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NMSK 2 - upper limb > forearm, wrist and hand fractures > Flashcards

forearm, wrist and hand fractures Flashcards

1
Q

what is a monteggia fracture?

A

-fracture on the proximal ulna in association with a radial head dislocation

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2
Q

what is the MOI of a monteggia fracture?

A

fal on outstretched fully pronated arm

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3
Q

how is a monteggia fracture managed?

A

-ORIF
-cast above elbow in 90 degrees flexion to below wrist and in supination x4-6 weeks
-physio post cast

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4
Q

what is a galeazzi fracture?

A

-fracture of distal 1/3 of radius

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5
Q

what is a galeazzi fracture associated with?

A

a distal radioulnar joint injury

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6
Q

what complications are associated with a galeazzi fracture?

A

-malunion
-unstable distal fragment

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7
Q

how is a galeazzi fracture managed?

A

-ORIF - plate and screws
-cast as for monteggia

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8
Q

what is the MOI for a radial and ulna fracture?

A

-twisting injury / rotational deformity

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9
Q

what are the complications for a radius and ulna fracture?

A

-mal union
-non union
-compartment syndrome

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10
Q

what is the conservative management of a radius and ulna?

A

-not usually successful due to unopposed supination due to rotational deformity and slippage

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11
Q

how is a radial and ulna fracture treated surgically?

A

-ORIF - treatment of choice for this fracture
-cast above elbow

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12
Q

what is acute compartment syndrome?

A

-can happen after fracture - due to pressure increase - leading to ischaemia
-affects flexor muscles in forearm
can also affect median nerve, brachial artery etc

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13
Q

what condition can a patient have if their acute compartment syndrome is not treated?

A

-volkmann’s ischaemic contracture

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14
Q

what pressure in compartment syndrome requires fasciotomy?

A

30mmhg

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15
Q

list symptoms of compartment syndrome

A

-pain
-swelling
-numbness
-pins and needles
-painful ROM

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16
Q

what is a colles fracture?

A

fracture of distal radius but the broken end of radius is bent backwards (dorsally displaced)

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17
Q

what age pop is coleus fracture common in?

A

-common in middle aged and elderly women
-NB osteoporosis

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18
Q

what is the MOI for a colles fracture?

A

fall on outstretched hand

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19
Q

what is a smiths fracture?

A

fracture of distal radius w/ volar displacement

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20
Q

what is Bartons fracture?

A

fracture of distal radius - compression fracture - intraarticular

21
Q

what deformity is seen with colles fracture?

A

classical dinner fork deformity

22
Q

what are complications of colles fracture?

A

-complex regional pain syndrome (sympathetic NS dysfunction)
-carpal tunnel syndrome
-rupture EPL tendon
-malunion / deformity

23
Q

how is a colles fracture managed?

A

-manipulation under anaesthetic
-POP short arm cast - 4-6 weeks
-ORIF - K wires (removed when fracture healed), POP for 6 weeks

24
Q

what is the MOI of smiths fracture?

A

patient lands w/ wrist flexion

25
Q

what is important to note about osteoporosis & wrist fractures?

A

-high degree of suspicion if coleus fracture presents with low force
-wrist fracture is most common fragility fracture in perimenopausal and young post menopausal women
-DEXA scan needed

26
Q

how is a smiths fracture managed?

A

-reduction of fracture
-long arm plaster - above elbow in supination, wrist ext and elbow flex
-remove POP 6 weeks and refer to physio

27
Q

what is the MOI for Bartons fracture?

A

fall on extended and rotated wrist

28
Q

what can Bartons fracture also be associated?

A

dislocation of wrist

29
Q

how is Bartons fracture managed?

A

-ORIF to ensure stabilisation
-need to restore radoiocarpal joint integrity
-below elbow cast

30
Q

what are the most common fractured carpal bones?

A

-scaphoid
-triquetrum
-trapeuzium

31
Q

how can smiths and coleus fracture be differentiated from Bartons fracture?

A

bartons fracture is intraarticular and also involves carpal displacement / dislocation

32
Q

Describe a scaphoid fracture - MOI, what pops is it common in?

A

-MOI - fall on outstretched hand w/ wrist extension and radial deviation
-rare in younger children

33
Q

what would a patient w/ a scaphoid fracture present with?

A

-radial sided pain
-swelling
-limited range of wrist motion
-tenderness in the anatomical snuff box
-pain with axial loading along thumb

34
Q

how is a scaphoid fracture managed conservatively?

A

-cast immobilisation for minimum 6-8 weeks
-can often need longer or transfer to a thumb spica splint after 6 weeks
-can take up to 3 months to heal

35
Q

how can a scaphoid fracture be managed surgically?

A

-ORIF
-immobilised in thumb spica for 4-6 weeks post op

36
Q

what is the MOI for a triquetrum?

A

-direct blow to the dorsum of the hand or a fall resulting in extreme dorsiflexion of the wrist

37
Q

how is a trapezium fracture managed ?

A
  • if non displaced immobilised in thumb spica
    -surgery if displaced - OORIF
38
Q

what is a Bennetts fracture?

A

-a radial intraarticular fracture at the base of the 1st metacarpal phalangeal joint

39
Q

what is a MOI for a trapezium fracture?

A

-direct blow to the dorsum of the hand or a fall onto a radially deviated closed fist

40
Q

what is the MOI for a Bennetts fracture?

A

-FOOSH - fall on outstretched hand

41
Q

what are the symptoms of Bennetts fracture?

A
  • pain
    -swelling at the base of the thumb
    -limited ROM
    -pain and weak pinch grip
    -reduction and painful grip strength
42
Q

what is a Rolando fracture?

A
  • a comminuted intra-articular fracture at the base of the 1st MCP
43
Q

what is an MOI for a Rolando fracture?

A

-punch or FOOSH with thumb in partial flexion

44
Q

what is the most common upper limb fracture?

A

finger fractures

45
Q

what are common site of finger fractures?

A
  • base of 5th phalanx
    -distal phalanx of 4th
46
Q

what is a boxers fracture & MOI?

A

-fracture to neck of 5th MCP
-MOI - punching @ speed

47
Q

what are the symptoms of a boxers fracture?

A

-reduced ROM of 5th digit
-swelling and pain in hand
-may or may not have malalignment

48
Q

how is boxers fracture managed?

A

-casting
-may to may not need closed reduction w/ physio if non displaced
-surgery if displaced and immobilisation and physio

49
Q

what is important physiotherapy treatment for forearm, wrist and finger fractures?

A

-POLICE
-strengthening & ROM exercises - wrist fingers, thumb, elbow
-manual therapy once fracture well healed
-hand function - gross grip and fine grip

NMSK 2 - upper limb (16 decks)

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