Upper Limb Injuries Flashcards

1
Q

What is the epidemiology of clavicle fracture?

A

1 in 20 fractures involve the clavicle
Middle is most common then lateral then medial as most stable

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2
Q

What is the most common cause of clavicle fractures?

A

Fall onto shoulder and outstretched hand

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3
Q

What is the management for clavicle fracture?

A

Vast majority unite
Analgesia
Sling - 3-4 weeks then progressive mobilisation after 2 weeks
Figure of 8 bandage

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4
Q

When is surgery done for clavicle fractures?

A

Some displaced
Open fractures
Threatening the skin
Neurovascular complication
Polytrauma

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5
Q

When is their injury to the acromioclavicular joint?

A

Fall onto the point of shoulder
Dislocation of AC joint - graded from sprain to complete dislocation

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6
Q

What is the treatment for acromioclavicular joint?

A

Sprains in a sling for 3-4 weeks
Displaced AC joint may benefit from early fixation - manmade ligament to hold clavicle down so joins

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7
Q

Describe proximal humerus fractures

A

Similar epidemiology to hip fractures
Young high energy injuries
Elderly osteoporotic injuries

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8
Q

What is the management for proximal humerus fracture?

A

Depends on fracture configuration and patient biology
Conservative - sling, mobilise from 6 weeks
Operative - fixation with plate and joint replacement

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9
Q

Describe shoulder dislocation

A

Most mobile joint in the body and stability sacrificed for mobility
Most are anterior then posterior then inferior
Make sure to test axillary nerve - regimental badge

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10
Q

What investigation is done for shoulder dislocation?

A

Two views on X-ray are mandatory
High proportion esp. posterior dislocation is missed in one view

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11
Q

What is the treatment for shoulder dislocation?

A

Acute reduction under sedation/ anaesthetic - various methods like Hippocratic and Kocher’s

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12
Q

What is the recurrence risk with shoulder dislocation?

A

Risk increases with younger age, male and participation in contact sport
18 year old male in contact sport has 90% recurrence rate

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13
Q

What are causes of posterior dislocation?

A

Seizure, electrocution and direct blow to front of shoulder

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14
Q

How is posterior dislocation diagnosed?

A

Check passive external rotation - unilateral loss
X-ray - 2 views

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15
Q

What causes a distal radial fracture in young patients?

A

High velocity injury

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16
Q

What causes a distal radial fracture in elderly patients?

A

Low velocity injuries, Colles fracture, osteoporotic, fall on outstretched hand, dinner fork deformity, radial shortening, radial deviation and dorsal angulation

17
Q

What is the treatment for distal radial fracture?

A

Conservative - if not displaced then splints/ casts and if displaced then reduce and cast
Surgical - plate and external fixator

18
Q

What are the complication of Colles fracture - distal radial fracture?

A

Malunion, DRUJ pain (distal radial ulnar joint), EPL rupture (extensor pollicus longus), carpal tunnel syndrome and CRPS

19
Q

Describe scaphoid bone fractures

A

Most common fractured bone in carpus
80% occur at wrist scaphoid
Often difficult to see on X-ray
Risk of non-union or avascular necrosis if fracture in proximal 1/3 - retrograde blood supply to distal pole

20
Q

How do you get a scaphoid fracture?

A

Fall onto outstretched hand
Pain at base of thumb
Tenderness on anatomical snuffbox
Pain telescoping thumb

21
Q

What is the treatment for scaphoid fracture?

A

Cast for 6 weeks
Surgery - displaced and non-union - screw in scaphoid or grafting

22
Q

Where is the anatomical snuffbox?

A

Space bordered by abductor pollicis longus and extensor pollicis brevis longus anteriorly
Extensor pollicis longus posteriorly
Radial styloid proximally

23
Q

What is ulnar collateral ligament injury to thumb due to?

A

Due to radial force
Gamekeeper thumb - attrition
Skiers thumb - ski pole/mat
Can be ligament only or avulsion fracture

24
Q

What is the symptoms of a ulnar collateral ligament injury of thumb?

A

History of injury and weak pinch grip
Examination - tenderness on ulnar side joint and joint opens on radial stress

25
What is the treatment for UCL injury of thumb?
Conservative - splints/ casts on for 6 weeks Operative - repair ligament and fix avulsion fragment
26
What is a Bennett's fracture?
Intra-articular fracture at base of 1st metacarpal
27
What is the aetiology of Bennett's fracture?
Axial compression of slightly flexed CMC joint Falling on outstretched hand and boxing Displacement is due to proximal pull from abductor pollicis longus - joint very unstable
28
What is the treatment for Bennett's fracture?
Reduce Maintenance reduction - plaster cast, possible wire and screw fixation
29
What is seen on fight injuries?
Swelling of hand in boxers fracture Flight bites - hit teeth, broken teeth in situ. Beware MCP joint penetration - immunocompromised area
30
What is a boxer's fracture?
Fracture of little finger in metacarpal neck May also be ring finger Volar angulation - pushed into palm
31
What is the treatment for Boxer's fracture?
Conservative management Reduce if significant angulation - prominent in palm
32
Describe flexor tendon injuries fingers
Usually knife laceration More males than females and young adults Repair surgically and early - technically challenging repair
33
Why is zone 2 had to repair in hand?
Within flexor sheath is usually both FDS and FDP tendons involved Repair by secure low profile sutures - Kessler technique Problems with adhesion post-op restricting movement Partial tears do not need repaired
34
What is rehabilitation for tendon injury?
Early movement (stress) increases healing and strength, and reduces adhesions Active or passive