Upper Limb Fractures Flashcards
What does comminuted fracture mean?
Breaking into multiple fragments
What fractures are more commonly seen in children?
Greenstick
Buckle fractures
Salter-Harris fractures only occur in children as it is a growth plate fracture
Explain features of a Colles fracture
Usually occurs when fallen onto out streached hand. Typical fracture has three following features:
1. Transverse fracture of radius,
2. Fracture one inch proximal to radio-carpal joint,
3. Dorsal displacement and angulation
Explain features of Smith’s fractures
Reverse Colles fracture - Volar (relating to palm) angulation of distal radius
What is Monteggia’s fractures?
Dislocation of the proximal radioulnar joint with an ulna fracture.
Fall onto outstretched hand with pronation.
Needs prompt diagnosis to avoid disability.
Explain what Galeazzi fracture is?
Radial shaft fracture associated with dislocation of distal radioulnar joint.
Presents with bruising, swelling and tenderness over lower end of forearm.
Occurs after fall on hand with rotational force superimposed.
Explain features of Barton’s fractures
Distal radius fractures (eg, colles/Smith’s) with a radiocarpal dislocation.
Occurs when fall onto extended and pronated wrist.
Explain features of Clavicular fractures: Mechanism, treatment, complications.
Mechanism - FOOSH (fall onto outstretched hand)/blow to shoulder.
Treatment - Usually conservative but may need surgery if shortened/comminuted.
Complications - malunion, non-union, palpable bump, stiffness, infection.
Features of shoulder dislocations?
> 95% are anterior shoulder dislocations.
May be associated with brachial plexus injuries.
Treatment - emergent reduction with sedation and analgesia
Explain features of ACJ dislocation: Mechanism, treatment, complications.
Mechanism - Direct blow to shoulder/ falling onto shoulder.
Treatment - depends on grade. Grades I and II are typically managed with a sling. Grades Iv, V and VI required surgical intervention
Can be treated with physio, reconstruction or open reduction and internal fixation (ORIF)
Clinical features, investigations, management and complications of mid humeral shaft fractures
Clinical features - Pain and deformity. May have radial nerve involvement. Most commonly affect middle third of humerus.
Ix - AP and lateral plain x ray films. If comminuted then CT may be needed.
Rx - Often conservative (functional humeral brace) or occasionally ORIF.
Complications - Non-union, mal-union, radial nerve injury
What is Holstein-Lewis fracture?
Fracture a distal third of the humerus resulting in entrapment of radial nerve.
Evidence of radial nerve injury?
Wrist drop and loss of sensation on webspace between 1st and 2nd metacarpals.
Clinical features, investigations, management and complications of proximal humeral shaft fractures
Presentation - pain around upper arm and shoulder, inability to abduct atm. May have damage to axillary nerve and circumflex vessels.
Ix - AP and lateral x rays. Use Neer classification
Management - Mostly conservative, may need ORIF.
complications - Reduced function, avascular necrosis of the humeral head.
Features of radial head fracture
Mechanism - FOOSH
Examination - local tenderness over radial head, impaired elbow movement, sharp pain at lateral side elbow during extremes of rotation
Classification - Mason classification.
Management - conservative unless mason 3 or 4.
