upper limb injury

Question 1

clavicle fracture

Answer 1

fall onto outstretched hand

middle 1/3 most common
medial 1/3
lateral 1/3

Question 2

clavicle fracture management

Answer 2

vast majority unite w no Rx
analgesia
sling 3-4wks (mobilise 2wks)

Question 3

clavicle fracture surgery

Answer 3

uncommon
displaced #
open #
neurovascular compromise 
threatening skin 
polytrauma

Question 4

clavicle fracture: what neurovascular structures are compromised

Answer 4

brachial plexus

subclavian artery

Question 5

acromioclavicular joint injury

Answer 5

fall onto point of shoulder

graded from sprain to complete dislocation

Question 6

AC joint injury Rx

Answer 6

sprain: sling for 3-4wks

dislocations may benefit from early fixation

Question 7

proximal humerus fracture Rx

Answer 7

conservative: sling, mobilise from 6wks
operative: fixation w plate, joint replacement

Question 8

shoulder dislocation directions

Answer 8

anterior 80-85%
posterior 10%
inferior <5%

Question 9

shoulder dislocation: what nerve may be injured

Answer 9

axillary nerve - test regimental badge

Question 10

shoulder dislocation: x-rays

Answer 10

need 2 views - AP and Y

Question 11

shoulder dislocation Rx

Answer 11

reduction under sedation/anaesthetic

Question 12

shoulder dislocation risk factors for recurrence

Answer 12

younger age
male
contact sports

Question 13

what is commonest # in old people

Answer 13

distal radius

Question 14

causes distal radius # young

Answer 14

high velocity injury

Question 15

distal radius # old people

Answer 15

low velocity 
osteoporotic
fall outstretched hand
radial shortening, deviation  
colles fracture

Question 16

distal radius # Rx conservative

Answer 16

undisplaced: splint, case
displaced: cast +/- wires

Question 17

distal radius # Rx surgical

Answer 17

plate

external fixator

Question 18

distal radius # complications

Answer 18

malunion
distal radioulnar joint pain
extensor pollicis longus rupture
carpal tunnel syndrome

Question 19

scaphoid fracture x-rays

Answer 19

often difficult to see on initial x-ray

repeat x-ray at 2 wks or MRI

Question 20

scaphoid fractures clinical features

Answer 20

fall onto outstretched hand
pain base of thumb
pain telescoping thumb
tender anatomical snuffbox

Question 21

scaphoid fracture Rx

Answer 21

cast ~6wks

surgery if displaced, non-union

Question 22

ulnar collateral ligament injury of thumb MCPCJ features

Answer 22

weak pinch grip
Hx injury
tender ulnar side joint
joint opens on radial stress

Question 23

ulnar collateral ligament injury of thumb MCPCJ Rx

Answer 23

splint, cast

surgery: repair ligament, fix avulsion fragment

Question 24

bennet #

Answer 24

intra-articular fracture base 1st metacarpal

displacement due to proximal pull from abductor pollicis longus

Question 25

bennet # management

Answer 25

reduce

reduction maintenance: plaster cast +/- wire, screw fixation

Question 26

finger flexor tendon injuries: beware zone 2

Answer 26

within flexor sheath

usually involves FDS and FDP tendons - worse prognosis

Question 27

finger flexor tendon injuries: Rx

Answer 27

partial tears <60% don’t need repair

surgical repair, early - low profile sutures

Question 28

finger flexor tendon injuries rehabiliton

Answer 28

early movement inc strength and healing and reduces adhesions