Upper Limb

Question 1

What are the two types of fractures of distal radius?

Answer 1

Colle’s (FOOSH/extended wrist) -> dorsal angulation of the distal radius fragment

Smith (fall on flexed/bent wrist) –> palmar angulation of the distal radius fragment

Question 2

What is the sign you see in colle’s fracture on XR?

What structure is at risk in Colle’s?

Answer 2

Dinner fork appearance (dorsal or anterior angulation)

Median nerve

Question 3

What structure is at risk in humeral head/neck fractures and humeral head dislocation?

Answer 3

Axillary nerve

Sensory Test over regimental badge

Question 4

What are the 4 types of proximal humeral fracture?

Answer 4

Humeral head
Lesser tubercle
Greater tubercle
Surgical neck

Question 5

What will you see on XR (AP) with posterior shoulder dislocation?

Answer 5

Lightbulb sign (symmetrical round head of humerus) due to medial rotation

Question 6

4 views of the scaphoid

Answer 6

PA
PA with ulnar deviation
Lateral
Oblique

Question 7

6 Indications for imaging the upper or lower limb?

Answer 7

1. Suspicion/exclude fracture
2. ” dislocation
3. Assess bone/joint after manipulation
4. Suspicion of inflammation/infection (RA, OA, osteomyelitis, septic arthritis…)
5. 1st line in ongoing/worsening bony pain (cancer, occult fracture, other bony pathology)
6. Foreign body detection (glass in hand)

Question 8

What are CT and MRI indicated for In limb imaging? (Upper and lower)

Answer 8

MRI: soft tissues

CT: 1. Detailed anat info complex fractures

2. Surgical planning
3. If XR is ambiguous/equivocal
4. If XR appears normal but suspect pathology

Question 9

What type of angulation do you see in colle’s and smith fracture of the distal radial fragment?

Answer 9

Colle’s - dorsal/posterior

Smith’s - palmar/anterior