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Orthopaedics > Upper Limb Injuries > Flashcards

Upper Limb Injuries Flashcards

1
Q

How do humeral neck fractures usually occur?

A

Low energy, osteoporotic bone

Fall on outstretched hand or directly onto shoulder

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2
Q

What is the most common pattern of fractured humeral neck?

A

Fracture of surgical neck with medial displacement of humeral shaft due to pull of pectoralis major

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3
Q

What is the management for a humeral neck fracture?

A

If minimally displaced –> sling + immobilise

If displaced –> internal fixation

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4
Q

Which direction of shoulder dislocation is most common?

A

Anterior

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5
Q

What type of injury causes an anterior should dislocation?

A

Excessive external rotation or fall on back of shoulder

Can occur due to seizure (check if bilateral)

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6
Q

Which two ‘lesions’ may occur with an anterior should dislocation and what are they?

A

Bankart lesion –> detachment of anterior glenoid labrum + capsule
Hill-Sachs lesion –> impaction fracture of posterior humeral head

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7
Q

Which nerve might be injured in an anterior should dislocation and how would that present?

A

Axillary nerve –> loss of sensation in badge patch area (lateral arm)

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8
Q

How is an shoulder dislocation diagnosed?

A

Xrays –> traumatic shoulder series

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9
Q

How is a shoulder dislocation managed?

A

Closed reduction with sedation or anaesthetic
Sling for 2-3 weeks
Then physio/rehab

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10
Q

How do posterior should dislocations appear on an xray?

A

Light bulb sign –> often missed as less obvious on xray

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11
Q

Which nerve may be injured in a humeral shaft fracture and how does it present?

A

Radial nerve in spiral groove –>

  • wrist drop
  • loss of sensation in first dorsal web space
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12
Q

How is a humeral shaft fracture managed?

A

Most cases –> functional humeral brace

Internal fixation may allow faster recovery

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13
Q

How does an olecranon fracture occur?

A

Fall on point of elbow

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14
Q

How is an olecranon fracture managed?

A

Most need ORIF to restore triceps function + articular surface

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15
Q

What is it important to remember in regard to forearm fractures?

A

Usually both bones are affected because radius and ulna create a ring –> must check both bones

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16
Q

What is another name for an ulnar shaft fracture?

A

Nightstick fracture (direct blow)

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17
Q

How is an ulnar shaft fracture managed?

A

(make sure there isn’t Monteggia injury)

Conservative or ORIF

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18
Q

How is a fracture to both ulnar and radius simultaneously managed?

A

ORIF with plates + screws as highly unstable

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19
Q

What is a Monteggia fracture dislocation?

A

Fracture of ulna + dislocation of radial head at elbow

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20
Q

What must always be done if an ulnar fracture is identified?

A

Xray of elbow

21
Q

How is a Monteggia fracture dislocation managed?

A

ORIF of ulnar fracture –> leads to relocation of radio-capitellar joint
(too unstable for manipulation alone)

22
Q

What is a Galeazzi fracture dislocation?

A

Fracture of radius + dislocation of ulna at distal radioulnar joint

23
Q

What should always be done if radial shaft fracture is identified?

A

Xray of wrist

24
Q

How is a Galeazzi fracture dislocation managed?

A

ORIF of radius –> should allow reduction of dislocation

25
Q

What is a Colles fracture?

A

Extra-articular fracture of distal radius, within 1 inch of articular surface, with dorsal displacement/angulation

26
Q

How does a Colles fracture usually occur?

A

Fall on outstretched hand (FOOSH) with wrist extended

27
Q

How is a Colles fracture managed?

A

Minimally displaced/angulated –> splintage + manipulation of angulation
If dorsal comminution or unstable –> percutaneous wires or ORIF

28
Q

Which nerve may be damaged in a Colles fracture?

A

Median nerve

- from nerve stretching or bleeding into carpal tunnel

29
Q

How should you manage a Colles fracture with signs of median nerve damage?

A

ORIF

30
Q

Which late local complication may occur after a Colles fracture?

A

Rupture of extensor pollicis longus tendon

usually requires tendon transfer

31
Q

What is a Smith’s fracture?

A

Extra-articular distal radius fracture with volar displacement/angulation

32
Q

How does a Smith’s fracture usually occur?

A

Falling onto the back of a flexed wrist

33
Q

How is a Smith’s fracture managed?

A

ORIF with plates + screws (highly unstable)

34
Q

How does a scaphoid fracture usually occur?

A

Fall onto outstretched hand

35
Q

What are the clinical features of a scaphoid fracture?

A

Tenderness in anatomical snuff box

Pain on compressing the thumb metacarpal

36
Q

How is a scaphoid fracture investigated?

A

4 xray views (difficult to see)

Sometimes not visible on xray until 2 weeks after injury

37
Q

How is a scaphoid fracture managed?

A

Undisplaced –> plaster cast 6-12 weeks

Displaced –> fixed with compression screw to avoid non-union

38
Q

What is the main risk associated with a scaphoid fracture and why?

A

AVN of proximal pole –> blood supply comes distally from a branch of the radial artery

39
Q

What is Mallet finger?

A

Avulsion of extensor tendon from its insertion into terminal phalanx
Caused by forced flexion of extended DIPJ, often from a ball at sport

40
Q

What are the clinical features of Mallet finger?

A

Pain
Drooped DIPJ
Inability to extend

41
Q

How is Mallet finger managed?

A

Mallet splint holding DIPJ extended for 4 weeks

42
Q

What is a Boxer’s fracture?

A

Fracture of 5th metacarpal often due to a punching injury

43
Q

Which complication may occur following a punching injury to the hand?

A

Fight bite –> laceration from punchee’s tooth could penetrate MCP joint +/- disrupt extensor tendon

44
Q

What is the main concern with ‘fight bite’?

A

Intra-oral organisms may cause an aggressive infection –> septic arthritis

45
Q

How should a fight bite be managed?

A

Explored and washed out in theatre

DO NOT suture closed in A&E

46
Q

Which structure may be damaged in an injury to the anatomical snuff box?

A

Radial artery

47
Q

Which fracture is associated with a ‘dinner fork’ deformity?

A

Colles fracture

48
Q

What is DeQuervain’s syndrome and which condition is it strongly associated with?

A

Tenosynovitis of the base of the thumb

Associated with RA

Orthopaedics (18 decks)

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