T&O - Humerus And Scaphoid Fractures

Question 1

Scaphoid fracture: what are the borders and content of the anatomical snuff box?

Answer 1

Borders

• Medial: extensor pollicis Longus
• Lateral: extensor pollicis brevis and abductor pollicis Longus

Contents
-superficial branch of radial nerve and radial artery

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Question 2

Scaphoid fractures: clinical features

Answer 2

• FOOSH
• Pain in anatomical snuffbox
• Pain on telescoping thumb
• swollen thumb

Question 3

Scaphoid fractures: Mx

Answer 3

◦ If clinical Hx and exam suggest scaphoid fracture, treat as such even if X-ray is normal
◦ Place wrist is scaphoid plaster (beer glass position)
◦ If initial X-ray is -ve, return pt in 10 days for re X-ray
◦ Must be in plaster for 6 weeks, if mal-united, can do further 6 weeks or ORIF (single screw) + bone graft

Question 4

Scaphoid fracture: identify all of the carpal bones in picture and the fracture

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Answer 4

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Question 5

Scaphoid fractures: complications

Answer 5

◦ AVN: blood supply enters bone distally - proximal fragments at risk of AVN (esp if displaced fracture) - pt has pain and wrist stiffness

Question 6

Supracondylar fractures of humerus: presentation

Answer 6

• elbow swollen and semi flexed in position
• Distal fragment: usually displaces backwards + proximal numeral edge may compress the brachial artery or median nerve

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Question 7

Supracondylar fracture of humerus: Key Mx

Answer 7

• Check for neurovascular damage (check radial pulse and median nerve territory)
• Undisplaced: collar and cuff (with very flexed arm) or back slab - 3 week immobilisation
• Displaced: needs manipulation under GA (MUA- manipulation under anaesthesia) +position held in place by K wires + Collar and cuff or back slab applied with arm fully flexed

Question 8

Supracondylar fracture: main risks

Answer 8

◦ Compartment syndrome (check for pain on passive extension), angular deformities
◦ Neurovascular injury: brachial artery, radial nerve, median nerve (esp anterior interosseus branch- which supplies FPL, lat half of FDP and pronator quadratus)
◦ Gun stock deformity: valgus, varus and rotational deformities in the coronal place that do not remodel and lead to cubital varus