Injuries To The Upper Limb

Question 1

Sprain

Answer 1

Stretching of the joint capsule and ligaments of a joint, which is not sufficient to cause dislocation or subluxation

Question 2

Causes of fractures

Answer 2

Mechanical stress / trauma

Can be due to excess force on normal bone

or normal force on weakened bone (osteoporosis, osteogenesis imperfecta, pagets)

Question 3

How is integrity if the bone maintained?

Answer 3

Calcium, provides rigidity.

Use/stress on the bone encourages remodelling and strengthens the bone

Collagen fibres reinforce structure of bone

Question 4

Clinical signs and symptoms of fracture

Answer 4

Pain
Swelling
Tenderness
Bruising

Deformity - defining feature
Crepitus
Abnormal movement

Question 5

Source of pain in a fracture

Answer 5

Bleeding due to fracture increases pressure in the bone. Sensory fibres in the periosteum which are compressed due to pressure causing pain

Question 6

Compound fracture

Answer 6

Fracture of the bone together with a breach of the skin, bone is exposed to the air, which may allow an infection to enter

Two types: protrusion of bone out due to fracture, bone exposed due to crushing injury

Question 7

Risks in compound fracture

Answer 7

Can lead to infection, site needs to be washed with saline, some tissue may need to be removed. ,

Question 8

Complicated fracture

Answer 8

Fracture with damage to the surrounding soft tissues and associated structures e.g. blood vessels, nerves, viscera

Question 9

Delayed union

Answer 9

Bone takes longer to heal than expected (different for each bone)

Question 10

Non-union

Answer 10

Bone does not unite after a fracture.

Can be due to the bone dying and becoming sclerotic. Requires surgical intervention e.g. Replacement

Question 11

Mal union

Answer 11

Bones join in the incorrect alignment

Question 12

Diagnosis of fractures

Answer 12

History, examination
CT
X-ray
MRI
Ultrasound (particularly in children) 
Bone scan

Question 13

Complication of posterior displacement of sternoclavicular joint

Answer 13

Compression of the subclavian. Causes ischemia of the limb

Question 14

AC subluxation/dislocation

Answer 14

Caused by overuse of joint ( repetitive strain damages ligaments)

Question 15

Why is callus formation common following clavicle fractures?

Answer 15

Because the clavicle is highly mobile, healing tends to form excess bone as the two ends unite. Process normally takes 6-9 weeks

Question 16

Fracture

Answer 16

Breach in integrity of part or all of the bone

Question 17

Dislocation

Answer 17

Complete separation of articulate surfaces in a joint

Caused due to compromised joint support, excess forces through the joint, or if the joint is stressed in a position of instability

Question 18

Subluxation

Answer 18

Partial separation of articular surfaces of a joint

Question 19

Fracture dislocation

Answer 19

Dislocation where there is a fracture involving one or more or the articular joint surfaces.

Results in degenerative changes

Question 20

Complication of supra condylar fracture of humerus

Answer 20

Loss of anterior interosseus nerve

Damage to median nerve, loss of flexion of 1st digit (pointing finger sign)

Flexor compartment syndrome

Damage to brachial artery

Question 21

Complication of elbow dislocation

Answer 21

Damage to ulnar nerve, loss of muscles in the hand.

First sign is lack of flexion in terminal joints, progresses to claw hand and muscle wasting

Question 22

Conditions which cause an increased risk of fractures

Answer 22

Osteoporosis - reduction of bone density due to increased osteoclast activity

Pagets disease - excessive bone remodelling results in weakened (woven) mishapen bone, increased blood flow reduces calcium levels

Osteogenesis imperfecta - insufficient or defective collagen production, bones are weakened.

Question 23

Complications of clavicular fractures

Answer 23

Damage to brachial plexus

Damage to subclavian vein

Question 24

Common sites of scapula fractures

Answer 24

Blade
Spine
Glenoid

Question 25

Complications of fractures at the neck of the humerus

Answer 25

Damage to axillary circumflex nerve and circumflex humeral arteries

Question 26

Common sites of proximal humerus fractures

Answer 26

greater tuberosity
anatomical neck
surgical neck
head

Question 27

Volkmann’s ischemic contracture

Answer 27

Permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers

Caused following supracondylar fracture of the humerus which can lead to obstruction of the brachial artery/compartment syndrome. Fibrosis and shortening of flexor muscles causes contracture

Question 28

Bennetts fracture

Answer 28

Fracture through the base of the first metacarpal

Intra-articular fracture, can result in arthritis in the thumb.