Upper Limb Injuries Flashcards
How do humeral neck fractures usually occur?
Low energy, osteoporotic bone
Fall on outstretched hand or directly onto shoulder
What is the most common pattern of fractured humeral neck?
Fracture of surgical neck with medial displacement of humeral shaft due to pull of pectoralis major
What is the management for a humeral neck fracture?
If minimally displaced –> sling + immobilise
If displaced –> internal fixation
Which direction of shoulder dislocation is most common?
Anterior
What type of injury causes an anterior should dislocation?
Excessive external rotation or fall on back of shoulder
Can occur due to seizure (check if bilateral)
Which two ‘lesions’ may occur with an anterior should dislocation and what are they?
Bankart lesion –> detachment of anterior glenoid labrum + capsule
Hill-Sachs lesion –> impaction fracture of posterior humeral head
Which nerve might be injured in an anterior should dislocation and how would that present?
Axillary nerve –> loss of sensation in badge patch area (lateral arm)
How is an shoulder dislocation diagnosed?
Xrays –> traumatic shoulder series
How is a shoulder dislocation managed?
Closed reduction with sedation or anaesthetic
Sling for 2-3 weeks
Then physio/rehab
How do posterior should dislocations appear on an xray?
Light bulb sign –> often missed as less obvious on xray
Which nerve may be injured in a humeral shaft fracture and how does it present?
Radial nerve in spiral groove –>
- wrist drop
- loss of sensation in first dorsal web space
How is a humeral shaft fracture managed?
Most cases –> functional humeral brace
Internal fixation may allow faster recovery
How does an olecranon fracture occur?
Fall on point of elbow
How is an olecranon fracture managed?
Most need ORIF to restore triceps function + articular surface
What is it important to remember in regard to forearm fractures?
Usually both bones are affected because radius and ulna create a ring –> must check both bones
What is another name for an ulnar shaft fracture?
Nightstick fracture (direct blow)
How is an ulnar shaft fracture managed?
(make sure there isn’t Monteggia injury)
Conservative or ORIF
How is a fracture to both ulnar and radius simultaneously managed?
ORIF with plates + screws as highly unstable
What is a Monteggia fracture dislocation?
Fracture of ulna + dislocation of radial head at elbow
What must always be done if an ulnar fracture is identified?
Xray of elbow
How is a Monteggia fracture dislocation managed?
ORIF of ulnar fracture –> leads to relocation of radio-capitellar joint
(too unstable for manipulation alone)
What is a Galeazzi fracture dislocation?
Fracture of radius + dislocation of ulna at distal radioulnar joint
What should always be done if radial shaft fracture is identified?
Xray of wrist
How is a Galeazzi fracture dislocation managed?
ORIF of radius –> should allow reduction of dislocation
What is a Colles fracture?
Extra-articular fracture of distal radius, within 1 inch of articular surface, with dorsal displacement/angulation
How does a Colles fracture usually occur?
Fall on outstretched hand (FOOSH) with wrist extended
How is a Colles fracture managed?
Minimally displaced/angulated –> splintage + manipulation of angulation
If dorsal comminution or unstable –> percutaneous wires or ORIF
Which nerve may be damaged in a Colles fracture?
Median nerve
- from nerve stretching or bleeding into carpal tunnel
How should you manage a Colles fracture with signs of median nerve damage?
ORIF
Which late local complication may occur after a Colles fracture?
Rupture of extensor pollicis longus tendon
usually requires tendon transfer
What is a Smith’s fracture?
Extra-articular distal radius fracture with volar displacement/angulation
How does a Smith’s fracture usually occur?
Falling onto the back of a flexed wrist
How is a Smith’s fracture managed?
ORIF with plates + screws (highly unstable)
How does a scaphoid fracture usually occur?
Fall onto outstretched hand
What are the clinical features of a scaphoid fracture?
Tenderness in anatomical snuff box
Pain on compressing the thumb metacarpal
How is a scaphoid fracture investigated?
4 xray views (difficult to see)
Sometimes not visible on xray until 2 weeks after injury
How is a scaphoid fracture managed?
Undisplaced –> plaster cast 6-12 weeks
Displaced –> fixed with compression screw to avoid non-union
What is the main risk associated with a scaphoid fracture and why?
AVN of proximal pole –> blood supply comes distally from a branch of the radial artery
What is Mallet finger?
Avulsion of extensor tendon from its insertion into terminal phalanx
Caused by forced flexion of extended DIPJ, often from a ball at sport
What are the clinical features of Mallet finger?
Pain
Drooped DIPJ
Inability to extend
How is Mallet finger managed?
Mallet splint holding DIPJ extended for 4 weeks
What is a Boxer’s fracture?
Fracture of 5th metacarpal often due to a punching injury
Which complication may occur following a punching injury to the hand?
Fight bite –> laceration from punchee’s tooth could penetrate MCP joint +/- disrupt extensor tendon
What is the main concern with ‘fight bite’?
Intra-oral organisms may cause an aggressive infection –> septic arthritis
How should a fight bite be managed?
Explored and washed out in theatre
DO NOT suture closed in A&E
Which structure may be damaged in an injury to the anatomical snuff box?
Radial artery
Which fracture is associated with a ‘dinner fork’ deformity?
Colles fracture
What is DeQuervain’s syndrome and which condition is it strongly associated with?
Tenosynovitis of the base of the thumb
Associated with RA
