Upper Limb Injuries Flashcards
What are some examples of upper limb injuries?
- Clavicular fracture
- Acromioclavicular injury
- Shoulder dislocation
- Proximal humeral fracture
- Distal radial fracture
- Scaphoid fracture
- Bennet’s fracture
- Ulnar collateral ligament of thumb
- Boxers injury
- Flexor tendon injury
Describe the aetiology of clavicular fracture?
- Fall onto shoulder/outstretched hand
Where is the most common location of clavicular fracture?
- Middle 1/3 80%
- Lateral 1/3 15%
- Medial 1/3 5%
Describe the management of clavicular fracture?
- Vast majority unite
- Analgesia
- Sling
- 3-4 weeks
- Progressive mobilisation from 2 weeks
- Surgery
- Indications
- Some displaced
- Open fractures
- Threatening to skin
- Neurovascular complications
- Polytruma
- Indications
What are indications for surgery for clavicular fracture?
- Some displaced
- Open fractures
- Threatening to skin
- Neurovascular complications
- Polytruma
Describe the aetiology of dislocation of AC joint?
- Fall onto the point of shoulder
How is dislocatino of AC joint graded?
- Graded from sprain to complete dislocation
Describe the treatment for dislocation of AC joint?
- Sprains
- Treated in sling 3-4 weeks
- Displaced AC joint displocation
- Early fixation
What does AC joint stand for?
Acromioclavicular joint
Describe the aetiology of proximal humerus fracture?
- Young
- High energy injuries
- Elderly
- Osteoporotic injuries
Describe the management of proximal humerus fracture?
- Depends on fracture configuration and patient biology
- Conservative
- Sling, mobilise from 6 weeks
- Operative management
- Fixation with plate
- Joint replacement
What is the most commonly dislocated joint?
- Shoudler
- Shoulder most mobile joint in body, at cost of stability
In what direction is a shoulder dislocation most common?
- Anterior 80-85%
- Posterior 10%
- Inferior <5%
What investigations are done for shoulder dislocation?
- Test axillary nerve
- Regimental badge
- X-ray
- 2 views as posterior dislocation can be missed on 1 view
Describe the management of shoulder dislocation?
- Acute reduction under sedation/anaesthetic
- Method – Hippocratic, Kocher’s
Describe possible complications of shoudler dislocation?
- Recurrence
- Increases with younger age, male, participation in contact sport
- 90% recurrence rate for this
Describe the aetiology of posterior shoulder dislocation?
- Seizure
- Electrocution
- Direct blow to front of shoulder (boxing)
How is posterior shoulder dislocation diagnosed?
- Check passive external rotation (unilateral loss)
- X-ray
Describe aetiology of distal radial fracture?
- Young patients
- High velocity injury
- Older
- Low velocity injury
- Colles fracture
- Osteoporotic
- Fall outstretched hand
Describe presentation of distal radial fracture?
- Examination
- Dinner fork deformity
- Radial shortening
- Radial deviation
- Dorsal angulation
Describe management of distal radial fracture?
- Conservative
- Undisplaced
- Splint/cats
- Displaced
- Cast
- Cast with/without wires
- Undisplaced
- Surgical
- Plate
- External fixator
What is Colles fracture?
Type of fracture of distal radius
Describe complications of Colles fracture?
- Malunion
- DRUJ pain
- EPL rupture
- Carpal tunnel syndrome
- CRPS
Describe the aetiology of scaphoid fracture?
- Fall onto outstretched hand
What is the most commonly fractured bone in the carpus?
- Most common fracture boned in carpus
What investigations are done for scaphoid fracture?
- X-ray
- Often difficult to see
- Repeat x-ray at 2 weeks or MRI
Describe the presentation for scaphoid fracture?
- Pain base of thumb
- Tenderness anatomical snuff box
- Pain telescoping thumb
Describe the management of scaphoid fracture?
- Cast 6 weeks
- Surgery
- Indications – displaced, non-union
What are possible complications of scaphoid fracture?
- Risk of non-union or avascular necrosis if fracture in proximal third
- Retrograde blood supply to distal pole
What is the anatomical snuff box bordered by:
- anteriorly
- posteriorly
- proximally
- Anteriorly
- Abductor pollicis longus and extensor pollicis brevis longus
- Posteriorly
- Extensor pollicis longus
- Proximally
- Radial styloid/radius
Describe the aetiology of ulnar collateral ligament injury of thumb MCPJ?
- Radial force
- Gamekeepers thumb
- Skiers thumb
What are the different types of ulnar collateral ligament injury of thumb MCPJ?
- Ligament only
- Avulsion fracture
Descibe the presentation of ulnar collateral ligament injury of thumb MCPJ?
- Injury
- Weak pinch grip
- Examination
- Tender ulnar side joint
- Joint opens on radial stress
Describe the management of ulnar collateral ligament injury of thumb MCPJ?
- Conservative
- Splint/cast
- Operative
- Repair ligament
- Fix avulsion fragment
What is Bennett’s fracture?
Intra-articular fracture at base of 1st metacarpal
Describe the aetiology of Bennett’s fracture?
- Axial compression of slightly flexed CMC joint
- Falling on outstretched hand
- Boxing
- Displaced due to proximal pull from abductor pollicis longus
Describe the management of Bennett’s fracture?
- Reduction
- Maintenance reduction
- Plaster cast
- With or without wire
- Screw fixation
What are some signs of fight injuries?
What is a boxer’s fracture?
Fracture of little finger metacarpul neck:
- May also be ring finger
Describe the deformity of boxer’s fracture?
- Volar angulated
Describe the management of boxer’s fracture?
- Usually conservative
- Reduce if significant angulation (prominent in palm)
Describe the aetiology of flexor tendon injuries of fingers?
- Usually knife laceration
Describe the epidemiology of flexor tendon injuries of fingers?
(incidence rising or decreasing, sex, age)
Describe the zones of the hand to describe flexor injuries?
Describe the management of flexor of the hand injuries?
- Surgically and early
- Beware old injuries
- Partial tears (<60%) do not require repair
- Rehabilitation
- Early movement (stress) increases healing and strength
Which zone of the hand has the worst prognosis for flexor injuries?
- Zone 2 worst
- Usually both FDS and FDP tendons involved
