Upper limb injuries Flashcards
Name some different types of fractures and describe them (10)
- Avulsion fracture – a muscle or ligament pulls on the bone, fracturing it.
- Comminuted fracture – the bone is shattered into many pieces.
- Compression fracture – generally occurs in the spongy bone in the spine. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.
- Fracture dislocation – a joint becomes dislocated, and one of the bones of the joint has a fracture.
- Longitudinal fracture – the break is along the length of the bone.
- Oblique fracture – a fracture that is diagonal to a bone’s long axis.
- Pathological fracture – bone fracture caused by an underlying disease/condition that weakened the bone.
- Spiral fracture – a fracture where at least one part of the bone has been twisted.
- Stress fracture – more common among athletes. A bone breaks because of repeated stresses and strains.
- Transverse fracture – a straight break right across a bone.
Common upper limb injuries (10)
- Clavicular fracture
- Acromioclavicular injury
- Shoulder dislocation
- Proximal humeral fracture
- Distal radial fractures
- Scaphoid fractures
- Bennet’s fracture
- Ulnar collateral ligament of thumb
- Boxers injuries
- Flexor tendon injury
Clavicular fracture
- Very common - 1 in 20 fractures seen involve the clavicle
- Middle 1/3 is the most common 80%
- Commonly caused by a fall onto shoulder or outstretched hand
Treatment:-
- The vast majority unite without any treatment
- Analgesia provided for pain relief
- Sling for 3-4 weeks mainly for comfort
When would you operate on a clavicular fracture?
- If it is a very displaced fracture
- Always in open fractures or when the fracture is threatening to come through the skin
- If concerned about associated neurovascular complications
- Polytrauma - trying to stabilise limbs in general
Acromioclavicular injury
- Usually caused by a fall onto a point of the shoulder
- AC joint is between clavicle and acromium
- Dislocation of the AC joint is graded from sprain to complete dislocation
Treatment
- Sprains - sling for 3-4 weeks.
- Displaced AC joint dislocation may benefit from early fixation
Proximal Humerus fractures
- In the young they are caused by high energy injuries i.e fall from height
- In the elderly they are often caused by a standard fall at low speed onto the arm but due to osteoporotic bones they fracture
- Management depends on fracture configuration and patient biology
- Conservative - sling, mobilise from 6 weeks
- Operative - fixation with plate, joint replacement
Important aspects of taking an x-ray of your shoulder and other joints too
Must take 2 views on x-ray
High proportion of dislocations especially posterior are missed on one view. If you miss it, it increases your risk of long term nerve damage and shoulder problems.
Treatment of shoulder dislocation
Reduction - aligning the bones so that they can heal better - either carried out with pain killers in A+E or done under sedation/anaesthetic with orthopaedic team:
Options:-
- Closed reduction - manipulation/pulling of the bone fragments without surgical exposure of the fragments
- Open reduction surgery
However, there is a risk of recurrence in younger, male patients who play contact sports. More agressive treatment is required for these patients.
Common causes of posterior dislocation of the shoulder
- Seizure
- Electrocution
- Direct blow to front of shoulder (boxing)
Causes of a distal radial fracture
Young patients:
- High velocity injury
Older patients
- Low velocity injury
- Colles fracture - most common type
- Osteoporotic bones
- Fall on an outstretched hand
- Causes radial shortening and radial deviation
Treatment for Distal Radial fracture
Conservative
- Undisplaced
- splints/cast
- Displaced
- Reduction
- Cast +/- wires
Surgical
- Plate
- External fixator
Complications of a Colles fracture (type of distal radial fracture)
- Malunion of bones
- Tendon damage - Extensor pollicis longus rupture
-
Carpal Tunnel Syndrome
- Swelling compressing the nerves
- Change in the shape of the tunnel
-
CRPS - chronic regional pain syndrome
- Long term symptoms of pain, stiffness, change in skin or restriction in joint movement
Scaphoid fractures
- 80% occur at the waist of the scaphoid
- Commonly caused by falling onto outstretched hand
- Pain at base of thumb, tenderness in the anatomical snuff box region
- Often difficult to see fractures on x-ray so in recent times an early MRI is done to prevent missing the fracture
- Risk of non-union or avascular necrosis if the fracture is in the proximal 1/3
Management:
- Cast for 6 weeks
- Surgery if displaced or non-union
What are the borders of the Anatomical snuffbox
- Abductor pollicis longus and extensor pollicis brevis longus anteriorly
- Extensor pollicis longus posteriorly
- Radial styloid/radius proximally
Ulnar collateral ligament injury of the thumb
- Ligament injury due to radial force i.e the thumb is pushed back too far and the ulnar collateral ligament is torn
- Usually causes an avulsion fracture as the bone is sheared away from the joint
- Patients complain of pain/swelling in 1st webspace and about having a weak pinch grip
Bennet’s fracture
Occurs at the base of the thumb (at the base of the 1st metacarpal)
- Common causes: falling on outstretched hand or boxing
- Displacement due to proximal pull from the abductor pollicis longus muscle - makes the fracture unstable
- As it is unstable this fracture requires reduction
- Plaster cast
- +/- wire - pass through the base of the thumb and into the carpus to lock it on until the bone heals
- Screw fixation
Boxer’s fracture
Typically a fracture of the little finger metacarpal neck
Usually conservative management
