Upper limb fractures Flashcards
What is a Boxer fracture?
A Boxer fracture describes a minimally displaced fracture of the fifth metacarpal.
This typically results following the patient punching a hard surface, for example a wall.
What is a Colles’ fracture?
A distal radius fracture with dorsal displacement of fragments.
It classically follows a fall onto an outstretched hand (FOOSH) and is described as a dinner fork type deformity.
What are the three classical features of a Colles’ fracture?
- Transverse fracture of the radius
- 1 inch proximal to the radio-carpal joint
- Dorsal displacement and angulation.
What is the deformity associated with a Colles’ fracture?
Dinner fork deformity.
What are the early complications of a Colles’ fracture?
- Median nerve injury: acute carpal tunnel syndrome presenting with weakness or loss of thumb or index finger flexion
- Compartment syndrome
- Vascular compromise
- Malunion
- Rupture of the extensor pollicis longus tendon.
What are the late complications of a Colles’ fracture?
- Osteoarthritis
- Complex regional pain syndrome.
What is a Colles’ fracture?
A transverse fracture of the radius occurring 1 inch proximal to the radio-carpal joint with dorsal displacement and angulation.
Also known as the dinner fork deformity, typically caused by a fall onto an extended outstretched hand.
What characterizes a Smith’s fracture?
A reverse Colles’ fracture with volar angulation of the distal radius fragment.
Also known as the garden spade deformity, caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed.
What is a Bennett’s fracture?
An intra-articular fracture of the first carpometacarpal joint caused by impact on a flexed metacarpal.
Often seen in fist fights; X-ray shows a triangular fragment at the ulnar base of the metacarpal.
What is a Monteggia’s fracture?
A fracture involving dislocation of the proximal radioulnar joint in association with an ulna fracture.
Typically results from a fall on an outstretched hand with forced pronation and requires prompt diagnosis to avoid disability.
What is a Pott’s fracture?
A bimalleolar ankle fracture caused by forced foot eversion.
What is a Barton’s fracture?
A distal radius fracture (Colles’ or Smith’s) with associated radiocarpal dislocation.
Usually results from a fall onto an extended and pronated wrist.
What are the types of humeral fractures?
Humeral fractures may be divided into proximal humeral fractures, humeral shaft fractures, and distal humeral fractures.
Proximal fractures are typically seen in the elderly, while distal fractures are typically seen in children and include supracondylar fractures.
What are supracondylar fractures?
Supracondylar fractures are fractures of the distal humerus just above the elbow joint, typically seen in children.
They are the most common type of elbow fracture in this demographic.
What are the common features of supracondylar fractures?
Common features include pain, swelling over the elbow immediately, and the elbow typically being in a semi-flexed position.
They typically result from a fall onto an outstretched hand.
What complications can arise from supracondylar fractures?
Complications due to neurovascular involvement can include injury to the median nerve, radial nerve, brachial artery, and ulnar nerve.
How are non-displaced supracondylar fractures managed?
Non-displaced fractures are managed with a collar and cuff.
How are displaced supracondylar fractures managed?
Displaced fractures are managed with manipulation under anaesthesia with fixation.
What is a complete fracture?
Both sides of the cortex are breached.
What is a toddler’s fracture?
Oblique tibial fracture in infants.
What is plastic deformity?
Stress on bone resulting in deformity without cortical disruption.
What is a greenstick fracture?
Unilateral cortical breach only.
What is a buckle (‘torus’) fracture?
Incomplete cortical disruption resulting in periosteal haematoma only.
What are growth plate fractures classified by?
The Salter-Harris system.
What characterizes a Type I Salter-Harris fracture?
Fracture through the physis only (x-ray often normal).
What characterizes a Type II Salter-Harris fracture?
Fracture through the physis and metaphysis.
What characterizes a Type III Salter-Harris fracture?
Fracture through the physis and epiphysis to include the joint.
What characterizes a Type IV Salter-Harris fracture?
Fracture involving the physis, metaphysis and epiphysis.
What characterizes a Type V Salter-Harris fracture?
Crush injury involving the physis (x-ray may resemble type I, and appear normal).
What is an indicator of an underlying fracture in growth plate tenderness?
It is safer to assume that growth plate tenderness indicates an underlying fracture even if the x-ray appears normal.
Which Salter-Harris injury types usually require surgery?
Types III, IV and V.
What are signs of non-accidental injury?
Delayed presentation, delay in attaining milestones, lack of concordance between proposed and actual mechanism of injury, multiple injuries, injuries at sites not commonly exposed to trauma, children on the at risk register.
What can cause pathological fractures?
Genetic conditions, such as osteogenesis imperfecta.
What is osteogenesis imperfecta?
Defective osteoid formation due to congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine.
What are the characteristics of osteogenesis imperfecta?
Failure of maturation of collagen in all the connective tissues.
What does radiology show in osteogenesis imperfecta?
Translucent bones, multiple fractures, particularly of the long bones, wormian bones, and a trefoil pelvis.
What are the subtypes of osteogenesis imperfecta?
Type I - Normal quality but insufficient quantity; Type II - Poor collagen quantity and quality; Type III - Poorly formed collagen, normal quantity; Type IV - Sufficient quantity but poor quality.
What is osteopetrosis?
Bones become harder and more dense.
What is the inheritance pattern of osteopetrosis?
Autosomal recessive condition.
In which age group is osteopetrosis most common?
It is commonest in young adults.
What does radiology reveal in osteopetrosis?
A lack of differentiation between the cortex and the medulla described as marble bone.
What is a scaphoid fracture?
A scaphoid fracture is a type of wrist fracture, typically arising from a fall onto an outstretched hand (FOOSH).
What causes a scaphoid fracture?
Causes include falling onto an outstretched hand (FOOSH) and contact sports, particularly during the autumn season.
What are typical patient presentations for a scaphoid fracture?
Patients typically present with pain along the radial aspect of the wrist and loss of grip/pinch strength.
What is the point of maximal tenderness in scaphoid fractures?
Point of maximal tenderness is over the anatomical snuffbox, which is a highly sensitive but poorly specific test.
What are some signs of a scaphoid fracture?
Signs include wrist joint effusion, pain on telescoping of the thumb, tenderness of the scaphoid tubercle, and pain on ulnar deviation.
What is the sensitivity and specificity of clinical examination for scaphoid fractures?
Clinical examination has a sensitivity of 100% and specificity of 74% when certain signs are positive.
What investigations should be conducted for suspected scaphoid fractures?
Plain film radiographs in anterior-posterior and lateral views, as well as specific ‘scaphoid views’ should be requested.
What is the sensitivity of radiographs in the first week of injury?
The sensitivity in the first week of injury is only 80%.
What is considered the definitive investigation for scaphoid fractures?
MRI is considered the definitive investigation to confirm or exclude a diagnosis.
What is the initial management for suspected scaphoid fractures?
Initial management includes immobilisation with a Futuro splint or standard below-elbow backslab and referral to orthopaedics.
How are undisplaced scaphoid waist fractures managed?
Undisplaced fractures are typically managed with a cast for 6-8 weeks, achieving union in over 95% of cases.
What are the complications of scaphoid fractures?
Complications include non-union, leading to pain and early osteoarthritis, and avascular necrosis.
What is a Colles’ fracture?
A fracture caused by a fall onto extended outstretched hands, described as a dinner fork type deformity.
Classical Colles’ fractures have three features: transverse fracture of the radius, 1 inch proximal to the radio-carpal joint, and dorsal displacement and angulation.
What characterizes a Smith’s fracture?
A reverse Colles’ fracture with volar angulation of the distal radius fragment, resembling a garden spade deformity.
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed.
What is a Bennett’s fracture?
An intra-articular fracture at the base of the thumb metacarpal, typically caused by impact on a flexed metacarpal, often from fist fights.
X-ray shows a triangular fragment at the base of the metacarpal.
What defines a Monteggia’s fracture?
A fracture involving dislocation of the proximal radioulnar joint in association with an ulna fracture, often due to a fall on an outstretched hand with forced pronation.
Needs prompt diagnosis to avoid disability.
What is a Galeazzi fracture?
A radial shaft fracture with associated dislocation of the distal radioulnar joint, occurring after a fall on the hand with a rotational force.
Examination reveals bruising, swelling, and tenderness over the lower end of the forearm; X-rays show a displaced fracture of the radius and a prominent ulnar head.
What is a Barton’s fracture?
A distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation, typically resulting from a fall onto an extended and pronated wrist.
What are scaphoid fractures?
The most common carpal fractures, associated with falls onto an outstretched hand.
Main signs include swelling and tenderness in the anatomical snuffbox, pain on wrist movements, and pain on longitudinal compression of the thumb.
What is a radial head fracture?
A common fracture in young adults, usually caused by a fall on the outstretched hand, characterized by marked local tenderness over the head of the radius and impaired elbow movements.
Sharp pain occurs at the lateral side of the elbow at the extremes of rotation (pronation and supination).
