Elbow, Forearm and Wrist Trauma Flashcards
How is an intra-articular distal humerus fracture managed?
Under what circumstances would an elbow replacement be considered?
With ORIF (as are most intra-articular fractures), along with anatomic reduction and rigid fixation to minimise loss of function
Elbow replacement only considered in highly comminuted fractures in the elderly
How should the following olecranon fractures be managed?
- comminuted
- simple transverse avulsion
Comminuted - ORIF
Transverse avulsion - fixed with tension band wiring
How are fractures of the radial head and neck commonly caused?
What tell-tale sign shows up on Xrays? And how might they present clinically?
Commonly caused by FOOSH
May be undetected on Xray, other than a fat pad sign
Presents with lateral elbow pain on supination and pronation
What is a “nightstick fracture”?
How are they managed?
Fracture of the ulna without a dislocation of the radius
Most can be managed conservatively, however ORIF may give earlier return to function and lower the risk of non-union
An injury to the forearm that fractures both the radius and ulna is (stable/unstable)
How are they best managed?
Highly unstable
Best managed with ORIF
Flexible IM nails can be used if the fractures are still very unstable after reduction
What are Monteggia and Galeazzi fractures?
How are they both treated?
Monteggia - fracture of the ulna and dislocation of the radial head at the elbow (number 2 in the diagram)
Galeazzi - fracture of the radius and dislocation of the ulna at the distal radioulnar joint (number 1 in the diagram)
Both are treated sith ORIF
What is a Colles fracture?
How is it caused and how is it managed?
What is the classic deformity sign seen on Xray?
Extra-articular fracture of the distal radius within an inch of the articular surface and with dorsal displacement or angulation
Due to FOOSH
Treatment is dependent on severity
- minimal displacement - splintage alone, but need to manipulate any angulation past neutral
- can use plaster cast alone
- percutaneous wires can be used to pin the distal segment
- ORIF with plate and screws is the preferred management
Dinner fork deformity is seen on Xray
What nerve may be damaged in a Colles fracture?
The median nerve
What is a Smith’s fracture? What commonly causes it?
How is it best managed?
As with a Colles fracture, except the distal radius is displaced volarly
Caused by falling onto a flexed wrist
All Smith’s fractures need to be managed with ORIF using plate and screws as they are highly unstable
What is a Barton’s fracture?
How are they best managed?
Barton’s fracture is essentially the same as either a Colles or a Smith fracture except it is intra-articular
Best managed with ORIF
What make up the borders in the anatomical snuff box?
Pain and tenderness here after a FOOSH may indicate fracture of what bone?
Medial side (closer to the radius) - tendons of extensor pollicis brevis and abductor pollicis longus
Lateral side (closer to the ulna) - tendon of extensor pollicis longus
Pain/tenderness here could indicate fracture of the scaphoid
How are fractures of the scaphoid best visualised?
Due to the complex kidney bean shape, a standard Xray may not show fractures
4 separate Xrays are taken - 1 AP, 1 lateral and 2 oblique
What needs to be kept in mind when trying to visualise scaphoid fractures?
How is this managed clinically?
Around 5% will not be able to be visualised, and will only show up 2 weeks after resorption of the fracture ends
If the above is suspected, the wrist is placed in a cast at the time of injury and visualised again in 2 weeks, termed a “clinical scaphoid fracture”
How are the following scaphoid fractures managed
- undisplaced
- displaced
- non-union
undisplaced - cast for 6-12 week
displaced - fixed with a special compression screw sunk into the bone to avoid non-union
non-union - screw fixation and bone grafting
What % of peri-lunate dislocations go undiagnosed at presentation?
25% - classic “missed case diagnosis” injury
What is the difference between a lunate and a peri-lunate dislocation?
How are they commonly caused?
Peri-lunate - dislocation of one of the carpal bones around the lunate
Lunate - similar injury, but the lunate itself dislocates, usually volarlly
Classicaly caused by FOOSH
What classic radiographic sign might be seen in a lunate dislocation?
A spilt cup sign might be seen on Xray - as the lunate appears to look a little bit like a tea cup, on dislocation it looks like it is being poured out
How are lunate and peri-lunate dislocations managed?
Emergency treatment required as the median nerve may have been damaged causing acute carpal tunnel
Treatment is closed reduction (or open if this is not possible) and percutaneous pinning
What is Mallet Finger?
How is it treated?
Avulsion of the extensor tendon from its insertion into the terminal phalanx, caused by forced flexion of the extended DIP joint
Treated with a mallet splint holding the finger in extension. Should be worn for a minimum of 4 weeks
