upper limb injuries Flashcards
What part of the clavicle is the most common location for fracture on the clavicle
Middle 1/3
What causes clavicle fractures
falling onto a shoulder or an outstretched hand
What is the treatment for clavicular fracture
The majority unite but:
Anaglesia is given
sling is provided for comfort for up to one month
Progressive mobilisation 2 weeks post fracture
When is surgery indicated in clavicular fractures
Some displaced fractures
open fracture
When the fracture threatens to become an open fracture through the skin
Neurovascular complication
When they have more than one trauma
What causes injury to the acromioclavicular joint
Fall onto the shoulder which causes the acromion and shoulder joint to separate
What is the treatment of acromio-clavicular strain
3-4 weeks in a sling with analgesics
What is the treatment of acromio-clavicular dislocation
Early fixation by pulling them down and hold the clavicle down until the joint scars together
What is the treatment of proximal humerus fractures
Sling and mobilise from 6 weeks
Operative management - fixation with plate or joint replacement
What nerve should be tested in shoulder dislocation
Axillary nerve - if it is damaged the deltoid muscle will not be functioning
how are shoulder dislocations diagnosed
2 views on X ray - many dislocations are missed by just doing from one view
What is the treatment of shoulder dislocation
Reduction in the dislocation under anaesthetic
What increases the risk of recurrence of shoulder dislocation
Younger age, male sex and participation in contact sports
What are the most common causes of posterior dislocation of the shoulder
Seizure
electrocution
Direct punch to the front of the shoulder
How is posterior dislocation of the shoulder diagnosed
When the passive external rotation is done, when the doctor tries to externally rotate the shoulder it will not rotate as much as the other arm
X-ray - at least 2 views
What is the most common fracture in elderly patients
distal radial fracture - commonly occurs in patients with osteoporosis
What commonly causes distal radial fracture
Falls
How is distal radial fracture treated if it is undisplaced
Splints/casts
How is distal radial fracture treated if it is displaced
Reduce the displacement under anaesthetic then attach a cast with wires through the bone to lock the cast on
What is the surgical treatment of distal radius fracture
Fixing the distal radius with a plate and screws
External fixator - pins into the radius above the wrist and pins into the metacarpal below the wrist - lock the external fixator to hold the position
What are the complications of distal radial fracture repair
Malunion - bone heals in abnormal position
DRUJ pain – distal radial ulnar joint pain due to the joint not fit for the shortened radial bone – the radius shortening is a complication of fracture repair
EPL rupture – extensor pollicis longus rupture – runs across the fracture and into the thumb – the fracture damages its blood supply and then causes the tendon of it to rupture
Carpal tunnel syndrome – swelling due to the fracture which causes compression of the median nerve
CRPS – chronic regional prame syndrome – long term stiffness and pain and restriction of movement
What is the most common fractured carpal bone
scaphoid
Why are repeat x-rays done or MRI for scaphoid fracture
They are difficult to see on the initial x-ray
What can cause non-union or avascular necrosis if the fracture is in the proximal third
Scaphoid fracture
What is the most common cause of scaphoid fracture
falling onto outstretched hand
How does scaphoid fracture present
Pain in the base of the thumb
Tenderness at the anatomical snuff box
Pain telescoping thumb - pulling and pushing thumb down and away from wrist
What is the non surgical treatment of scaphoid
cast for 6 weeks
What is the surgical treatment for scaphoid fracture
Fix with a single screw but if there is displacement, they are fixed immediately
What causes ulnar collateral ligament injury of the thumb
Due to radial force - pulling the thumb radially (laterally)
How does ulnar collateral ligament (UCL) injury of thumb present
Injury with a weak pinch grip
What is found on examination in ulnar collateral ligament injury of the thumb
Tenderness on the ulnar side of the joint (medial side of thumb)
How is UCL injury of the thumb treated
Splint/cast
Surgical - repair ligament
Fix avulsion fragment (broken part of bone fragment which came away when the UCL became injured)
What is a Bennett’s fracture
Intra-articular fracture at the base of the first metacarpal (thumb)
What causes Bennet’s fracture
Axial compression of slightly flexed carpo-metacarpal joint
e.g Falling on outstretched hand or boxing
Why is there displacement in Bennet’s fracture
proximal pull from abductor pollicis longus
How is Bennet’s fracture treated
The dislocation is reduced under anaesthetic
Apply a plaster cast which will hold it in position - wire can be added as extra support to lock the cast on
Screws can attach the bone to another bone
What is a boxers fracture
Fracture of little finger - normally the neck of the metacarpal neck
What is the treatment of boxer’s fracture
Strap the fingers together and mobilisation
May pull the bone back into position if it is very angulated and hold it into position
What is the most common of flexor tendon injuries in the fingers
Knife laceration
Who most commonly gets flexor tendon injuries in the fingers
Males
Young adults
What is the treatment of flexor tendon injuries of the fingers
Repair surgically early
What surgery of tendon injuries in the upper limb have worst prognosis
Within the flexor sheath where the FDS and FDP tendons are involved
