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Orthopaedics > upper limb fractures and dislocations > Flashcards

upper limb fractures and dislocations Flashcards

1
Q

for the following images identify the fracture or dislocation
[55]

A

clavicle fracture

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2
Q

for the following images identify the fracture or dislocation [56]

A

proximal humerus fracture

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3
Q

for the following images identify the fracture or dislocation [57]

A

acromioclavicular joint dislocation

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4
Q

for the following images identify the fracture or dislocation[58]

A

anterior and posterior shoulder dislocation x ray

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5
Q

for the following images identify the fracture or dislocation[59]

A

elbow dislocation simple and complex

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6
Q

for the following images identify the fracture or dislocation[60]

A

radial head fracture

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7
Q

for the following images identify the fracture or dislocation[61]

A

forearm fractures

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8
Q

for the following images identify the fracture or dislocation[62]

A

distal radius fracture

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9
Q

for the following images identify the fracture or dislocation[63]

A

scaphoid and other carpal fractures and dislocations

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10
Q

for the following images identify the fracture [64]

A

metacarpal and phalangeal fractures

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11
Q

who gets clavicle fractues

A

young active patinets

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12
Q

where anatomically do clavicle fractures occur

A

80% middle third
15% lateral third
5% medial third

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13
Q

mechanism of injury in clavicle fracture 2

A

FOOSH- fall on outstreched hand)

direct blow to shoulder
-cyclist

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14
Q

treatment for clavicle injury 2

A

usually conservative
-broad-arm sling w follow up XRs at 6wks to ensure union

ORIF- open reduction internal fixation if displaced significantly

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15
Q

complications of clavicle fractures 4

A

deformity may lead to functional problems in adulthood
-palpable bump

stiffness, infection, malunion

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16
Q

who gets acromioclavicular joint dislocations

A

male athletes, contact sports

*-remeber this is clavicle dislocation not shoulder

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17
Q

mechanism of injury in acromioclavicular joint dislocations 2

A

direct blow to top of shoulder

fallowing onto shoulder

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18
Q

presenation of acromioclavicular joint dislocations 2

A

tender prominence over AC joint

adduction of arm across body will increase pain

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19
Q

imaging of acromioclavicular joint dislocations 1

A

on XR- chekc for congruity of underside of acromino with distal clavicle

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20
Q

classificaitons for acromioclavicular joint dislocations

A

Rockwood Type 1-6:
1 = AC sprain
2 = AC torn
3 = AC torn
4 = Posterior displacement of clavicle
5 = >100º superior displacement
6 = Inferior displacement of clavicle

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21
Q

treatment for grade 1-3 acromioclavicular joint dislocations 1

A

conservatievly with broad-arm sling and physio

-chronic sympatonitc grade 3 with reconstruction

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22
Q

treatment for grade 4-6 acromioclavicular joint dislocations 2

A

reconstruction
or
ORIF with hook plate

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23
Q

complications of acromioclavicular joint dislocations 2

A

cosmetic issues
-large bump, skin necrossi

ACJ arthitits or ongoing pain

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24
Q

state the two types of shoulder dislocation

A

anterior dislocation

posterior dislocation

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25
Q

which type of shoulder dislocaiton is more common

A

anterior dislocaiton
-accounts for up to 95% of shoulder dislocations

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26
Q

who gets anterior shoulder dislocations

A

typically young males after contact sport

elderly patients can have FOOSH

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27
Q

what movment causes a anterior shoulder dislocations from contact sports 3

A

forced arm into:
-abduction
-extension
-external rotation

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28
Q

what does anterior shoulder dislocations cuase a risk of

A

humeral fracture

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29
Q

signs of anterior shoulder dislocations 2

A

loss of shoulder contour
-flattening of deltoid

anterior bulge from head of humerus
-palpated in axilla

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30
Q

what needs to be checked before and after reduction in anterior shoulder dislocations 2

A

pulses and nerves

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31
Q

treatment for anterior shoulder dislocations 4

A

relieve pain - ENTONOX

simple reduction

Kocher’s method

support arm in internal rotation with broad arm sling and refer to fracture clinic for follow up

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32
Q

describe the simple reduction method for anterior shoulder dislocations

A

apply longitudinal traction to the arm in abduction

replace humeral head by gentle pressure

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33
Q

describe the Kocher’s method for anterior shoulder dislocations reduction 1

A

flex elbow to 90degree and externall rotate shoulder
-bring arm anteiorly and then internally rotate

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34
Q

overveiw of posterior shoulder dislocation 4

A

rare

presentes with limitation of extetrnal rotation

can be assoc w epileptic seizures or electrical shocks

hard to diagnose with AP XR
-‘light bulb’ appearance of humeral head
LATERAL XR ESSENTIAL

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35
Q

complications of shoulder dislocations 3

A

recurrent dislocation
-can cause further instability due to damaged joint capsule component s
-those <25yrs have higher risk of recurrent events

bankart lesions
-avulsion of glenoid labrum from glenoid

Hill-sachs lesions
-impaction fracture of humeral head following anterior dislocation

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36
Q

who gets proximal humerus fractures 2

A

elderly population FOOSH

high energy

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37
Q

describe the neer classification for proximal humerus fractures

A

divides promixal humerus into 4 parts
-humeral head
-greater tuberosity
-lesser tuberosity
-femoral shaft

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38
Q

what is defined as displaceemnt in a proximal humerus fractures

A

if angulation >45˚ or >1cm

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39
Q

treatment for proximal humerus fractures 4

A

depends on no of fragments and displacement

2 parts, displaced= ORIF

severely comminuted, 4 parts= conservative

if unable to fix and rotator cuff defunctioned due to tuberosity involvement
-reverse shoulder replacement

young patients with fracture not suitable for fixation
-hemiarthroplasty

40
Q

cause of humeral shaft fracture 1

A

typically fall onto arm

41
Q

classification for humeral shaft fracture

A

location by proximal, middle or distal 1/3

42
Q

define a hollstein-lewis humeral shaft fracture fracture

A

spiral fracture of distal 1/3
-assocaited with radial nerve palsy (wrist drop)

43
Q

what does a radial nerve palsy cause

A

wrist drop

44
Q

treatment for humeral shaft fracture

A

usually conservatie with humeral brace
-collar and cuff sling
-immobilise for 8-12wks

ORIF if:
-open
-vascular injury
-forearm fracture
-polytrauma
*ORIF involves locking or compression plating

45
Q

management of radial nerve palsy in humeral shaft fracture

A

surgery if still fucked after intervention or manipulation of fracture

46
Q

msot common elbow fracture

A

radial head fracture

47
Q

cause of radial head fracture

A

FOOSH with pronated forearm

48
Q

features of radial head fracture 2

A

elbow swollen and tender over radial head

flexion and extension may be possible
-supination and pronation will HURT

49
Q

XR findings in radial head fracture

A

shows effusion

minor fractures often missed

50
Q

classiication for radial head fracture

A

mason type 1-4 [65]

51
Q

define an essex-lopresti injury regarding radial head fracture

A

interosseous membrane disruption and DRUJ injury

52
Q

treatmet for radial head fracture 4

A

Mason I- conservative

Mason II- conservative unless block to rotation

Mason III&IV- ORIG, excision or replacement

depends on how stable the elbow is

53
Q

complications of radial head fracture 3

A

soft tissue injuries in 1/3rd of patients

loss of forearm movements

terrible triad
-elbow dislocation
-coronoid fracture
-radial head fracture

54
Q

angle of elbow dislocation that is most common

A

posterolateral

55
Q

mechanism of elbow dislocation

A

axial loading

supination

valgus force

posterior ulnar displacement on the humerus, fixed in flexion

56
Q

imaging of elbow dislocation 3

A

look for anterior humeral line and radiocapitellar line

posterior fat pad is ALWAYS abnormal

57
Q

classfications of elbow dislocation

A

anatomical location of olecranon in relation to humerus

simple vs complex

58
Q

define simple vs complex elbow dislocations

A

he simple dislocation is characterised by the absence of fractures, while the complex dislocation is associated with fractures

59
Q

treatment for elbow dislocation 3

A

closed reduction ± GA

post-reduction image needed to exclude fractures

immobolise on back slab for 10 days

60
Q

describe a closed reduction of elbow dislocation

A

stand behind patient, flex elbow

-fingers around epicondyls
=PUSH FORWARD ON OLECRANON with thumbs and down on forearm
-hear a clunk- success

61
Q

complications of elbow disocations 3

A

stiffness

instability

neurovascular injuries

62
Q

2nd most common open fracture after the tibia

A

forearm fractures

63
Q

cause of forearm fractures

A

direct trauma to forearm

64
Q

what are patinets with forearm fractures at risk of 2

A

comparment syndrome

can also have damage to radial, ulner or median nerves (anterior interosseous branch)

65
Q

treatment for forearm fractures 4

A

ATLS, compartments thorough neurovascular assessment

open fracture?- NEEDS OPERATIVE MANAGEMENT

minimally displaced/isolated ulna fracture- conservative

radial shaft fracture or proximal 1/3 ulna- ORIF

66
Q

define moteggia fracture

A

proximal 1/3 ulna fracture with assocaited dislocation of radial head
-remembered by ‘monty loses his head’

peak incidence 4-10yrs

4types

67
Q

define galeazzi fracture

A

distal radius shaft fractue and assoc DRUJ injury
-stbaility depends on proximity to joint lin e

all require reduction ± operative fixation

68
Q

define nightstick fracture

A

isolated ulnar shaft fracture

typically assoc w direct blow to forearm held up in self-defence
-high force

LOOK FOR OTHER INJURIES

69
Q

who gets distal radius fractures

A

bimodal distribution
young-high energy

old-low energy- FOOSH

osteoporotic fracture predictor

70
Q

treatment for distal radius fractures 6

A

depends on 3 things (rulle of 11s)
-radial height-11mm
-inclination- 22˚
-tilt 11˚

MUA (manipulation under anaesthetic) and plaster

K-wires (extra-articular with little comminution)

ORIF
-complex, intra-articular, shortened & comminuted fractures

volar fractures are unstable and require ORIF

71
Q

define colles fracture

A

extra-articular fracture of distal radia with DORSAL displacement

-described as a dinner fork deformities
-can get avulsions of ulna styloid process

72
Q

3 features of colles fracture

A

transverse fracture of radius

1 inch proximal to radio-carpal joint

dorsal displacement and angulation

73
Q

define smiths fracture

A

AKA reverse colles

extraarticular fractuer of distal radius with VOLAR displacement
-garden spade deformity

caused by falling backwards on outstreched hand

fixation is needed more commonly than in colles
-fragure fragments tend to migrate palmarly

74
Q

define bartons fracture

A

INTRA-artiuclar involving the dorsal aspect of the distal radius

75
Q

define chauffeurs fracture

A

fratue of radial styloid

76
Q

when is a reduciotn of a distal radius needed

A

commonly in colles

77
Q

describe reduction of the distal radius 4

A

ensure analgeisa

traction applied to hand with an assistant to provide counter-traction at the elbow

fractue can often be felt to disimpact with a clunk

correct dorsal and radial angulation

78
Q

acceptable radiographic angle after distal radius reduction 5

A

dorsal tilt <10˚

radial shortening <2mm

radial inclination >15˚

articular step <2mm (between radius and ulna)

distal radio-ulnar joint congruence

79
Q

where abouts in the scaphoids are commonly affected in fractures

A

65% are in the ‘waist’ of the scaphoid

25% proximal third

10% distal third

80
Q

what is at risk with scaphoid fractures

A

blood supply is retrograde from branches of radial artery
-THEREFORE RISK OF AVASCULARNECROSIS INCREASES WITH PROXIMITY OF FRACTURE

81
Q

features of scaphoid fractures 4

A

tender in anatomical snuff box and over scaphoid tubercles

pain on axial compression of thumb

pain on ulnar deviation of wrist pronation

pain on supination against resistantce

82
Q

imaging of scaphoid fractures

A

request deticated scaphoid series

if negative and fracture suspected request MRI
-CT is alternative

83
Q

treatment for scaphoid fractures

A

usually non-operative

if negative XR repeat in 10-14 days

ORIF for proximal pole fractures or waist fractures displaced >2mm

tubulercles, distal poles & undisplaced waist fractues= conservative

84
Q

carpal bones and mneomonic

A

[66]

85
Q

complications of scaphoid fracture

A

SNAC wrist- scaphoid nonunion advanced collapse

AVN- avascular necrosis

86
Q

describe perilunate dislocation

A

injuries that involve traumatic rupture of the radioscaphocapitate (RSC) ligament, the scapholunate interosseous (SLI) ligament, and the lunotriquetral interosseous (LTI) ligament.

always high energy with poor functional outcome

87
Q

diagnosis of perilunate dislocation

A

image with lateral xray of wrist

88
Q

mechanism of injury of perilunate dislocation

A

wrist extended with ulnar deviation
-leads to intercarpal supination

89
Q

classification of perilunate dislocation

A

Stage I = Scapholunate dissociation
Stage II = Perilunate dislocation
Stage III = Midcarpal dislocation
Stage IV = Lunate dislocation

90
Q

treatment for perilunate dislocatiron

A

urgent reduction and fixation with K-wires

ligament reconstruction ± carpal tunnel release

91
Q

most common metacarpal fracture

A

5th MC- often from a punch
-‘Boxers fracture’

92
Q

management of 5th metacarpal fracture

A

stable- closed fracture
-mangaed in split/ cast for 2wks
-wrist in partial extension MCPJ in 70-90˚ flexion with fingers in extension

unstable fractues
-may need K-wires or ORIF

93
Q

describe bennets fracture

A

intra-articular fracture of first carpometacarpal joint

impact on flexd MC, caused by fist fights

XR shows triangular fragment at ulnar base of MC

94
Q

define proximal phalanx fractures

A

spiral or oblique fractuers occurrring at this site are likely to have a rotational deformity
-must be corrected

ORIF- with a single compression screw

95
Q

define middle phalanx fractues

A

manipulate these
-split flexion over a malleable metal splint
-buddy strap

aims to control rotation

96
Q

define distal phalanx fractures

A

may be caused by crush injuries often OPEN

if closed syx may be relieved by trephining the nail (hole in nail)

Orthopaedics (15 decks)

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