upper limb injuries Flashcards
where is most common place to fracture clavicle
middle 1/3
then lateral
management of clavicular fracture
majority heal
analgesia
sling 3-4 weeks
progressive mobilisation from 2 weeks
surgery needed if displaced or open fracture or threatening neurovasculature- uncommon
acromioclavicular joint is injured by
falling on to point of shoulder, common in sporting accidents. can be sprain or dislocation
treatment of AC joint injury
sprains- sling for 3-4 weeks
displaced- may benefit from early fixation surgery
proximal humerus fractures epidemiology
similar to hip fractures
young high energy
elderly osteoporotic
management of proximal humeral fracture
sling mobilise for 6 weeks
fixation with plate or joint replacement - usually elderly
recurrence increases with younger age, male sex and participation in contact sports
investigation for shoulder dislocation
two views on xray MANDATORY as many are missed esp posterior
test axillary nerve- regimental badge. if damaged then long rehab
check passive external rotation (unilateral loss) in posterior dislocation
most common shoulder dislocation
anterior (80-85%)
then posterior
then inferior (<5%)
treatment of shoulder dislocation
acute- reduction under sedation/anaesthetic
distal radial fracture
commonest fracture in elderly. fall on outstretched hand (FOOSH)
high velocity injury in young
dinner fork deformity
distal radial fracture treatment
undisplaced - splint/cast
minimally displaced- reduce, cast with or without wires
significantly displaced- surgical plate or external fixator
colles fracture
involves a break in the radius bone of the forearm near the wrist. most common type of wrist fracture
scaphoid fracture diagnosis, investigations
most common fractured bone in carpus
often difficult to see on xray
repeat x ray at 2 weeks or MRI
fall onto outstretched hand (FOOSH)
pain base of thumb
tenderness anatomical snuff box
pain telescoping thumb
scaphoid fracture treatment
cast 6 weeks
surgery if displaced with screw or non union with screw or bone graft
how does ulnar collateral ligament injury of thumb happen
radial force
“skiers thumb”
“gamekeepers thumb”
ulnar collateral ligament of thumb symptoms
PAIN
weak pinch grip
weakness and looseness in thumb
swelling
tenderness
tender ulnar side joint
joint opens on radial stress
ulnar collateral ligament of thumb treatment
splint/cast
repair ligament
fix avulsion ligament
what is bennetts fracture
intraarticular fracture at base of 1st metacarpal
what causes bennetts fracture
axial compression of slightly flexed carpometacarpal joint eg falling on outsretched hand or boxing
displacement due to proximal pull from abductor pollicis longus
treatment of bennetts fracture
reduction
maintenance reduction eg plaster cast, wire, screw fixation
what must you be careful of in fight injuries
MCP joint penetration
broken teeth in situ
immunocompromised area and can get septic arthritis
boxers fracture
fracture of little finger metacarpal neck
may also be ring finger
usually conservative management
reduce if significant angulation
flexor tendon injuries
usually knife laceration, young adults usually males,
repair surgically and early
beware area in flexor tendon injuries
zone 2
both FDS and FDP involved- worst prognosis
remember position of hand at time of injury to see if changes
what to be aware of in scaphoid fracture
risk of non union or avascular necrosis if fracture in proximal third as has retrograde blood supply (only runs in one direction)
