Upper limb injuries Flashcards
Describe the most common types of clavicular fracture and the usual mechanics/reason of its injury
1/20 fractures involve clavicle. Middle 1/3rd – most common 80%; Lateral 1/3rd – 12-15%; medial 1/3rd – 5-6%.
Fall onto shoulder/outstretched hand.
How do you manage a clavicular fracture?
Vast majority unite.
Analgesia
Sling – 3-4 weeks, progressive mobilization from 2 weeks.
Possibly a figure of 8 bandage
When would you consider surgery for clavicular fractures?
Surgery – some that are displaced, open fractures, threatening of the skin, neurovascular complications, polytrauma.
Describe the acromio-clavicular injury and what causes it
When fall onto shoulder (point of shoulder). AC joint injury – graded from sprain to complete dislocation.
How do you treat an acromio-clavicular injury?
Sprains – treated in sling for 3-4 weeks.
Displaced AC joint dislocations - early fixation.
What are proximal humeral fractures associated with?
Similar epidemiology to hip fractures.
Young high energy injuries
Elderly osteoporotic injuries.
Describe the management of proximal humeral fractures
Depends on fracture configuration and patient biology.
Conservative management – sling, mobilise from 6 weeks.
Operative management – fixation with plate, joint replacement.
Where/how would you test for shoulder dislocations (clinical/imaging)?
Test axillary nerve – regimental badge area.
2 views on X-ray mandatory – high proportions of dislocation esp. posterior missed on one view
What is the treatment and rate of recurrence of shoulder dislocations?
Treatment: acute-reduction under sedation/anaesthetic, manipulation, immobilise.
Recurrence: risk increases with younger age, male sex, participation in contact sports,
so e.g. 18y/o male in contact sports – 90% recurrence
What may be the cause of posterior shoulder dislocation (10% of cases)?
Seizure, electrocution, direct blow to front of shoulder (boxing).
How do you check for a posterior dislocation (clinical + imaging)?
Check passive external rotation (unilateral loss)
X-ray (different view)
What is the usual cause of distal radius fracture in young patients?
High velocity injury
What are the causes of distal radial fractures in older patients?
Low velocity injury. Colles fracture (broken end of radius bend backwards). Osteoporotic. Fall outstretch hand (Colles). Dinner fork deformity. Radial shortening. Radial deviation. Dorsal angulation.
How do you treat distal radial fractures?
undisplaced, displaced
Conservative: Undisplaced# – splints/casts; Displaced # – reduce, casts +/- wires.
Surgical: Plate; External fixator.
What are complications of Colles fracture of distal radius?
Malunion. DRUJ pain. EPL rupture. Carpal Tunnel syndrome. CRPS (complex regional pain syndrome, severe persistent pain).
