Upper limb injuries Flashcards
Where do most clavicular fractures occur?
Middle third (80%) Then lateral, then medial
How are clavicle fractures managed?
Analgesia
Sling for 3-4 weeks
Progressive mobilisation from 2 weeks
How do AC joint injuries occur?
Impact onto point of shoulder
Dislocation of AC joint
How are AC joint injuries managed?
Sprains treated with sling for 3-4 weeks
Dislocations may benefit from early fixation
What is involved in the conservative management of a proximal humerus fracture?
Sling
Mobilise from 6 weeks
What is involved in the operative management of a proximal humerus fracture?
Fixation with plate
Joint replacement
What is the most commonly dislocated joint?
Shoulder
Mostly anterior, then posterior, than inferior
How are shoulder dislocations treated acutely?
Reduction under sedation/analgesia
What are some significant factors in shoulder dislocation recurrence?
Younger age
Male
Contact sports
What usually causes posterior shoulder dislocation?
Seizure
Electrocution
Direct blow to front of shoulder (Boxing)
How are posterior shoulder dislocations diagnosed?
Check passive external rotation (unilateral loss)
X-ray
How are undisplaced distal radial fractures managed?
Splint/cast
How are displaced distal radial fractures managed?
Reduction
What is the surgical management of distal radial fractures?
Plate
External fixator
What is a Colles fracture?
Fracture of the distal forearm in which the broken end of the radius is bent backwards
What are some complications of a Colles fracture?
Malunion DRUJ pain EPL rupture Carpal Tunnel Syndrome CRPS
What is the most commonly fractured bone in the carpus?
Scaphoid
How are suspected scaphoid fractures imaged?
Often difficult to see fractures on x-ray
Repeat x-ray at 2 weeks or MRI
What is a risk of fracture to proximal third of scaphoid?
Non-union
Avascular necrosis
How do scaphoid fractures present?
Fall onto outstretched hand
Pain at base of thumb
Tenderness in anatomical snuffbox
Pain telescoping thumb
What is the anterior border of the anatomical snuffbox?
Abductor pollicis longus
Extensor pollicis brevis
What is the posterior border of the anatomical snuffbox?
Extensor pollicis longus
What is the proximal border of the anatomical snuffbox?
Radial styloid
Radius
What is Ulnar collateral ligament injury of thumb MCPJ?
Ligament injury or avulsion fracture due to radial force
Complaint of injury/weak pinch grip
How does UCL injury of the thumb present?
Tender ulnar side of joint
Joint opens on radial stress
What are some treatment options for UCL injury of thumb?
Splint/cast
Repair ligament
Fix avulsion fragment
What is Bennett’s fracture?
Intra-articular fracture at base of 1st metacarpal
What are the main treatment options for Bennett’s fracture?
Plaster cast
Wire
Screw fixation
What is boxer’s fracture?
Fracture of little finger metacarpal neck
May also be the ring finger
Volar angulated
How is boxer’s fracture managed?
Reduce if significant angulation
What are some principles of rehabilitation in fracture?
Early movement increases healing and strength and reduces adhesions
