Upper limb fractures Flashcards
Distal radius types
Most common orthopaedic injury
50% intraarticular
Colles-> dorsal displacement
Smiths-> volar displacement
Barron’s-> #dislocstion and infra articular
Distal radius clinical features
Swelling Deformity -> dinner fork=colles FOOSH Pain Decreased rom Altered median sensation
Distal radius associated injuries
Joint dislocation
Radial styloid in high energy
Distal radius investigations
X Ray AP
-radial height >5mm shortening (top of ulnar to radial styloid)
-radial indination >5 degrees (line through both styloids)
-articular stop off >2mm (normally congruous)
Lateral
-volar tilt >5
CT -> evaluation inter articular damage
Distal radius management
Conservative
- closed reduction and cast immobilisation
- > extra articular
- > <5mm radial shortening
- > dorsal angulation <5
Surgery
- fixation
- > intraarticular
- > unstable
- > unsuitable angles/shortening
Physiotherapy
Distal radius complications
Median neuropathy 30% Ulnar neuropathy EPL rupture Arthrosis 2-30% Malunion ECU/EPM entrapment Compartment
Scaphoid epidemiology
Most frequently # carpal bone
65% through waist
Blood supply enters dis tally
Scaphoid clinical features
Axial load through hyperextended and radially deviated wrists Pain Swelling Anatomical snuffbox tenderness Scaphoid tubercle tenderness Pain on thumb compression Pain with resisted pronation
Scaphoid investigations
X Ray -> scaphoid views -> repeat 2 weeks later
MRI-> if suspicious after 2 weeks
Scaphoid management
Conservative
- thumb spica cast immobilisation 3-4m
- > stable and non displaced
- > suspicion -> review in 2w
Surgery
- > unstable
- > proximal pole
- > decreases time for Union
Scaphoid complications
Non Union
Scaphoid nonunion advanced collapse
Necrosis
Metacarpal epidemiology
40% of all hand injuries Men 10-29y Neck most common 5th most common Direct blow/rotational injury
Metacarpal clinical features
?open Deformity Malrotation Pain and swelling ?neurovascular
Metacarpal investigations
X Ray
CT if complex
Metacarpal management
Conservative
- immobilisation
- > stable
- > no rotational deformity
Surgery
- > intracellular articular
- > rotational maligment
Metacarpal complications
Tendon laceration
Neurovascular injury
Compartment syndrome
Stiffness
Phalanx epidemiology
Most common injury to the skeletal system
10% of all #
Most commonly distal phalanx
Phalanx clinical features
Pain and swelling
Local tenderness
Deformity
?open
Phalanx investigations
X Ray
Phalanx management
Conservative
- proximal and middle-> buddy tape
- reduction and splint-> distal
Surgery
-ORIF-> unstable
Phalanx complications
Decreased ROM
Malunion
Non Union
Nail bed injury
Proximal numerous epidemiology
4-6% of all -#
Females
Elderly
Proximal humerus clinical features
Pain and swelling
Decreased rom
Ecchymosis on chest, arm and forearm
Proximal humerus investigations
X Ray
CT if intraarticular
Proximal humerus management
Conservative
- sling immobilisation, start rom in 2w
- > non displaced 85%
Surgery
- comminuted
- unstable
- anatomical neck
Proximal humerus complications
A vascular necrosis Axial nerve injury45% Mal Union Non Union Rotator cuff injury Adhesive capsulitis Arthritis Infection
Humeral shaft epidemiology
3-5%
Low energy in elderly
Humeral shaft clinical features
Pain
Extremity weakness
Neurovascular
Humeral shaft investigations
X Ray
Humeral shaft management
Conservative
- cooption splint followed by functional brace
- > minimal displacement
Surgery
- ORIF
- > open
- > neurovascular injury
Humeral shaft management
Malunion
Non Union
Radial nerve palsy
Radial head epidemiology
20% of all elbow injuries
Radial head clinical features
FOOSH in pronation
Lateral pain and tenderness
Limited supination/pronation
Palpate wrist and inter osseos membrane
Radial head investigations
X Ray
-fat pad signs ant and post humerus
CT if comminuted
Radial head management
Conservative
-immobilisation
Surgery
- displaced/angulation
- comminuted
Radial head complications
DRUT injury Interosseous membrane disruption Coronoid # MCL/LCL injury Dislocation Terrible triad-> dislocation and radial head and coranoid Carpal # Posterior interosseous nerve damage Decreased forearm rotation Stiffness Arthritis Infection
Clavicle epidemiology
4%
Young active pt
Direct blow to lateral shoulder
Clavicle clinical features
Shoulder pain
Deformity
Tenting of the skin
Radial head investigations
X Ray
Clavicle management
Conservative
- sling immobilisation with ROM 2-4w
- > non displaced
- > stable
Surgery
- ORIF
- > unstable
- > open
- > non Union
Clavicle complications
Ipsilateral shoulder # Scapulothoracic desociations Rib# Pneumothorax Neurovascular injury Non Union
