Elbow, Wrist joint

Question 1

Supracondylar #

Answer 1

1. Fall on out stretched hand
2. Mc children
   3.Mx:
   Reduced with hyperflexion of elbow
   Collar and cuff immobilisation - 6wks
   Circulation monitoring 1 day

Question 2

Complications of sypracondylar #

Answer 2

1. Brachial artery impingement - forearm flexor compartment ischemia, muscle death (sev pain)
2. Median, radial, ulnar nerve damage

Question 3

Neck of radius #

Answer 3

Fall on outstretched hand
Closed reduction

Question 4

Pulled elbow

Answer 4

1. Children
2. Pulled at wrist … RADIAL HEAD DISLOCATION (injury/tear of annular radioulnar lig)
3. Pain on supination
4. Mx - Reduction (Xray not needed)
   If pain persists - Xray can be done

Question 5

Monteggia #

Answer 5

Ulna proximal 1/3 #
Dislocation of radial head
Mx - Sx plating of ulna, radial head reduction

Question 6

Shaft of ulna and radius #

Answer 6

Mx
1. Needs perfect reduction (non union otherwise)
2. Sx plating and reduction better
3. Healing
12wks - transverse #
6 wks - Spiral #

Question 7

Colles # c/f

Answer 7

1. Elderly, osteoporotic
2. Fall on hand
3. Distal 3cm of radius # (supination#)
4. DINNER FORK DEFORMITY
5. Posterior and lateral displacement

Question 8

**Colles # Mx

Answer 8

1. Minimal diaplacement:
   Below elbow plaster 4wks
   f/b crepe bandage
2. Major displacement
   Sx reduction under GA -FUP
   Flexion 10deg
   Ulnar deviation 10deg
   Pronation
   Below elbow plaster 4-6wks
   CXR after 10-14 days to check position

Question 9

**Colles # complication

Answer 9

Thumb extension lost - ruptured extensor pollicis longus tendon

Question 10

Smiths #

Answer 10

Reverse colles
fall on back of the hand
Mx - EUP
Extension, ulnar deviation, pronation

Question 11

*Scaphoid #

Answer 11

1. Fall on outstretched hand
2. @ base of thumb
3. Pain, swelling of snuffbox
4. Pain with thumb movement
5. Mx-
   Even if xray normal,
   Apply below elbow scaphoid plaster (with thumb and middle palm crease) - 10days
   Repeat Xray - # seen .. below elbow cast for 6-8wks (OR) surgical internal fixation

If second xray normal …
CT/MRI or isotope bone scan(best)

Question 12

Metacarpal #

Answer 12

Correct marked displacement with manipulation, under anaesthesia
Below elbow padded posterior plaster slab,
extending to dorsum of 1st pallanx