixed
ORIF
how do you restore the shortening in comminuted intra-articular distal radius fractures
an external fixator +/- supplementary wires
what do penetrating volar injuries risk
damage to flexor tendons, digital nerves and digital arteries
what do dorsal penetrating injuries risk
damage to the extensor tendons
what is the treatment for complete or significant partial hand tendon injuries
surgical repair
what do digital nerve injuries proximal to the DIPJ need
repair
what does an arterial injury to a digit cause
injury to the adjacent digital nerve
circulation may also be lost
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
what is mallet finger
avulsion of the extensor tendon from its insertion into the terminal phalanx
what causes mallet finger
forced flexion of the extended DIPJ- e.g. ball at sport
how does a mallet finger present
pain, drooped DIPJ, inability to extend at DIPJ
what is the treatment for mallet finger
mallet splint, holds DIPJ extended for 4 weeks
what are hand tendon pulleys
thickenings of the tendon sheaths which hold the tendon to the finger
what else is at risk in flexor tendon injuries
digital nerves and arteries
what are the two types of hand flexor tendons
superficial and deep (distal to superficial)
why are pulley important
prevent bowstringing of the tendon
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
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)
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
what often causes a fracture of the 5th metacarpal
punching injury
how much angulation in a 5th metacarpal fracture can be tolerated
45 degrees
what is the treatment for a 5th metacarpal fracture
neighbour strapping
early motion
possible K wire stabilisation
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
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.
