Upper Arm and Hands Trauma Flashcards
what is the most common cause of proximal humerus fracture?
low energy fall onto outstretched hand in osteoporotic bone or directly onto shoulder
what is the most common pattern of fracture in the humerus?
fracture of surgical neck with medial displacement of humeral shaft due to pull of pectoralis major
other fracture patterns in humerus?
avulsion of greater and lesser tuberosities due to attachment of rotator cuff muscles
isolated fractures of greater tuberosity
head splitting intra-articular fractures
treatment of humeral neck fracture?
conservative - sling and gradual mobilisation - if minimally displaced
internal fixation if persistently displaced
when is a shoulder replacement used?
3 or 4 part comminuted fracture
head splitting fractures
how does a scaphoid fracture present and how is it diagnosed?
occur after FOOSH
tenderness in anatomical snuff box
pain on compressing the thumb metacarpal
difficult to diagnose on X ray so 4 views taken but sometimes still invisible until healing starts
what views are taken of scaphoid fracture?
AP
lateral
2 oblique views
what is a clinical scaphoid treatment?
if scaphoid fracture is clinically suspected but X ray fails to show it so wrist is splinted and further clinical assessment and X ray arranged in 2 weeks time
how is a scaphoid fracture managed?
plaster cast for 6-12 weeks if undisplaced
compression screw sunk into bone to avoid non-union if displaced
screw fixation and grafting if non-union
partial/total wrist fusion of AVN
complications of scaphoid fracture?
non union
AVN of proximal pole
what structures are at risk in penetrating injuries to the hand?
volar injury = damage to flexor tendons and digital nerves/arteries
dorsal injury = damage to extensor tendons
- beware on examination a tendon can function even if partially ruptured
when is surgical repair used in penetrating hand injuries?
tendon rupture
digital nerve injury proximal to DIP joints
injury to both digital arteries to a digit
how are extensor tendon divisions managed if more than 50%?
surgical repair with splintage in extension for 6 weeks
what is mallot finger and what causes it?
avulsion of the extensor tendon from its insertion into the terminal phalanx
caused by forced flexion of the extended DIP, often from a ball during sport
how does mallot finger present and how is it treated?
pain
drooped DIP and inability to extend at DIP
treatment = mallot splint holding DIP in extension for 4 weeks
why do injuries in flexor tendons cause problems?
as they need to run smoothly within tendon sheath and under the pulleys
run adjacent to digital nerves and arteries so are at risk of injury
how are flexor tendon injuries managed?
partial divisions with a flap of tendon = smoothed out
significant partial lacerations or complete divisions = repair
fingers splinted in flexed position
considerations with tendon repair?
tendon sheath requires careful repair to preserve pulleys to prevent bowstringing of the tendon
what structures are at risk with flexor tendon injury?
interdigital nerves
radial and ulnar arteries
volar forearm injury = wrist, fingers and thumb flexors
median and ulnar nerves
fracture of which metacarpals are treated conservatively?
3rd 4th and 5th
what usually causes 5th metacarpal fracture and how is this managed?
punching injury (boxers fracture)
neighbour strapping
early motion
manipulation and neighbour strapping or wire stabilization of rotational alignment
how are phalangeal fractures managed?
neighbour strapping
splintage
manipulation under anaesthetic or nerve block if displaced/angulated
K wiring or fixation with screws if unstable or intra-articular
what is the most common cause of distal radial fractures?
fall onto outstretched hand
what is a colles fracture?
extra articular fracture of distal radius within an inch of the articular surface and with dorsal displacement or angulation
what injury are colles fractures associated with?
fall onto outstretched hand
how are colles fractures treated?
depends on degree of displacement/angulation and dorsal comminution
minimal displacement = splintage
displacement >10 degrees volar = manipulation
fracture held with plaster case
- if comminuted or unstable = wires or ORIF + plate and screws
what other injuries are colles fractures associated with?
ulnar styloid fracture
median nerve compression due to stretch or bleed into carpal tunnel
rupture of extensor pollicis longus tendon (late)
how is median nerve compression associated with colles fracture managed?
reduction can relieve pressure and fracture stabilised with fixation
carpal tunnel can be surgically decompressed if needed
what is a smith’s fracture?
volarly displaced/angulated extra-articular fracture of the distal radius
what commonly causes smith’s fractures?
falling onto the back of a flexed wrist
how is a smith’s fracture managed?
all undergo ORIF with plate and screws as V unstable
what is a bartons fracture?
intra articular fractures of the distal radius involving dorsal or volar rim where the carpal bones sublux with the displaced rim fragment
how are bartons fractures classified and how are they managed?
volar = intra articular smiths fracture
dorsal = intra articular colles fracture
all require ORIF
what causes comminuted intra articular distal radius fracture and how is it managed?
high energy injury or poor bone quality
external fixation
sometimes supplementary wires used to pin large fragments
