Upper Limb Injuries Flashcards
Which part of the clavicle is most commonly fractured?
Middle 1/3- 80%
What commonly causes clavicular fracture?
Fall onto shoulder outstretched hand
How are clavicular fractures treated?
Vast majority unite themselves
Analgesia
Sling for 3-4 weeks for progressive mobilization
When are clavicular fractures operated on?
Rarely
Very displaced fractures
Open fractures when bone is piercing through skin
Polytrauma
Neurovascular complication
When in the acromioclavicular joint commonly injured?
In sports injuries, commonly rugby
What is the treatment for acromioclavicular injuries?
Sprains treated using a sling for 3-4 weeks
Displaced AC dislocations may benefit from early fixation
Define dislocation.
Complete loss of contact between two ends of a joint
What is the common cause of proximal humerus fractures in younger patients?
High energy injuries e.g. fall from height or motor vehicle accidents
What is the common cause of proximal humerus fractures in older patients?
Osteoporotic injuries
What is conservative management of proximal humerus fractures?
Sling- mobilising for 6 weeks
What is surgical management of proximal humerus fractures?
Fixation with plate
Joint replacement
RECAP- most mobile joint in the body?
Shoulder joint
Three types of shoulder dislocation?
Anterior
Posterior
Inferior
What nerve may be damaged in shoulder dislocation?
Axillary nerve
->test regimental badge area
If axillary nerve is damaged, rehabilitation will take a while. Which muscle in particular won’t work?
Deltoid muscle
How many x-ray views are required for shoulder dislocations?
Two because high proportion of posterior dislocations are missed
Treatment for shoulder dislocation?
Acute-reduction of dislocation under sedation or anaesthetic
Who is at a higher risk of shoulder dislocation reoccurrence?
Younger age, male sex, participation in contact sports
->these patients get treated more aggressively and often undergo surgical stabilisation to reduce risks of reoccurrence
What are the common causes of posterior shoulder dislocation?
Seizures
Electrocution
Direct blow to shoulder e.g. boxing
How is a diagnosis of a posterior shoulder dislocation made?
Checking passive external rotation- there will be unilateral loss
X-ray
->beware of bilateral posterior dislocation in seizures and electrocution
What is the classic appearance of the humerus in a posterior dislocation on x-ray?
Light bulb
Distal radial fractures in younger patients are usually because of high velocity injuries e.g. falling from height or vehicle injuries.
Older patients can get these # because of lower velocity injuries like what?
Falls, classically onto an outstretched hand
->other causes = osteoporotic
What is the most common fracture in older patients?
Distal radial fracture
->think of Granny
How are undisplaced distal radial fractures treated conservatively?
Splints/casts
How are displaced distal radial fractures treated conservatively?
Reduce fracture first by pulling bone back into position
Then cast with wiring
How may a distal radial fracture be treated surgically?
Plates
External fixation
->most are treated conservatively though
Complications of distal radial fractures?
Malunion
DRUJ pain (distal radioulnar joint)
EPL rupture (extensor pollicus longus, runs along back of fracture)
Carpal Tunnel syndrome
CRPS- chronic regional pain syndrome
Which bone is the most commonly fractured bone in the carpus?
Scaphoid bone
Are scaphoid fractures easy to see on x-ray?
No, difficult to see on initial x-ray so repeat x-rays are taken 2 weeks after leaving the patient in a cast
->early MRI’s more common now as can identify a fracture immediately after it has happened
How does scaphoid fracture occur?
Falling onto outstretched hand commonly
Where will pain be felt in a scaphoid fracture?
Pain at the base of thumb, pain telescoping thumb (pushing thumb up and down mainly)
Tenderness of the anatomical snuff box
Which area of the scaphoid bone can damage the blood supply if fractured?
Fracture in the middle third of scaphoid
How are scaphoid fractures treated?
6 weeks in a cast or splint
If displaced, or there in non-union, can be treated surgically
What causes ulnar collateral ligament injury of thumb?
Radial force
-> known as gamekeepers thumb as ruptured when using a shotgun or skiers thumb
Ulnar collateral ligament injuries of thumb can injure the ligament only but may also pull off some bone (avulsion fracture).
What is usually the presenting complaint?
Pain over radial border with history of injury
Weak pinch grip
What would be seen upon examination of a ulnar collateral ligament injury of the thumb?
Tender ulnar side joint (called ulnar side of finger so side of thumb closest to ulna, use this as won’t change with pronation and supination
How is a UCL injury of thumb treated conservatively?
Splint or cast
How is a UCL injury of thumb treated operatively?
Repair ligament
Fixing any avulsion fracture
Where does Bennett’s fracture occur?
Thumb (intra-articular fracture at the base of the 1st metacarpal)
->idk maybe think of Amy B being a teacher, doing heads down thumbs up??
What are some of the common causes of Bennett’s fracture?
Boxing
Falling on outstretched hand
There is often displacement in Bennett’s fracture, why is this?
Proximal pull from abductor pollicus longus
What is the treatment of Bennett’s fracture?
Reduction of fracture
Maintenance of this reduction using plaster cast and wiring and screw fixation
What is something to be aware of in fighting injuries?
There may be pieces of teeth in the laceration in MCP joint- cause for infection which can lead to septic arthritis of this joint
->known as fight bites
Boxer’s fracture?
Fracture of little finger metacarpal neck
(may also be ring finger)
How is boxer’s fracture usually treated?
Conservatively, reducing if significant angulation
->note that reducing means reducing space between bone(s) involved in a fracture
What is the usual cause of flexor tendon injuries of the fingers?
Knife laceration e.g. fish gutting or cutting food in kitchen
->tends to be young adults, male>female
How are flexor tendon injuries of the fingers treated?
Early surgical repair
Which flexor tendons of the fingers have the worst prognosis if injured?
FDS and FDP
How are flexor tendon finger injuries repaired?
Secure low profile sutures
->partial tears (<60%) do not need repair
What is involved in rehabilitation of flexor tendon finger injuries?
Early movement increases healing and strength
