Upper Limb Injuries

Question 1

Which part of the clavicle is most commonly fractured?

Answer 1

Middle 1/3- 80%

Question 2

What commonly causes clavicular fracture?

Answer 2

Fall onto shoulder outstretched hand

Question 3

How are clavicular fractures treated?

Answer 3

Vast majority unite themselves
Analgesia
Sling for 3-4 weeks for progressive mobilization

Question 4

When are clavicular fractures operated on?

Answer 4

Rarely
Very displaced fractures
Open fractures when bone is piercing through skin
Polytrauma
Neurovascular complication

Question 5

When in the acromioclavicular joint commonly injured?

Answer 5

In sports injuries, commonly rugby

Question 6

What is the treatment for acromioclavicular injuries?

Answer 6

Sprains treated using a sling for 3-4 weeks
Displaced AC dislocations may benefit from early fixation

Question 7

Define dislocation.

Answer 7

Complete loss of contact between two ends of a joint

Question 8

What is the common cause of proximal humerus fractures in younger patients?

Answer 8

High energy injuries e.g. fall from height or motor vehicle accidents

Question 9

What is the common cause of proximal humerus fractures in older patients?

Answer 9

Osteoporotic injuries

Question 10

What is conservative management of proximal humerus fractures?

Answer 10

Sling- mobilising for 6 weeks

Question 11

What is surgical management of proximal humerus fractures?

Answer 11

Fixation with plate
Joint replacement

Question 12

RECAP- most mobile joint in the body?

Answer 12

Shoulder joint

Question 13

Three types of shoulder dislocation?

Answer 13

Anterior
Posterior
Inferior

Question 14

What nerve may be damaged in shoulder dislocation?

Answer 14

Axillary nerve

->test regimental badge area

Question 15

If axillary nerve is damaged, rehabilitation will take a while. Which muscle in particular won’t work?

Answer 15

Deltoid muscle

Question 16

How many x-ray views are required for shoulder dislocations?

Answer 16

Two because high proportion of posterior dislocations are missed

Question 17

Treatment for shoulder dislocation?

Answer 17

Acute-reduction of dislocation under sedation or anaesthetic

Question 18

Who is at a higher risk of shoulder dislocation reoccurrence?

Answer 18

Younger age, male sex, participation in contact sports

->these patients get treated more aggressively and often undergo surgical stabilisation to reduce risks of reoccurrence

Question 19

What are the common causes of posterior shoulder dislocation?

Answer 19

Seizures
Electrocution
Direct blow to shoulder e.g. boxing

Question 20

How is a diagnosis of a posterior shoulder dislocation made?

Answer 20

Checking passive external rotation- there will be unilateral loss
X-ray

->beware of bilateral posterior dislocation in seizures and electrocution

Question 21

What is the classic appearance of the humerus in a posterior dislocation on x-ray?

Answer 21

Light bulb

Question 22

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?

Answer 22

Falls, classically onto an outstretched hand

->other causes = osteoporotic

Question 23

What is the most common fracture in older patients?

Answer 23

Distal radial fracture

->think of Granny

Question 24

How are undisplaced distal radial fractures treated conservatively?

Answer 24

Splints/casts

Question 25

How are displaced distal radial fractures treated conservatively?

Answer 25

Reduce fracture first by pulling bone back into position Then cast with wiring

Question 26

How may a distal radial fracture be treated surgically?

Answer 26

Plates External fixation ->most are treated conservatively though

Question 27

Complications of distal radial fractures?

Answer 27

Malunion DRUJ pain (distal radioulnar joint) EPL rupture (extensor pollicus longus, runs along back of fracture) Carpal Tunnel syndrome CRPS- chronic regional pain syndrome

Question 28

Which bone is the most commonly fractured bone in the carpus?

Answer 28

Scaphoid bone

Question 29

Are scaphoid fractures easy to see on x-ray?

Answer 29

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

Question 30

How does scaphoid fracture occur?

Answer 30

Falling onto outstretched hand commonly

Question 31

Where will pain be felt in a scaphoid fracture?

Answer 31

Pain at the base of thumb, pain telescoping thumb (pushing thumb up and down mainly) Tenderness of the anatomical snuff box

Question 32

Which area of the scaphoid bone can damage the blood supply if fractured?

Answer 32

Fracture in the middle third of scaphoid

Question 33

How are scaphoid fractures treated?

Answer 33

6 weeks in a cast or splint If displaced, or there in non-union, can be treated surgically

Question 34

What causes ulnar collateral ligament injury of thumb?

Answer 34

Radial force -> known as gamekeepers thumb as ruptured when using a shotgun or skiers thumb

Question 35

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?

Answer 35

Pain over radial border with history of injury Weak pinch grip

Question 36

What would be seen upon examination of a ulnar collateral ligament injury of the thumb?

Answer 36

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

Question 37

How is a UCL injury of thumb treated conservatively?

Answer 37

Splint or cast

Question 38

How is a UCL injury of thumb treated operatively?

Answer 38

Repair ligament Fixing any avulsion fracture

Question 39

Where does Bennett's fracture occur?

Answer 39

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??

Question 40

What are some of the common causes of Bennett's fracture?

Answer 40

Boxing Falling on outstretched hand

Question 41

There is often displacement in Bennett's fracture, why is this?

Answer 41

Proximal pull from abductor pollicus longus

Question 42

What is the treatment of Bennett's fracture?

Answer 42

Reduction of fracture Maintenance of this reduction using plaster cast and wiring and screw fixation

Question 43

What is something to be aware of in fighting injuries?

Answer 43

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

Question 44

Boxer's fracture?

Answer 44

Fracture of little finger metacarpal neck (may also be ring finger)

Question 45

How is boxer's fracture usually treated?

Answer 45

Conservatively, reducing if significant angulation ->note that reducing means reducing space between bone(s) involved in a fracture

Question 46

What is the usual cause of flexor tendon injuries of the fingers?

Answer 46

Knife laceration e.g. fish gutting or cutting food in kitchen ->tends to be young adults, male>female

Question 47

How are flexor tendon injuries of the fingers treated?

Answer 47

Early surgical repair

Question 48

Which flexor tendons of the fingers have the worst prognosis if injured?

Answer 48

FDS and FDP

Question 49

How are flexor tendon finger injuries repaired?

Answer 49

Secure low profile sutures ->partial tears (<60%) do not need repair

Question 50

What is involved in rehabilitation of flexor tendon finger injuries?

Answer 50

Early movement increases healing and strength