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MSK > Upper Limb Injuries > Flashcards

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
Q

What is the treatment for UCL injury of thumb?

A

Conservative - splints/ casts on for 6 weeks
Operative - repair ligament and fix avulsion fragment

26
Q

What is a Bennett’s fracture?

A

Intra-articular fracture at base of 1st metacarpal

27
Q

What is the aetiology of Bennett’s fracture?

A

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
Q

What is the treatment for Bennett’s fracture?

A

Reduce
Maintenance reduction - plaster cast, possible wire and screw fixation

29
Q

What is seen on fight injuries?

A

Swelling of hand in boxers fracture
Flight bites - hit teeth, broken teeth in situ. Beware MCP joint penetration - immunocompromised area

30
Q

What is a boxer’s fracture?

A

Fracture of little finger in metacarpal neck
May also be ring finger
Volar angulation - pushed into palm

31
Q

What is the treatment for Boxer’s fracture?

A

Conservative management
Reduce if significant angulation - prominent in palm

32
Q

Describe flexor tendon injuries fingers

A

Usually knife laceration
More males than females and young adults
Repair surgically and early - technically challenging repair

33
Q

Why is zone 2 had to repair in hand?

A

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
Q

What is rehabilitation for tendon injury?

A

Early movement (stress) increases healing and strength, and reduces adhesions
Active or passive

MSK (39 decks)

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