Upper Limb Fractures Flashcards
A fracture, also referred to as a break, crack or hairline crack is a disruption in the continuity of the bone. Which of the following is NOT a type of fracture?
1 - transverse
2 - axial
3 - linear
4 - oblique misplaced
5 - oblique displaced
6 - spiral
2 - axial
What is an avulsion?
1 - tearing of a ligament where it attaches to the bone
2 - tearing of a tendon where it attaches to the bone
3 - part of bone breaks away attached to a ligament/tendon
4 - part of bone becomes calcified and tears tendon
3 - part of bone breaks away attached to a ligament/tendon
What is a pathological fracture?
1 - a fracture in a patient with comorbidities
2 - a fracture when someone is ill
3 - a fracture that would not have occured if the patient was well
3 - a fracture that would not have occured if the patient was well
- suggest pathology of the bone
MSK There are 3 main types of joint injury. Which one of the following is NOT one of these?
1 - subluxed
2 - dislocated
3 - relined
4 - fracture with dislocation
3 - relined
- subluxed means there is still some contact between the joint surfaces
- dislocated means there is no contact between joints surfaces
When we describe the site of the bone injured, we typically use ALL of the following EXCEPT:
1 - metaphysis
2 - epiphysis
3 - marrow
4 - diapphysis
3 - marrow
When we talk about displacement or undisplaced, we must talk about:
- direction
- amount of
We must also talk about whether the joint is rotated or not
When we talk about angulated or non-angulated, we must talk about:
- direction
- angulation
We must also comment on if the fracture is open or not, i.e has it broken the skin
What is a comminution fracture?
1 - fracture of a bone in one place
2 - fracture of a bone in 2 places
3 - fracture of a bnone that breaks the skin
2 - fracture of a bone in 2 places
When a patient has a fracture, one of the key principles is to reduce movement. Although there are several reasons for this, what is the primary for the patient?
1 - increase recovery time
2 - reduce pain
3 - reduce risk of neuro damage
4 - reduce risk of PE
2 - reduce pain
- the others are valid, but pain is key for patient care
The following are all used to treat soft tissue trauma:
- Elevation
- Monitor compartments (specific fractures)
- Mobilise joints
- Maintain muscle bulk
- Physiotherapy
The following are all methods of conservative management of a fracture, EXCEPT which one?
1 - plaster of Paris
2 - removable splint
3 - brace
4 - removable pins on bone
5 - watch and wait
4 - removable pins on bone
Which 2 of the following are immediate general fracture complications?
1 - UTI
2 - PE
3 - cardiorespiratory
4 - fat embolism
3 - cardiorespiratory
4 - fat embolism
Which 2 of the following are immediate local fracture complications?
1 - bleeding/vascular comprimise
2 - nerve injury
3 - cardiorespiratory
4 - fat embolism
1 - bleeding/vascular comprimise
2 - nerve injury
All of the following are early general fracture complications:
- PE (DVT)
- Fat embolism
- MI
- CVA
- Sepsis
- UTI
All of the following are early local fracture complications:
- Haematoma
- Wound infection
- Wound dehiscence
- Implant issues – loss of reduction, dislocation
All of the following are late local fracture complications:
- Delayed union, non-union, malunion
- Avascular necrosis
- Chronic infection
- Implant failure
- Secondary osteoarthritis
When considering a fracture, we have to be careful comparing adults with children. What extra part do we typically see in children that might look like a fracture, but is a growth plate?
1 - epiphysis
2 - metaphysis
3 - diaphysis
4 - physis
4 - physis
When considering adult vs paediatric bones, which has the higher cartilaginous component?
- paediatrics
- cartilage is what goes on to form bone
- cortical bone is also more porous than adults
- periosteum is thicker though
Why must we be careful in fractures where the level of injury does not match the description in children?
1 - patient may be more severely injured than expected
2 - internal bleeding
3 - unknown pathology
4 - safeguarding issue
4 - safeguarding issue
- parents/carer may be to blame for injury
Why are growth plate fractures in children more important than fractures in adults?
1 - higher risk of bleeding
2 - higher risk of neuro damage
3 - risk of abnormal fgrowth
4 - risk of amputation
3 - risk of abnormal growth
What is the name the the categories used to identify the type of fracture at the growth plates in a child?
1 - modified glasgow scale
2 - salter-harris scale
3 - CURB scale
4 - WELLS scale
2 - salter-harris scale
What is a torus fracture in paediatrics?
1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone
1 - involves only one cortex of bone
- cortex refers to the hard outer layer of bones
What is a greenstick fracture in paediatrics?
1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone
2 - involves both cortices but one is still intact
What is a plastic deformation fracture in paediatrics?
1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone
3 - bone bends and is deformed like a plastic bone
What % of fractures in children <1 y/o are due to non-accidental injury?
1 - 5%
2 - 25%
3 - 50%
4 - 75%
3 - 50%
- 2nd most common cause of death in children
90% of fractures are due to abuse in children under what age?
1 - <1 y/o
2 - <5 y/o
3 - <10 y/o
4 - <15 y/o
2 - <5 y/o
- if underreported there is a 30-50% change of further abuse
- 5-10% change of death from abuse
All of the following fractures can occur through non-accidental injury, but which is the most common?
1 - humerus
2 - tibia
3 - femur
4 - ribs
1 - humerus
If we suspect a safeguasrding issue, who should we get involved in the care and management of a child?
1 - senior nurse on department
2 - crash team
3 - pediatric and safeguarding team
4 - consultant on call
3 - pediatric and safeguarding team
Are upper of lower limb fractures more common?
- upper limbs
- distal radius and ulna are most common
What are 2 of the most common causes of upper limb injury from the list below:
1 - fall on outstretched hand (FOOSH)
2 - impact trauma
3 - direct injury (punch)
4 - infection
1 - fall on outstretched hand (FOOSH)
3 - direct injury (punch)
A clavicular fracture generally occurs when someone falls onto an outstretch hand or a fall from a bike and can be managed conservatively by putting their arm in a sling. However, all of the following are indication for surgery, EXCEPT which one?
1 - Neurovascular injury
2 - Penetration of skin
3 - Lateral third injury
4 - Floating shoulder
5 - Risk of pulmonary embolism
5 - Risk of pulmonary embolism
What is the most common dislocation of the shoulder joint?
1 - posterior
2 - inferior
3 - superior
4 - anterior
4 - anterior
- occurs when abducted arm is externally rotated
- common reoccurence, especially un younger children
When a patient has a shoulder dislocation, we must check which sensory nerve supply?
1 - median nerve
2 - ulnar nerve
3 - radial nerve
4 - axillary nerve
4 - axillary nerve
Proximal fracture of the humerous are common in the elderly and can be caused by a fall on an outstretched hand (FOOSH). Are these operated on in both younger and elderly patients?
- no
- elderly are managed conservatively
- younger patients may be operated on
A colles fracture occurs most commonly following a fall onto an outstretched hand (FOOSH). What is a colles fracture?
1 - radius and ulna are fracture
2 - fracture of proximal radius with displacement and deformity
3 - fracture of distal radius with displacement and deformity
4 - fracture of distal ulna with displacement and deformity
3 - fracture of distal radius with displacement and deformity
- resembles dinner fork deformity
- generally treated with a cast or surgery depending on the severity
A colles fracture is a fracture of the distal radius with obvious displacement and deformity that resembles a fork. It commonly occurs following a fall onto an outstretched hand (FOOSH). Which nerve function needs be checked with this type of fracture?
1 - radial nerve
2 - ulnar nerve
3 - median nerve
4 - axillary nerve
3 - median nerve
A colles fracture is a fracture of the distal radius with obvious displacement and deformity that resembles a fork. It commonly occurs following a fall onto an outstretched hand (FOOSH). How is this commonly treated?
1 - open surgery or cast
2 - cast only regardless of damage
3 - surgery only
4 - analgesis and splint
1 - open surgery or cast
- depends on severity
Using the mnemonic below, what are the 8 carpal bones of the hand?
Some
Lovers
Try
Positions
That
They
Can’t
Handle
1 - Some – Scaphoid
2 - Lovers – Lunate
3 - Try – Triquetrum
4 - Positions – Pisiform
5 - That – Trapezium
6 - They – Trapezoid
7 - Can’t – Capitate
8 - Handle – Hamate
What is the most frequently fractured bone in a fall onto an outstretched hand (FOOSH)?
1 - Scaphoid
2 - Lunate
3 - Triquetrum
4 - Pisiform
1 - Scaphoid
- causes tenderness over the anatomical snuffbox
- may be normal on X-ray, but CT may show it
The Scaphoid bone is the most frequently fractured bone in a fall onto an outstretched hand (FOOSH). What is a significant risk of this type of fracture?
1 - further bones may become fractured
2 - increased risk of RA
3 - result in avascular necrosis
4 - abnormal remodelling
3 - result in avascular necrosis
- if radial artery of branch is damaged it can cause avascular necrosis of proximal part of the scaphoid bone
A boxers fracture is when there is a fracture in the hand due a punch being thrown. Which bone is typically fractured?
1 - 5 metacarpal neck
2 - 5 metacarpal head
3 - 1st metacarpal neck
4 - 3 metacarpal neck
1 - 5 metacarpal neck
