Upper Limb Injuries Flashcards
What is the epidemiology of clavicle fracture?
1 in 20 fractures involve the clavicle
Middle is most common then lateral then medial as most stable
What is the most common cause of clavicle fractures?
Fall onto shoulder and outstretched hand
What is the management for clavicle fracture?
Vast majority unite
Analgesia
Sling - 3-4 weeks then progressive mobilisation after 2 weeks
Figure of 8 bandage
When is surgery done for clavicle fractures?
Some displaced
Open fractures
Threatening the skin
Neurovascular complication
Polytrauma
When is their injury to the acromioclavicular joint?
Fall onto the point of shoulder
Dislocation of AC joint - graded from sprain to complete dislocation
What is the treatment for acromioclavicular joint?
Sprains in a sling for 3-4 weeks
Displaced AC joint may benefit from early fixation - manmade ligament to hold clavicle down so joins
Describe proximal humerus fractures
Similar epidemiology to hip fractures
Young high energy injuries
Elderly osteoporotic injuries
What is the management for proximal humerus fracture?
Depends on fracture configuration and patient biology
Conservative - sling, mobilise from 6 weeks
Operative - fixation with plate and joint replacement
Describe shoulder dislocation
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
What investigation is done for shoulder dislocation?
Two views on X-ray are mandatory
High proportion esp. posterior dislocation is missed in one view
What is the treatment for shoulder dislocation?
Acute reduction under sedation/ anaesthetic - various methods like Hippocratic and Kocher’s
What is the recurrence risk with shoulder dislocation?
Risk increases with younger age, male and participation in contact sport
18 year old male in contact sport has 90% recurrence rate
What are causes of posterior dislocation?
Seizure, electrocution and direct blow to front of shoulder
How is posterior dislocation diagnosed?
Check passive external rotation - unilateral loss
X-ray - 2 views
What causes a distal radial fracture in young patients?
High velocity injury
What causes a distal radial fracture in elderly patients?
Low velocity injuries, Colles fracture, osteoporotic, fall on outstretched hand, dinner fork deformity, radial shortening, radial deviation and dorsal angulation
What is the treatment for distal radial fracture?
Conservative - if not displaced then splints/ casts and if displaced then reduce and cast
Surgical - plate and external fixator
What are the complication of Colles fracture - distal radial fracture?
Malunion, DRUJ pain (distal radial ulnar joint), EPL rupture (extensor pollicus longus), carpal tunnel syndrome and CRPS
Describe scaphoid bone fractures
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
How do you get a scaphoid fracture?
Fall onto outstretched hand
Pain at base of thumb
Tenderness on anatomical snuffbox
Pain telescoping thumb
What is the treatment for scaphoid fracture?
Cast for 6 weeks
Surgery - displaced and non-union - screw in scaphoid or grafting
Where is the anatomical snuffbox?
Space bordered by abductor pollicis longus and extensor pollicis brevis longus anteriorly
Extensor pollicis longus posteriorly
Radial styloid proximally
What is ulnar collateral ligament injury to thumb due to?
Due to radial force
Gamekeeper thumb - attrition
Skiers thumb - ski pole/mat
Can be ligament only or avulsion fracture
What is the symptoms of a ulnar collateral ligament injury of thumb?
History of injury and weak pinch grip
Examination - tenderness on ulnar side joint and joint opens on radial stress
What is the treatment for UCL injury of thumb?
Conservative - splints/ casts on for 6 weeks
Operative - repair ligament and fix avulsion fragment
What is a Bennett’s fracture?
Intra-articular fracture at base of 1st metacarpal
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
What is the treatment for Bennett’s fracture?
Reduce
Maintenance reduction - plaster cast, possible wire and screw fixation
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
What is a boxer’s fracture?
Fracture of little finger in metacarpal neck
May also be ring finger
Volar angulation - pushed into palm
What is the treatment for Boxer’s fracture?
Conservative management
Reduce if significant angulation - prominent in palm
Describe flexor tendon injuries fingers
Usually knife laceration
More males than females and young adults
Repair surgically and early - technically challenging repair
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
What is rehabilitation for tendon injury?
Early movement (stress) increases healing and strength, and reduces adhesions
Active or passive
