Upper Limb

Question 1

What signs are seen on an anterior shoulder dislocation?

Answer 1

Anterior-inferior/medial dislocation
Hill-sachs deformity and bony bankart lesion
Displaced fracture of greater tuberosity
Subacromial lipo-haemarthosis

Question 2

What signs could be present on a posterior shoulder dislocation?

Answer 2

Light-bulb sign

Reverse hill-sachs and reverse bony bankart lesion

Question 3

What are the causes of posterior dislocation?

Answer 3

Seizures
Electrical shock
Violent muscular contractions

Question 4

What happens in inferior dislocation of the shoulder?

Answer 4

Glenohumeral joint trapped under the Coracoid and glenoid

• very rare
• Typically high energy injury
• Hyperabduction

Question 5

What classification system is used for Humeral head fractures?

Answer 5

Neer classification

Question 6

What is the fallen fragment sign?

Answer 6

Bony fragments with bone cysts that lead to a pathological fracture in the humerus

Question 7

Where is a common place for pathological fractures to occur?

Answer 7

Clavicle

Question 8

What is significant about the AC joint inferior margin?

Answer 8

When the inferior margin of the clavicle is above the acromion then implies at least a grade3 injury

Question 9

What is the classification used for AC joint injuries?

Answer 9

Rookwood classification - 6 grades

Question 10

What are the lines/thing look for in elbow x-rays?

Answer 10

Anterior numeral line
Radio-capitalliar line

Areas for effusion - fat pad sign

Question 11

What is the terrible triad?

Answer 11

Posterior elbow dislocation
Radial head fracture
Coronoid process fracture

Question 12

What are the two types of fracture patterns on lower/upper forearm?

Answer 12

Monteggia fracture-dislocation

Galeazzi fracture-dislocation

Question 13

What is an monteggia fracture-dislocation?

Answer 13

Ulnar shaft fracture + radial head dislocation

Mechanism is FOOSH

Question 14

What is a galeazzi fracture-dislocation?

Answer 14

Distal radial fracture + distal radio-ulnar joint dislocation

Mainly encountered in children (9-12 yrs old)

FOOSH with elbow in flexion

Question 15

What is the mnemonic for monteggia and galeazzi fracture?

Answer 15

MU - man united = Monteggia = ulnar fracture

GR - Glasgow rangers - galeazzi = radius fracture

Question 16

How would you describe a fracture in a systematic way?

Answer 16

• fracture type
• location
• displacement
• angluation
• growth plate involvement?
• joint alignment
• Intra-articular extension

Question 17

What is a Colles fracture?

Answer 17

Distal radial (metaphysical region) fracture 
Dorsal angulation and impaction 
No intraarticular extension

Question 18

What is a smith fracture?

Answer 18

Distal radial fracture
Volar angulation of distal fracture fragments
Extra-articular fracture

Question 19

What is the terry Thomas sign?

Answer 19

Usually in distal radius fracture

Scaphoid-lunate dissociation - suggests damage to the scaphoid-lunate ligament - capitate will migrate proximally if missed and lead to significant OA - requires ligamentous repair

Question 20

What else would you look out for in x-ray of wrist?

Answer 20

Disruption of proximal carpal row

Triangle shaped lunate on AP projection - lunate dislocation - Pie sign

Question 21

What is a triquetrial fracture?

Answer 21

2 nd most common carpal bone fracture
Usually tiny dorsal fragment seen in lateral view

Pooping duck sign

Question 22

What is seen in 5th metacarpal dislocation?

Answer 22

No articulation with hamate

Question 23

What is a Bennett’s fracture?

Answer 23

Avulsion fracture of the base of the thumb resulting from forced abduction of the first metacarpal - due to attachment of abductor pollicus longus ligament - requires urgent surgery

Question 24

What is the boxers fracture?

Answer 24

Fracture of the neck of the 5th metacarpal due to direct blow/trauma