Upper limb injuries 1

Question 1

Dis deck will cover

Answer 1

Fractures of the clavicle

Shoulder dislocation

AC joint injuries

Fractures of the proximal humerus

Fractures of distal radius

Question 2

Clavicle fractures:

• a) Where on the clavicle do they happen?
• b) How do they happen? (mechanism)

Answer 2

a) Where on the clavicle do they happen?

• middle 1/3rd most common (80%)
• lateral 1/3rd (12-15%)
• medial 1/3rd lest common (5-6%)

b) Mechanism - fall on shoulder or outstretched hand

Question 3

Describe the natural course & management of clavicle fractures…

Answer 3

Analgesia

Sling (3-4 weeks)

Progressive mobilisation after 2 weeks

Usually no surgery - most unite on their own

Question 4

When would surgery be indicated for a clavicle fracture?

Answer 4

Very displacement

Open fracture or threatening skin

Neurovascular complications*

Polytrauma

*brachial plexus & subclavian art/vein closeby

Question 5

What causes AC dislocations?

How are AC injuries graded?

Answer 5

Acromioclavicular dislocations caused by vertical falls onto the point of the shoulder (imagine tipping & falling after a lineout in rugby)

Graded from sprains (still quite serious) to minor ligament damage to full on dislocations

Question 6

How are AC injuries treated?

Answer 6

Sprains - sling 3-4 weeks

Analgesics

Serious dislocations - ~early fixation

Question 7

Who gets proximal humeral fractures?

Answer 7

Young people - high energy impacts

Elderly - low energy on osteoperotic bones

Question 8

How are proximal humeral fractures managed?

Answer 8

Conservatively or operatively - depending on the fracture and the patient’s biology

Conservative - sling, mobilise from 6 weeks

Operative - plate fixation or joint replacement

Question 9

Shoulder dislocations are in other lectures so heres a wee summary about the basic stuff

Answer 9

Epidemiology/aetiology:

• most common dislocation of all
• most common direction - anterior (~85%)

Investigation - xray (2 views 90 degrees rotated!)

Complications - axillary nerve damage (badge sensation)

Question 10

How are shoulder dislocations treated?

Answer 10

Acute reduction under sedation/anaesthetic

Various methods

Question 11

What causes posterior dislocations?

Indicative feature on examination?

Sign on xray?

Answer 11

Causes:

• generalised tonic-clonic seizures (aka grand-mal)
• electrocution
• punch to the front of shoulder

Feature on examination - passive external rotation impossible

Xray finding - light bulb appearance

Question 12

What causes distal radial fractures?

Answer 12

Young patients - high energy impacts on outstretched hand

Older - low energy impacts on outstretched hand

Question 13

What are the 2 main types of distal radial fracture?

Answer 13

Colles fracture - most common

Smith’s fracture

Question 14

Describe the typical mechanism for a Colles fracture

Answer 14

Old, osteoporotic patient or young sporty patient with fall onto outstretched palm

Question 15

What deformities are seen on an xray of someone with a Colles fracture?

Answer 15

‘Dinner fork appearance’ - lateral view

Radial shortening

Radial deviation

Dorsal angulation

Question 16

How are Colles fractures treated?

Answer 16

Undisplaced…

• conservatively managed
• splint or cast

Displaced…

• reduce under anaesthetic
• cast +/- wires to fix in place

Badly displaced…

• surgical management
• plate & screws - or - external fixator

Question 17

What are the complications of a Distal radial fracture?

Answer 17

Malunion

DRUJ pain

EPL rupture

Carpal Tunnel Syndrome

CRPS

(DRUJ distal radio-ulnar joint, EPL extensor pollicis longus, CRPS chronic regional pain syndrome)

Question 18

How do Smith’s fractures differ from Colles’?

Answer 18

In Smith’s fractures, the wrist is displaced ventrally (ie. anterior in Anat.Pos) whereas in Colles’, the wrist is displaced dorsally (dinner fork).

Smith’s fractures are way less common but are also caused by FOOSH where the wrist is dorsiflexed.