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Trauma > Upper limb injuries > Flashcards

Upper limb injuries Flashcards

1
Q

Features of SCJ dislocation:

A

FOOSH/direct blow to shoulder
Anterior > Posterior
Sprain more common

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2
Q

Complications of posterior SCJ dislocation:

A

Pneumothorax
Great vessel injury - subclavian veins, R brachiocephalic artery, L common carotid artery, L subclavian veins
Dyspnoea, stridor and dysphagia
CT mandatory

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3
Q

AC joint injuries: Rockwood classification:

A

1 = Radiographically normal
2 = Distance between clavicle and acromion <1cm
3 = Distance between clavicle and acromion >1cm
4-6 are defined by displacement
(1-2 = sling + rest, 3 = sling + referral, 4-6 = sling +surgery)

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4
Q

Difference in treatment between anterior and posterior SCJ dislocations?

A

Anterior requires broad arm sling and fracture clinic

Posterior requires orthopaedics referral

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5
Q

When do you refer a fracture?

A

Open fractures
Neurovascular compromise
Tenting of the skin

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6
Q

Clavicular fracture associations?

A

Middle - intra-thoracic injury
Distal - rupture of C-C ligament (floating fragment)
Medial - intra-thoracic injury to subclavian vessels

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7
Q

Most common type of shoulder dislocation?

A

Anterior: Subcoracoid, subglenoid, subclavicular, intrathoracic

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8
Q

Signs of shoulder dislocation:

A

Arm abducted and externally rotated with flexed elbow
“Squaring” loss of contours
Palpable head in the infra-clavicular fossa

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9
Q

Humeral head may appear falsely dislocated with…

A

Proximal humerus fracture due to bleeding into joint and displacement

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10
Q

What should you always check before manipulation of the dislocated shoulder?

A

Sensation of the deltoid and radial pulse

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11
Q

Complications of shoulder dislocation:

A

Axillary nerve/artery injury - badge sign
Bruising of lateral chest wall
Axillary haematoma/bruit
Fractures of humeral head, ant. glenoid lip, greater tuberosity
Rotator cuff injuries - pain and weakness after 2 weeks
Radial/medial/ulnar/musculocut/brachial plexus injury

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12
Q

Neer classification of fracture surgical neck of the humerus:

A 
1 = one-part fracture - no displacement
2 = two-part fracture - displacement of one fragment
3 = three-part fracture - displacement of two fragments
4 = four-part fracture - displacement of all segments
5 = dislocation (ant. or post.) regardless of displaced segment
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13
Q

Management of fracture surgical neck of the humerus:

A

Broad arm sling, analgesia and refer
Early mobilisation to prevent capsulitis
Ortho referral for very comminuted fractures

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14
Q

Associations with fracture shaft of humerus:

A

Elderly/FOOSH
Middle 1/3
Elderly
Metastatic (e.g. pathologic fracture from breast cancer)
Osteoporosis
Radial nerve injury and wrist drop in 10-20%
Brachial artery injury

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15
Q

Management of fracture shaft of humerus:

A

Conservatively
Humeral brace - reduced risk of compartment syndrome
U-slab for minimally displaced +/- referral for displaced
Always X-ray elbow and shoulder

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16
Q

What is the positioning of a dislocated elbow?

A

Elbow flexed at 45 degrees and prominent olecranon posteriorly

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17
Q

Complications of elbow dislocation:

A

Injury to brachial artery, median, ulnar and radial nerves (10%)

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18
Q

Which fractures occur with elbow dislocation?

A

Fracture medial epicondyle in children

Fracture coronoid, radial head, capitellum and olecranon in adults

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19
Q

Signs of fracture of radial head:

A

Tender radial head
Tender on pronation and supination
FOOSH

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20
Q

Associated injuries with fracture of the radial head:

A

Fracture of capitellum, olecranon, coronoid, medial epicondyle

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21
Q

Treatment for simple clavicular fracture?

A

Either broad arm sling (BAS) or collar and cuff (C+C)

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22
Q

Management of shoulder dislocation:

A

7 weeks immobilisation to allow the surrounding structures to recover
Younger people need longer immobilisation
Need to move shoulder within 2 days of immobilisation

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23
Q

Normal shoulder vs posterior GH dislocation?

A

Normally the humeral head appears asymmetric on X-ray whereas with posterior GH dislocation it is symmetrical and looks like a lightbulb

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24
Q

What is chocolate therapy?

A

Midazelam and morphine - give for big muscley men

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25
Q

Management of elbow dislocation:

A

Manipulation under anaesthesia

Back slab for a week for swelling then full cast

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26
Q

Management of fracture of the radial head:

A

Broad arm sling for minimally displace

Ortho referral for grossly displaced

27
Q

Which two lines should intersect within the capitellum?

A

Anterior humeral line and radiocapitellar line

28
Q

Features of supracondylar fractures:

A

Direct blow to posterior aspect of the flexed elbow

Open fractures

29
Q

Management of supracondylar fractures:

A

Splint for non-displaced

If displaced then ortho referral and admission for displacement and soft tissue swelling

30
Q

Complications of supracondylar fractures:

A 
Radial nerve (posterior-medial displacement)
Median nerve (posterior-lateral displacement)
High incidence of anterior interosseous nerve injuries so test 'OK' sign for the motor component
Vascular entrapment of the brachial artery
Non-union/mal-union and loss of mobility
31
Q

Associations of fracture olecranon:

A

Other fracture in 30% (radial head)
Ulnar nerve injury
Triceps rupture

32
Q

Management of fractured olecranon:

A

Undisplaced (<2mm in flexion) = conservative management

Majority require operative fixation

33
Q

What should you rule out in fracture of forearm bones?

A

Compartment syndrome

34
Q

What is the Galeazzi fracture?

A

Fracture to the distal radius which distal radio-ulnar dislocation
Caused by FOOSH/direct blow to back of wrist

35
Q

Complication of Galeazzi fracture?

A

Ulnar nerve injury

36
Q

Treatment of Galeazzi fracture?

A

Open reduction and internal fixation (ORIF)

37
Q

What is the Monteggia fracture?

A

Fracture to the proximal 1/3 of ulnar with dislocation of the radial head
Caused by FOOSH/direct blow to the posterior aspect of the ulnar

38
Q

Complication of Monteggia fracture?

A

Radial nerve injury

39
Q

Treatment of Monteggia fracture?

A

ORIF and closed reduction/splinting

40
Q

What is the Colles’ fracture?

A

Transverse fracture of distal radius with dorsal displacement of distal fragment
Impaction, radial deviation, ulnar angulation and rotation

41
Q

Signs of Colles’ fracture:

A

FOOSH
Age >50
Dinner fork deformity

42
Q

Associated injuries of Colles’ fracture:

A

Ulnar styloid fracture

Median nerve injury

43
Q

What makes an unstable Colles’ fracture?

A

> 20 degrees of angulation
Intra-articular involvement
Comminuted
1cm of shortening

44
Q

Treatment of Colles’ fracture:

A 
Non-displaced = Sugar tong splint and refer to trauma clinic
Displaced = Reduction: finger traps and manipulation under sedation or with haematoma block then sugar tong splint and ortho referral
45
Q

Differential in the history between Colles’ and Smith’s fractures?

A

Colles’ fracture is due to falling onto wrists in extension

Smith’s fracture is due to falling onto wrists in flexion

46
Q

What is Smith’s fracture?

A

Fracture of the distal radius with solar (palmar) displacement and angulation

47
Q

What is Barton’s fracture?

A

Fracture of the distal radius which extends through the dorsal aspect of the articular surface with associated dislocation of radoiocarpal joint

48
Q

What differentiates Barton’s fracture?

A

No disruption of radoiocarpal ligaments and the fractured articular surface of the distal radius remains in contact with the carpal row

49
Q

What is Hutchinson’s fracture?

A

Intra-articular fractures of the radial styloid process
Radial styloid is within the fracture fragment
Fragments can vary markedly in size

50
Q

Complications of Hutchinson’s fracture:

A 
Median nerve injury
Carpal tunnel syndrome
Mal-union
Reflex sympathetic dystrophy
Rupture of extensor policis tendon
Osteoarthritis of the wrist
51
Q

When should you reduce although the fracture is not grossly displaced?

A

> 20 degrees angulation
1cm shortening
Intra-articular involvement
Marked comminution

52
Q

What is Bier’s block?

A

Prolocaine or lignocaine

53
Q

What is Haematoma block?

A

Adrenaline and bupivacaine

54
Q

What is Conscious sedation?

A

Midazolam, morphine an cyclizine

55
Q

Management of distal radius fractures:

A

Smith and Barton fracture = refer to ortho
Distal radius fracture in young = refer to ortho
Otherwise back-slab and follow up in fracture clinic

56
Q

Above elbow injuries…

A

Usually managed in a sling

57
Q

Always assess what?

A

The joint immediately proximal and distal (might tell you the wrong joint e.g. if dementia)

58
Q

Which fractures do you always refer?

A

Smith’s
Barton’s
Hutchinson’s

59
Q

Protocol for palmarly displaced fracture e.g. Smith’s?

A

Urgent ortho referral

60
Q

Management for articular step-off >2mm?

A

Urgent ortho referral

61
Q

Risk with large ulnar styloid fractures with displaced fragments at the styloid base?

A

Increased risk of distal radioulnar joint instability

Urgent ortho referral

62
Q

Management of fracture dislocations?

A

Urgent ortho referral

63
Q

What are distal radial fractures associated with?

A

Scaphoid fractures or scapholunate ligament injuries

Require urgent ortho referral

64
Q

Problem with near-anatomic reduction of comminuted/displaced fractures?

A

Need urgent ortho referral as they are unstable even if reduction is near-anatomic and are likely to lose position

Trauma (8 decks)

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