Ortho - Acute/Trauma

Question 1

What is it called when a wrist fracture fragment is too far forward?

Answer 1

Volar angulation

Normal: 11-12 degrees

Question 2

What is it called when a wrist fracture fragment is too far backwards?

Answer 2

Dorsal angulation

Question 3

What can happen when a wrist fracture is tilted to the side?

Answer 3

Loss of radial inclination

Normal: 23 degrees

Question 4

What it commonly used to hold fractured wrist in place?

Answer 4

Sugar tong splint

Question 5

What ligament is most commonly injured in anterior shoulder dislocation?

Answer 5

Inferior glenohumeral ligament

Question 6

What can increase risk of shoulder dislocation?

Answer 6

Damage to axillary nerve or rotator cuff muscles

Question 7

Give potential causes of shoulder dislocation?

Answer 7

Ligament laxity
Recent trauma
Congenital malformation of glenoid or humeral head
Neuromuscular causes: cerebral palsy, axillary nerve damage

Question 8

What are the likely findings of shoulder dislocation?

Answer 8

Pain and tenderness
Pain and limitation in range of movement
Arm positioned in abduction and external rotation, supported by the other hand

Question 9

Describe the shoulder profile in a dislocation

Answer 9

Loss of normal shoulder profile, squared deltoid
Prominent humeral head anteriorly below the coracoid process and a dip posteriorly
Prominent acromiom

Question 10

What is the examination finding in posterior shoulder dislocation?

Answer 10

Arm in adduction, held against the torso with the arm in internal rotation

Question 11

What xrays should be taken in posterior shoulder dislocation?

Answer 11

AP
Lateral scapula
Modified axillary view

Question 12

What is the management for shoulder dislocation?

Answer 12

Prompt reduction

Question 13

What should happen before relocation of shoulder?

Answer 13

Neurovascular assessment
Assess motor and sensory function of axillary nerve
Assess pulses

Question 14

What can be seen on xray in anterior shoulder dislocation?

Answer 14

Humeral head lies anteriorly to glenoid and inferior to coracoid process
Glenoid fossa is empty
Take note of fractures

Question 15

What is required to perform shoulder relocation?

Answer 15

Ideally anaesthesia, or analgesia/sedation

Relaxation of shoulder musculature

Question 16

When can Koucher manoeuvre be used?

Answer 16

On any type of anterior shoulder dislocation

Typically subcoracoid

Question 17

What are the advantages of Koucher manoeuvre?

Answer 17

Painless

No use of traction

Question 18

When might the Koucher manoeuvre be ineffective?

Answer 18

Greater tuberosity avulsion

Joint capsule torn

Question 19

When should Koucher manoeuvre not be used?

Answer 19

In elderly population as gross movements may result in humeral fractures

Question 20

What is the hippocrates method?

Answer 20

Traction and countertraction

Question 21

What are the complications of hippocrates method?

Answer 21

Capsular tears
Soft tissue injury
Fractures
Brachial plexus injury

Question 22

What is the preferred method of shoulder reduction?

Answer 22

Modified milch
Safe, well tolerated, painless, effective
No anaesthetic required - analgesia +/- mild sedation

Question 23

What makes up the neurovascular assessment following shoulder reduction?

Answer 23

• Sensation dermatomes C4 to T2
• Power around elbow, wrist and hand
• Shoulder power tested separately
• Test peripheral nerves (esp Axillary)
• Biceps and triceps reflexes
• Radial pulses