Upper Limb Fractures ☺️

Question 1

Clavicle fractures

• MOI
• common in
• location
• management
• complications

Answer 1

FOOSH/direct shoulder blow => middle 1/3

Broad arm sling/collar and cuff + analgesia

Phrenic nerve injury
Pneumothorax
Neurovascular compromise

Question 2

Surgical neck of humerus fracture

• MOI
• common in
• presentation
• management
• complications

Answer 2

FOOSH/direct blow
Elderly, children

Elbow pain
Axillary damage

BAS + analgesia
-EARLY MOBILISATION TO PREVENT FROZEN SHOULDER

Question 3

Humeral shaft fracture

• MOI
• common in
• presentation
• management

Answer 3

FOOSH/direct blow/pathological
Elderly, active youth

Swelling, deformity, pain
Radial damage

U-slab + collar and cuff

Question 4

Supracondylar fracture

• MOI
• common in
• Xray findings
• management
• complications

Answer 4

Direct blow to back of flexed elbow
Children

Posterior displacement of fragment

Undisplaced - C&C or above elbow cast + analgesia
Displaced - MUA or ORIF

AIN damage - not ‘ok’

Question 5

Forearm fractures

• types
• management
• complications

Answer 5

Galeazzi - Radial fracture (distal), ulnar dislocation
Monteggia - Ulnar fracture (proximal), radial dislocation,

ORIF

PIN, radial nerve damage

Question 6

Wrist fractures

• types
• management

Answer 6

Colles - MOST COMMON

• FOOSH
• dorsal distal extraarticular radius displacement => fork

Smiths

• inverse FOOSH
• volar distal extraarticular radius displacement

Non surgical - plaster, splints
Surgical - ORIF, MUA

Question 7

Carpal fractures
Scaphoid fracture
-MOI
-presentation
-importance of identifying this
-management

Answer 7

FOOSH => pain in anatomical snuffbox

Can be missed on Xray
If not visible => rescan in 10-14 days

Cast
Proximal fracture or unstable - ORIF due to risk of AVN

Question 8

Metacarpal fractures
Boxers fracture
-MOI
-presentation
-management

Bennets fracture

• MOI
• presentation
• management

Answer 8

Punch => 5th MC

• Buddy strap + volar slab
• ORIF

HyperABDuction of thumb => 1st MC fracture + dislocation

• K wires
• ORIF

Question 9

Dislocation

• pathophysiology
• management

Answer 9

Extreme force on ligaments => head of bone to come out of socket

RICE
Reduction, splint/cast to immobilise
Surgery

Question 10

Hand fractures

• possible MOIs
• presentation

Answer 10

Possible MOIs

• falls
• sports injuries
• violence
• road accidents

Presentation

• pain
• swelling, bruising
• loss of movement

Immediate management

• remove rings, jewelry
• elevate hand
• cover wounds

Non surgical managent

• analgesia
• reduction, splinting, immobilisation, physio

Surgical management

• LA or GA
• kwires, external fixators => removed in OP, GP
• open reduction, internal fixators => not removed