MSK clinical blue pages Flashcards
1
Q
clavicle fracture
A
outstretched hand, or fall direct on shoulder
junction of middle and lateral third
sternocleidomastoid muscle elevate medial fragment
trapezius cant hold arm- so drops
coracoclavicular ligament stops dislocation
lateral fragment- medial, due to adductors of arm (pec major)
overriding shortens fragment
green stick fracture- children- when not completely broken
2
Q
ossification of clavicle
A
????
3
Q
scapula fracture
A
severe trauma
little treatment due to support of muscles
protruding subcutaneous acromion
4
Q
humerus fracture- surgical neck
A
direct blow
fall on outstretched hand
motor- damage axillary nerve- paralysis of deltoids, teres minor… cant abduct
sensory- regimental badge
5
Q
humerus fracture- transverse mid shaft fracture
A
direct blow
motor- radial nerve- extensors paralysed… wrist drop, weak arm extension (radial supplies triceps brachii)
sensory- dorsal hand
6
Q
humerus fracture- intercondylar fracture
A
fall on flexed elbow
olecranon driven between condyles
seperates humeral shaft
damage/ swelling interfere with brachial artery
… volkmanns ischaemic contactures (uncontrolled flexion of hand)
damage median, ulnar, radial nerve
7
Q
humerus fracture-Medial Epicondyle
A
damage ulnar nerve
ulnar claw
loss sensation- medial 1.5 digits (dorsal and palmer)
8
Q
humerus fracture- avulsion fracture- greater tuburcle
A
fall on abducted arm
fragment of bone torn away
muscles that remain attached cause medial rotation ( subscapularis)
9
Q
radius and ulnar fracture
A
middle third
transverse
isolated fracture associated with dislocation at nearest joint ( due to strong attachment between bones by interosseus membrane)
10
Q
distal end of radius fracture
A
over 50
women- osteoporosis
colles fracture- fall on dorsiflexed hand, distal 2cm, dinner fork (distal fragment posterior), avulsed ulnar styloid process, radial styloid process becomes more distal. good union due to rich blood supply.
smiths fracture- fall onto back of hand, distal end anterior displacement,
In children- fracture distal epiphysial plate- healing may cause malalignment of plate and disrupt growth.
11
Q
scaphoid fracture
A
fall on palm when hand abducted
across narrow part
not always present on radio-graphs ( 10- 14 days later, will show due to bone resorption)
avascular necrosis of proximal fragment
degenerative joint disease of wrist
arthrodesis- fuse carpal bones surgically
12
Q
hamate fracture
A
poor unison due to pull of muscles
damage ulnar nerve
decreased grip strength
damage ulnar artery
13
Q
metacarpal fracture
A
close together- isolated fractures are stable
crushing- multiple fractures
boxers fracture- 5th metacarpal unskilled punch with closed abducted fist, head rotates over distal end of shaft ( flexion deformity)
14
Q
phalanges fracture
A
crushing
painful- due to high sensitivity
distal- painful hematoma
proximal/ middle- crushing or hyperextension
must be carefully realigned in relation to flexor tendon to restore function
15
Q
poland syndrome
A
pectoralis major + minor absent
breast hypoplasia
2 to 4 rib segments absent
16
Q
serratus anterior paralysis
A
injury of long thoracic nerve
medial border of scapula moves laterally and posteriorly away from thoracic wall- winged scapula
patient press both hands on wall to see wing
may not above 90 ( trapezius may still be able to)
superficial when limb elevated- therefore susceptible to damage (stabbing)
17
Q
Triangle of ausculation
A
near inferior angle of scapula
gap in musculature
suerior horizontal border of latissimus dorsi, medial border of scapula, inferolateral border of trapezius
examine posterior segment of lung with stethoscope
drawing scapula anteriorly (folding arms) and arching back triangle becomes larger, 6th, 7th rib become subcutaneous
18
Q
spinal accessory nerve injury
A
spinal accessory nerve palsy
ipsilateral weakness when shoulder elevated against resistance
19
Q
thoracodorsal nerve injury
A
surgery in inferior axilla (supply latissimus dorsi)
mastectomies- when axillary tail of breast is removed
surgery on scapular lymph nodes (terminal part lies anterior to them)
latissimus dorsi + part of pec major form sling between trunk and limb.- in paralysis cant raise trunk with limb (eg climbing)
cant use axillary crutches- pushes shoulder superiorly
passive depression of shoulder by gravity is adequate for most actions.
20
Q
dorsal scapular nerve injury
A
nerve to rhomboids
if rhomboids on one side paralysed then scapula lies more laterally than the normal side
21
Q
axillary nerve injury
A
deltoid atrophies
surgical fracture of humerus
disslocation of glenohumeral joint
compression by incorrect use of crutches
shoulder has flat appearance and hollow inferior to acromion
sensory loss to lateral part of proximal region of arm due to supply from superior lateral cutaneous nerve, the cutaneous branch of axillary nerve
deltoid- site for intramuscular injection of drugs, in surgery must avoid axillary nerve( surgical neck under deltoids)
22
Q
fracture/dislocation of proximal humeral epiphysis
A
direct blow or indirect injury to child of adolescent
because joint capsule of gh is stringer than epiphysial plate
severe- shaft displaced completely but head remains in place.
23
Q
rotator cuff injury
A
injury or disease
unstable gh joint
trauma/ rupture of one or more SITS muscle
most common- supraspinatus
degenerative tendonitis of rotator cuff - esp in older people
????????
24
Q
arterial anastomoses around scapula
A
??????
25
compression of axillary aretry
palpated- inferior part of lateral wall of axilla
comprssion of third part against humerus when profused bleeding
OR more proximally at origin ( subclavian cross first rib) - pressure in angle between clavicle and inferior attachment of sternocleidomastoid
26
aneurysm of axillary artery
1st part of axillary artery
compress trunk of brachial plexus
pain + anesthesia in areas of skin supplied
baseball pitchers- rapid and forceful are movement
27
injury to axillary vein
wounds in axilla
large vein and exposed
abduction ( axillary vein anterior to axillary artery)
wound in proximal part- bleeding + air emboli
28
axillary vein in subclavian vein puncture
?
29
axillary lymph node enlargement
infection in upper limb
nodes enlarge, inflamed tender- lymphangitis
usually humeral group
warm, red, tender streaks in skin
also when- infection of pectoral region, breast, superior abdomen
metastatic cancer- node adhere to axillary vein- need excision of part of vessel
enlarged apical nodes- obstruct cephalic vein superior to pec minor
30
dissection of axillary lymph nodes
excision and analysis- show staging and treatment
receive lymph in a specific order- test in that order shows degree of spread of cancer
lymphedema after removal due to impeded drainage - swelling
nerves at risk- long thoracic (winged scapula)... thoracodorsal ( to latissimus dorsi- medial rotation + adduction weakened)
31
brachial plexus variation
prefiixed brachial plexus- superior c4, inferior c8
postfixed brachial plexus- superior c6, inferior t2 ( inferior trunk can be compressed against 1st rib, cause neurovascular symptoms)
variation in trunk, divisions, cords, branches
relationship with axillary artery, scalene muscles
trunk, divison, cord, absent in part of plexus- terminal branches unchanged.
32
brachial plexus injury- superior ( c5, c6)
excessive increase in angle between neck and shoulder
horse riding, motor bike,excessive stretching in delivery
stretch/ rupture superior brachial plexus
avulses roots from spinal cord
Erb Duchenne Palsy- paralysis of muscles supplied by c5, c6 ( deltoid, biceps, brachialis)-adducted shoulder, medially rotated arm, extended elbow
waiters tip
loss sensation to part of forearm
chronic microtrauma to superior trunk- heavy back pack- sensory loss due to musculocutaneous and radial nerve.
back pakers palsy- muscle spasm + disability
33
acute brachial plexus neuritis/ neuropathy
neurological disorder
unknown cause
sudden onset pain around shoulder
weakness, sometimes muscular atrophy- neurological neuritis)
can get brachial neuritis followed by- upper respiratory infection)
usually superior trunk
34
compression of cords of brachial plexus
prolonged hyperabduction of arm ( work above head)
cords impinged/ compressed against coracoid process + pec minor tendon
Hyperabduction syndrome-
- pain down arm
- numb
- paresthesia
- erythema ( redness due to capillary dilation)
- hand weakness
- compress axillary artery + vein cause ischemia + distension of vein
35
injury to inferior brachial plexus- klumpke paralysis)
```
less common
upper limb suddenly pulled superiorly (break fall)
inferior trunk ( c8, T1) avulsed
short muscles of hand effected- claw hand
```
36
brachial plexus block
anesthetic injection surrounding axillary sheath
interrupts conduction to peripheral nerves
anesthesia of structures supplied by cords
sensation blocked in all deep structures + skin distal to middle arm
tourniquet used to keep anesthetic in area,
operate without general anesthetic
37
bicipital myotatic reflex
deep tendon reflex
rwelaxed limb, passivel pronated, partially extemded
examiners thumb on bicep tendon
reflex hammer taps nail bed of examiners thumb
normal (+ve)- involuntary contraction of biceps (tense tendon, small flexion)
confirms musculocutaneous integrity at c5/6 spinal root segment
excessive, diminished, prolonged- cns/ pns disease or metabolic disorder
38
biceps tendinitis
bicep tendon moves between interubercular groove of humerus
wearing cause shoulder pain
inflammation from repetitive micro trauma in sport
tight, narrow, rough groove cause tenderness/ crepitus
39
long head of bicep brachii tendon dislocation
young person- traumatic separation of proximal epiphysis of humerus
old person- history of bicep tendinitis
popping, catching sensation on arm rotation
40
rupture tendon of long head of biceps brachii
wear of inflamed tendon in intertubecular groove
>35 year olds
tendon torn from attachment to supraglenoid tubercle
snap/ pop
popeye deformity- belly forms ball near centre or distal anterior aspect of arm
result of forceful flexion against resistance OR prolonged tendinitis (more common) with excessive over head action
41
interruption of blood flow (hemostasis) in brachial artery
compress medially to humerus near middle of arm
distal to deep artery of arm which supplies blood around elbow stops tissue damage, and will supply sufficient blood to ulnar and radial artery from anastomoses around elbow
sudden laceration/ occlusion of brachial artery is an emergency- ischemia of elbow + forearm muscles in hours
fibrous scar tissue replace necrotic tissue, muscles shorten permanently, flexion deformity- ischemic compartment syndrome ( volkmann or ischemic contractures)
necrosis of flexors of forearm (effect hand grip, fingers, wrist)
42
humeral shaft fractures
midline humeral shaft- injure radial nerve (in radial groove)
not paralyze tricep- high origin of nerves to 2 heads
distal fracture (near supraepicondylar ridge)- distal bone fragment displace anterior or posterior. brachialis + triceps pull distal fragment over proximal, shortens limb.
any nerve or vessel can be injured
43
musculocutaneous nerve injury
in axilla- by knife
paralysis of coracobracialis, biceps, brachialis
weak flexion at shoulder (still have short head)
flexion at elbow + supination weakened (brachioradialis + supinator)
loss sensation- lateral surface of forearm (lateral antebrachial cutaneous nerve)
44
radial nerve injury in arm
superior to branches to triceps causes paralysis of ...
- triceps
- brachioradialis
- supinator
- extensors of wrist and fingers
radial groove- only medial head of triceps affected, posterior forearm supplied by distal branches are paralyzed- wrist drop
45
venipuncture in cubital fossa
median cubital vein
diagonally, cephalic in forearm to basilic vein in arm
also used for
- coronary angiography
cardiac catheters to get samples from great vessels and chambers of heart.
46
variation in veins in cubital fossa
20% have median have median antebrachial vein joined to medial cephalic and median basilic vein
still good for drawing blood
bad for irritating drug injection due to risk of injecting into brachial artery
47
elbow tendinitis or lateral epicondylitis
tennis elbow
repetitive use of superficial extensors of forearm
pain over lateral epicondyle radiates down posterior surface of forearm
repeated forceful extension/ flexion of wrist strain attachment of common extensor tendon- inflamed periosteum of lateral epicondyle- lateral epicondylitis
48
mallet/ baseball finger
sudden severe tension on long extensor tendon avulse attachment to phalanx
hyperflexion of distal interphalangeal joint
(resembles mallet)
49
olecranon fracture
fractured elbow
fall on elbow with sudden contraction of triceps
considered avulsion fracture
pinning required as triceps pulls fragment away
slow healing- cast for a long time
50
synovial cyst of wrist
```
non tender cystic swelling on hand
usually dorsum of wrist
contains clear mucinous fluid
unknown cause
flexion causes cyst to enlarge
clinically called ganglion
extensor carpi radialis brevis at base of third metacarpal is a common site
cyst swelling on common flexor synovial sheath on anterior wrist can compress carpal tunnel and median nerve
carpal tunnel syndrome
```
51
high division of brachial artery
divide more proximal
ulnar and radial artery in arm- median nerve between
musculocutaneous communicate with median nerve
52
superficial ulnar artery
3% ulnar artery superficial to flexor musclles
| careful not too mistaken as vein- excessive bleeding, injecting drugs could be fatal
53
measuring pulse rate
common- radial artery lies on anterior dital end of the radius
between tendon of fcr and apl
aberrant artery on one side may be difficult to palpate
radial pulse felt in anatomical suffbox
54
variations in origin of radial artery
superficial to deep fascia
| aberrant vessel is vunerable to laceration
55
median nerve injury
severed at elbow
- flexion of proximal ip of 1-3 digits lost, 4-5 digit weakened
- flexion distal ip 2-3 digit lost, 4-5 not affected (medial part of fdp supply by ulnar)
- flexion mcp 2-3 digit affected, median nerve supply 1-2 lumbricals- hand of benediction
- thenar function lost- carpal tunnel syndrome
anterior interosseous nerve damaged
- thenar muscle unaffected
- paresis of fdp, fpl- when make okay sign, pinch sign instead (absence of flexion of ip thumb, distal ip of index finger- anterior interosseous syndrome
56
pronator syndrome
nerve entrapment
compress median nerve near elbow
between heads of pronator terres (trauma, hypertrophy, fibrous bands)
pin proximal aspect of anterior forearm
hypersthesia of radial 3 and half digits, palmar aspect and adjacent palm
57
median and ulnar nerve communication
even if lesions of ulnar nerve some muscles may not be paralysed
wrong diagnosis
58
4 places ulnar nerve injuries occur
(1) posterior to the medial epicondyle of
the humerus
(2) in the cubital tunnel formed by the tendinous arch connecting the humeral and
ulnar heads of the FCU,
(3) at the wrist,
(4) in the hand.
(1) posterior to the medial epicondyle of
the humerus,
-most common)
- medial part of the elbow hits a hard surface
-lesion superior to the medial epicondyle cause paresthesia of median part of dorsum of hand.
(2) in the cubital tunnel formed by the tendinous arch connecting the humeral and
ulnar heads of the FCU,
-Compress ulnar nerve at the elbow
-cubital tunnel syndrome Ulnar nerve injury
-numbness, paresthesia of the medial part of the palm and the medial one and a
half fingers
-elbow pain that radiates distally.
-Ulnar Canal Syndrome
Ulnar nerve injury can result in motor and sensory loss to the hand.
injury distal part of the forearm denervates most intrinsic hand muscles.
wrist adduction is impaired
flex the wrist joint, the hand is drawn to
the lateral side by the FCR
difficulty making a fist because, (absence of opposition)
metacarpophalangeal joints hyperextended
cannot flex the 4th and 5th digits at the distal interphalangeal joints
cannot extend the interphalangeal joints when trying to straighten fingers.
claw hand (main en griffe).
results from atrophy of the
interosseous muscle supplied by the ulnar nerve.
59
cubital tunnel syndrome
ulnar nerve compressed in cubital tunnel ( tendinous arch between humerus ulnar, and attachment of fcu
60
radial nerve injury forearm
humeral head fracture
wrist drop- injury proximal to motor branch of long and short extensors of wrist
deep wound of posterior forearm damage deep radial nerve- cant extent thumb, or mp of other digits
- test mp extension against resistance-mlong extensor tendon seen on dorsum of hand show mp not ip
- no loss of sensation
superficial nerve damage- minimal sensory loss- coin shaped anasthesia distal to base 2-3 metacarpals
61
dupuytren contractures of palmar facia
shortening, thickening, fibrosis of facsia and aponeurosis
medial side of palm causes partial flexion of 4-5 finger at mp and proximal ip
men>50
nodules then raised ridges extend proximal part of hand to base of 4-5 finger
sirgical incision of area
62
hand infection
```
swelling on dorsum- fascia is thinner
fascia space determines spread of pus
accumulate thenar, hypothenar, midpalmer, adductor compartment
antibiotic
can spred to forearm
```
63
tenosynovitis
| ???????????????????????
infection digital synovial sheath + tendon
digit sells, painful to move
2-3-4 seperate sheaths so confine infection
if rupture, infection spreads
little finger sheath continuous with flexor region- spread infection
in thumb can spread to fpl
64
tenosynovitis- quervain tenoginitis stenosans
excessive gripping and wrinkling hand
apl and epb in same sheath, flexion causes friction, - fibrous thickening - stensis of osteofibrous tunnel
pain in wrist ( to thumb and forearm
tenderness over lateral side of common flexor sheath
65
digital tenovaginitis stenosans ( trigger finger/ snapping finger)
forecful use of fingers
thick fibrous digital sheath on palmar aspect - stenosis of osteofibrous tunnel
if tendon of fds, fdp enlarge proximal to the tunnel- cant extend fingers
when finger extends - snap back
2nd snap on flexion when tendon moves
66
laceration of palmer arches
profuse
multiple branches
compress brachial artery and branches proximal to elbow- stop vlood reaching ulnar and radial artery from anastomoses at elbow ( eg in surgery)
67
ischemia of digits
```
cyanosis, parasthesia, pain
worse when cold or emotional stimuli
cause
- anatomical abnormality
- unknown- raynaud syndrome
presynaptic sympathectomy- remove sympathetic nerve- dilate digital arteries
```
68
carpal tunnel syndrome (median nerve lesion)
results from any lesion
-reduces the size of carpal tunnel
-increases the size of some of the nine
structures
Fluid retention, infection, and excessive exercise of the fingers- cause swelling of the tendons/ synovial sheaths.
two terminal sensory branches
- supply the skin of the hand- paresthesia (tingling), hypoesthesia (diminished sensation), or anesthesia (absence of
sensation) may occur in the lateral three and a half digits.
sensation in the central palm unaffected (palmar cutaneous branch of the
median nerve arises proximal ).
motor branch- recurrent branch, which serves the three thenar muscles- loss strength in the thumb- unable to oppose the thumb
sensory changes radiate into the forearm and axilla
complete surgical division of the flexor retinaculum, a procedure called carpal tunnel release
incision medial side of the wrist to avoid recurrent branch
69
trauma to median nerve
proximal to flexor retinaculum
elbow
simian hand
Laceration because close to the surface.
Iwrist slashing- injured proximal to flexor retinaculum -paralysis of thenar muscles, first two lumbricals. (opposition of the thumb is not possible)
Sensation- lost over the thumb and
adjacent two and a half fingers
perforating wound in the elbow region results in loss of flexion of the proximal and distal ip of the 2nd and 3rd digits. flex the mcp of these fingers is also affected (supply to 1st and 2nd lumbricals).
Simian hand-
- thumb movements are limited to flexion and extension
- thumb in plane of the palm.
- inability to oppose + limited abduction
recurrent branch to thenar muscles lies
subcutaneously- severance causes-palyzes the thenar muscles
70
ulnar canal syndrome
pass between pisiform and hook of hamate, under pisiohamate ligament ( ulnar canal/ guyon tunnel)
compress nerve
hyposthesia- medial 1.5 digits
weak intrinsic hand muscles
clawing, 4th, 5th digit (hyperextension mcp, flexion ip)
71
handle bar neuropathy
```
long distance
hand in extended position on grips
pressure on hook of hamate- compress ulnar nerve
sensory loss- medial side of hand
weak intrinsic hand muscles
```
72
radial nerve injury in arm and hand disability
cant extend wrist
wrist drop
mcp remain flxed
ip weak extension by lumbricals and interossei
anesthesia in small lateral area of dorsum of hand
73
dislocation of sternoclavicular joint
rare
<25
result of fracture through epiphyseal plate
74
ankylosis of sternoclavicular joint
anklosis ( stiffness/ fixation)
section of clavicle removed- create pseudo joint ( flail)
allow scapula movement
75
dislocation of acromioclavicular joint (shoulder seperation)
coracoclavicular ligament strong
ac joint weak
direct blow to shoulder, fall on outstreched upper limb
severe when coracoclavicular and ac ligament torn
shoulder seperates from clavicle, drops due to weight of upper limb
allows fibrous layer of capsule to be torn, acromion can pass inferior to acromion end of clavicle
acromion more prominent, clavicle may move superior to acromion
76
calcific supraspinatus tendinitis
pain, tender, limit movement of gh joint
pain on abduction
irritate subacromial bursa- cause inflammation- subacromial burstitis
if adducted no pdiskain- lesion on inferior surface o acromion
painful arc syndrome (50- 130 degrees), supraspinatus tendon in contact with inferior surface of acromion
male > 50
77
rotator cuff injuries- excessive movement above 90
repetitive use of the upper limb above the horizontal
degenerative tendonitis of rotator cuff
- humeral head + rotator cuff impinge on coraco acromial arch
- -test- lower abducted limb slowly, at 90 will drop suddenly if rotator cuff is diseased or torn
78
rotator cuff injuries- sudden strain of muscle
lifting- rupture previously degenerative cuff
fall on shoulder- tear cuff
79
dislocation of gh joint
coraco acromial arch + rotator cuff stops upward dislocation
usually humeral head moves downwards-
- described as anteriorly or posterior in relation to infraglenoid tuburcle
Anterior-
- young adults
- excessive extension and lateral rotation
- fibrous layer and glenoid labrum can be stripped off anterior aspect
- blow to humerus when abducted (head tilted down), tears the weak part of the capsule + dislocation- flexors and adductors pull head anterosuperiorly to subcoracoid position- cant use arm, support with other hand
avulsion fracture of greater tubercle cause inferior dislocation (no upward and medial pull from muscles attaching to tubercle
80
axillary nerve injury - glenohumeral joint dissslocation
close relation to inferior part of capsule
when subglenoid displacement of humerus head into quadrangular space
paralysis of deltoid (cant abduct to horizontal or above)
loss sensation to regimental badge
81
glenoid labrum tears
throw a baseball or football with previous instability or subluxion
sudden contraction of biceps or forceful subluxion of humeral head over labrum
tear anteriosuperior part
pain when throwing
popping/ snapping feeling in gh joint during abduction + lateral rotation
82
bursitis of elbow
subcutaneous olecranon bursitis
-subcutaneous olecranon bursa injured when fall on elbow and infection from abrasion of skin over elbow friction (students elbow, dart throwers elbow, miners elbow)
subtendinous olecranon burstitis
- friction between tricep tendon and olecranon
- excessive flexion + extension
- pain on flexion
Bicipitoradial bursitis (bicep bursitis)
- pain when pronated
- action compresses bicipitoradial bursa against anterior half of radial tuberosity
83
avulsion of medial epicondyle
in child fall that causes abduction of extended elbow (abnormal movement)
ulnar collateral ligament pulls medial epicondyle distally
epiphysis for medial epicondyle doesnt fuse until 20
stretch ulnar nerve as it passses posterior to the epicondyle
84
ulnar collateral ligament reconstruction
autologous transplant of long tendon ( palmaris long, plantaris longus)
passed through hole in medial epicondyle and lateral aspect of coronoid process of ulnar
85
dislocation of elbow joint
posterior dislocation
-child falls on hand with flexed elbow
hyperextension/ blow drives ulna posterior, humerus anterior through capsule
ulnar collateral ligament torn
associated fracture of radius head, coronoid process, olecranon process
ulnar nerve injury- numb little finger, weak flexion and adduction at wrist
86
subluxation and dislocation of radial head
preschool children (esp girls) (nursemaids elbow/ pulled elbow)
child liften by upper limb while forearm pronated
cry out, refuse to use limb, hold while flexed and pronated
tears distal attachment of anular ligament ( loosely attached to neck of radius)
radial head moves distally
proximal part of ligament trapped between head of radius and capitulum- pain
treat- supinator arm when flexed elbow
ligament heals when in sling for 2 weeks
87
wrist dislocation- anterior dislocation of the lunate
```
uncommon
serious
fall on dorsiflexed wrist
lunate pushed towards palmar surface
compress median nerve
carpal tunnel syndrome
avascular necrosis of lunate
may need carpal fusion
```
88
bull riders thumb
sprain radio collateral ligament + avulsion fracture of lateral part of proximal phalanx of thumb
when ride mechanical bulls
89
skiers thumb
rupture/ chronic laxity of collateral ligament of first mp joint
hyperabduction of mp joint
when thumb held by ski pole while hand hits ground and enters snow
severe- head of metacarpal- avulsion fracture
90
fracture seperation of distal radial epiphysis
children
fall on hand
dorsal displacement of distal radial epiphysis
after reduction-m good prognosis
