T&O - Humerus, Scaphoid Fractures, Shoulder ds, Radius, Ulna Flashcards
Scaphoid fracture: what are the borders and content of the anatomical snuff box?
Borders
- Medial: Extensor pollicis Longus
- Lateral: Extensor pollicis brevis and Abductor pollicis Longus
Contents
- Superficial branch of Radial nerve and Radial artery
Scaphoid fractures: clinical features
FOOSH
- Pain in anatomical snuffbox
- Pain on telescoping thumb
- Swollen thumb
Scaphoid fractures: Mx
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
Scaphoid fracture: identify all of the carpal bones in picture and the fracture
Carpal bones
![](https://s3.amazonaws.com/brainscape-prod/system/cm/278/533/484/a_image_thumb.jpg?1559685726)
Scaphoid fractures: complications
-
Avascular Necrosis
- Blood supply enters bone distally - proximally
- Proximal fragments more at risk of AVN (esp if displaced fracture)
- pt has pain and wrist stiffness as a result
Supracondylar fractures of humerus: presentation
- Most common in children, esp after FOOSH
- Elbow swollen and semi flexed in position
- Distal fragment: usually displaces backwards + proximal humeral edge may compress the brachial artery or median nerve
![](https://s3.amazonaws.com/brainscape-prod/system/cm/278/533/486/a_image_thumb.jpg?1559686143)
Supracondylar fracture of humerus: Key Mx
- Check for neurovascular damage (check radial pulse and median nerve territory). Ulnar nerve and radial can also be damaged if the fragments displace weirdly
-
Fracture management
- 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
Supracondylar fracture: main risks
-
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
What is the aetiology of posterior dislocation?
- Caused by direct trauma, epilepsy and electrocution
- Will show light bulb sign b/c greater tuberosity isn’t seen - must be reduced by specialist
![](https://s3.amazonaws.com/brainscape-prod/system/cm/279/742/899/a_image_thumb.jpeg?1559687526)
Shoulder dislocation: Rx
- Reduce and rest in sling for 3-4 weeks, then rehabilitate with physio
- Avoid abduction and external rotation (eg throwing baseball)
Shoulder dislocation - specific Mx
- Check for neurovascular deficit:
- Axillary nerve - Regimental badge area
- Do AP and Trans-scapular view to see direction of humeral head
Shoulder dislocation: general presentation
- Shoulder contour lost - appears square
- Bulge in infraclavicular fossa: humeral head
- Arm supported in opposite hand
- Severe pain
Shoulder dislocation:
Why does it dislocate?
What are the muscles of the rotator cuff?
Which dislocations are most common?
- Most mobile of all joints
- Rotator cuff muscles: supraspinatus, infraspinatus, teres minor and subscapularis
- 95% are anterior dislocations: direct trauma, falling on hand where humerus is driven forward teaching capsule of joint.
What three radiological features to you look for when interpreting wrist fractures?
Features of adequate reduction:
- 11mm radial height (<5mm variance)
- 22 degrees radial inclination (<5 degrees variance)
- 11 degrees of volar tilt (<5 degrees variance)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/279/746/073/a_image_thumb.gif?1559687945)
Which distal radius fracture require operative intervention?
- Intra-articular
- Volar fragments (smith’s)
- Dorsal fragments with inadequate reduction of comminution