Upper limb injuries

Question 1

Where do most clavicular fractures occur?

Answer 1

Middle third (80%)
Then lateral, then medial

Question 2

How are clavicle fractures managed?

Answer 2

Analgesia
Sling for 3-4 weeks
Progressive mobilisation from 2 weeks

Question 3

How do AC joint injuries occur?

Answer 3

Impact onto point of shoulder

Dislocation of AC joint

Question 4

How are AC joint injuries managed?

Answer 4

Sprains treated with sling for 3-4 weeks

Dislocations may benefit from early fixation

Question 5

What is involved in the conservative management of a proximal humerus fracture?

Answer 5

Sling

Mobilise from 6 weeks

Question 6

What is involved in the operative management of a proximal humerus fracture?

Answer 6

Fixation with plate

Joint replacement

Question 7

What is the most commonly dislocated joint?

Answer 7

Shoulder

Mostly anterior, then posterior, than inferior

Question 8

How are shoulder dislocations treated acutely?

Answer 8

Reduction under sedation/analgesia

Question 9

What are some significant factors in shoulder dislocation recurrence?

Answer 9

Younger age
Male
Contact sports

Question 10

What usually causes posterior shoulder dislocation?

Answer 10

Seizure
Electrocution
Direct blow to front of shoulder (Boxing)

Question 11

How are posterior shoulder dislocations diagnosed?

Answer 11

Check passive external rotation (unilateral loss)

X-ray

Question 12

How are undisplaced distal radial fractures managed?

Answer 12

Splint/cast

Question 13

How are displaced distal radial fractures managed?

Answer 13

Reduction

Question 14

What is the surgical management of distal radial fractures?

Answer 14

Plate

External fixator

Question 15

What is a Colles fracture?

Answer 15

Fracture of the distal forearm in which the broken end of the radius is bent backwards

Question 16

What are some complications of a Colles fracture?

Answer 16

Malunion
DRUJ pain
EPL rupture
Carpal Tunnel Syndrome
CRPS

Question 17

What is the most commonly fractured bone in the carpus?

Answer 17

Scaphoid

Question 18

How are suspected scaphoid fractures imaged?

Answer 18

Often difficult to see fractures on x-ray

Repeat x-ray at 2 weeks or MRI

Question 19

What is a risk of fracture to proximal third of scaphoid?

Answer 19

Non-union

Avascular necrosis

Question 20

How do scaphoid fractures present?

Answer 20

Fall onto outstretched hand
Pain at base of thumb
Tenderness in anatomical snuffbox
Pain telescoping thumb

Question 21

What is the anterior border of the anatomical snuffbox?

Answer 21

Abductor pollicis longus

Extensor pollicis brevis

Question 22

What is the posterior border of the anatomical snuffbox?

Answer 22

Extensor pollicis longus

Question 23

What is the proximal border of the anatomical snuffbox?

Answer 23

Radial styloid

Radius

Question 24

What is Ulnar collateral ligament injury of thumb MCPJ?

Answer 24

Ligament injury or avulsion fracture due to radial force

Complaint of injury/weak pinch grip

Question 25

How does UCL injury of the thumb present?

Answer 25

Tender ulnar side of joint

Joint opens on radial stress

Question 26

What are some treatment options for UCL injury of thumb?

Answer 26

Splint/cast
Repair ligament
Fix avulsion fragment

Question 27

What is Bennett’s fracture?

Answer 27

Intra-articular fracture at base of 1st metacarpal

Question 28

What are the main treatment options for Bennett’s fracture?

Answer 28

Plaster cast
Wire
Screw fixation

Question 29

What is boxer’s fracture?

Answer 29

Fracture of little finger metacarpal neck
May also be the ring finger
Volar angulated

Question 30

How is boxer’s fracture managed?

Answer 30

Reduce if significant angulation

Question 31

What are some principles of rehabilitation in fracture?

Answer 31

Early movement increases healing and strength and reduces adhesions