Upper limb fractures Flashcards
How do scaphoid fractures typically occur?
FOOSH (fall onto outstretched hand)
Contact sports
What is the presentation of a scaphoid fracture?
Pain along the radial aspect of the wrist, at the base of the thumb
Loss of grip/pinch strength
What are the signs of scaphoid fracture on examination?
Tenderness over the anatomical snuffbox
Wrist joint effusion
Pain elicited by telescoping of the thumb
Pain on ulnar deviation of the wrist
What initial investigations are used to diagnose scaphoid fracture?
Plain film radiographs of the wrist in anterior-posterior view and lateral view
What further investigations may be used to diagnose scaphoid fracture?
CT scan can give a more detailed view of the wrist bones if XR is inconclusive
What is the initial management of a scaphoid fracture?
Immobilisation with futuro splint or standard below-elbow backslab
Referral to orthopaedics
What is the orthopaedic management of a scaphoid fracture?
Undisplaced fracture
- Cast for 6-8 weeks
Displaced scaphoid fracture
- Surgical fixation
Proximal scaphoid pole fracture
- Requires surgical fixation
What are the complications of scaphoid fracture?
Non-union - can lead to pain and early osteoarthritis
Avascular necrosis
What is the blood supply to the scaphoid bone?
Retrograde blood supply - blood vessels supply the bone from only one direction
What is a Colles’ fracture?
A distal radial fracture resulting from a fall on an outstretched wrist
What is the characteristic pattern of injury in a Colles fracture?
Dorsal displacement of the distal radius
What is the presentation of a Colles’ fracture?
Immediate pain and swelling
Difficulty moving the wrist and hand
Tenderness over the distal radius
‘Dinner fork’ deformity
What is the primary investigation for a colles’ fracture?
Wrist XR
What is the management of a Colles’ fracture?
Manipulation under anaesthesia
Immobilisation with a plaster cast
How do elbow fractures typically occur?
Fall onto outstretched hand
Direct impact to the elbow
What is the presentation of an elbow fracture?
Pain and tenderness localised to elbow
Swelling and bruising around elbow
Difficulty or inability to move elbow
Visible deformity
What is the management of an elbow fracture?
Immobilisation with a splint or cast
Open reduction and internal fixation
What is a Bennett’s fracture?
An intra-articular fracture of the base of the thumb
How does a bennett fracture typically occur?
Forced abduction injuries
What is the management of a Bennett’s fracture?
Thumb spica cast immobilisation
Physiotherapy
Open reduction and internal fixation
What is a Boxer’s fracture?
A break in the neck of the 4th or 5th metacarpal
How does a Boxer’s fracture typically occur?
By punching a hard object, resulting in direct trauma to a closed dist
What are the indications for surgery in a Boxer’s fracture?
Significant rotation or angulation of the affected fingers
Articular involvement of the fracture
Multiple metacarpal fractures
Open fractures
What is a Monteggia fracture?
A fracture in the proximal third of the ulnar shaft, accompanied by anterior dislocation of the radial head (at the elbow)
What is a Galeazzi fracture?
A fracture of the distal third of the radial shaft, in association with a dislocation at the radio-ulnar joint
