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Charis & Ellie vs Complete MSK > Upper limb trauma > Flashcards

Upper limb trauma Flashcards

1
Q

what are the main causes of shoulder injury?

A

Falls and sporting injuries

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2
Q

most common type of humeral neck fracture?

A

Fracture of surgical neck with medial displacement of the humeral shaft - due to pull of the pectoralis major muscle
-greater and lesser tuberosities may also be avulsed (affects rotator cuff muscles)

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3
Q

how are humeral neck fractures?

A

Minimally displaced: conservative treatment with sling
Persistently displaced: internal fixation (plates, screws, wires or IMN), stiffness, chronic pain and failure of fixation can occur esp. in older people

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4
Q

which direction of gleno-humeral (shoulder) dislocation is more common?

A

Anterior dislocation

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5
Q

who is at risk of recurrent shoulder dislocation?

A

80% in patients under 20
20% in patients over 30 recurrent

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6
Q

what causes an anterior gleno-humeral dislocation?

A

Excessive external rotational force/fall onto the back of the shoulder

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7
Q

what accompanying damage can an anterior gleno-humeral joint cause?

A
  • Bankart lesion (detachment of the anterior glenoid labrum and capsule)
  • Posterior humeral head can impact on the anterior glenoid and cause a Hill-Sachs lesion (impaction fracture of the posterior head)

-Axillary nerve can be stretched as it goes through the quadrilateral space (other nerves of the brachial plexus/axillary artery can be stretched/compressed)

  • Rotator cuff tears in older people
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8
Q

what is the presentation of an anterior gleno-humeral dislocation?

A
  • Loss of symmetry/roundness of the shoulder
    -Arm held in adducted position supported by patients other arm
    -Loss of sensation in the regimental badge area
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9
Q

how is an anterior dislocation of the gleno-humeral joint diagnosed?

A

x-rays to confirm do 2 planes

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10
Q

how is an anterior gleno-humeral dislocation managed?

A

closed reduction under sedation/anaesthetic

do x-ray to cnfirm reduction full distal

neurovascular assessment (before and after reduction)
sling for 2-3 weeks
physiotherapy may need an open reduction for delayed presentation dislocations e.g. alcoholics

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11
Q

how are fracture-dislocations which involve the surgical neck of the humerus managed?

A

usually require surgery

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12
Q

how is a posterior shoulder dislocation investigated and managed?

A

light bulb sign on AP X-ray

closed reduction followed by physiotherapy

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13
Q

what causes acromioclavicualr joint (ACJ) injuries?

A

usually a fall onto the point of the shoulder pretty common sporting injury

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14
Q

how are the ACJ injuries treated?

A

mostly conservative (sling for few weeks followed by physio surgery - for those with chronic pain and maybe in young athletes with dislocation (controversial)surgery is reconstruction of the coracoclavicular ligaments

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15
Q

what causes humeral shaft fractures?

A

direct trauma (e.g. RTA) resulting in transverse/comminuted fractures

can be caused by fall with/without twisting injury - resulting in oblique/spiral fractures

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16
Q

how does a humeral shaft fracture heal?

A

union rates are high (90%)angulation can be accepted due to the mobility of the ball and socket shoulder joint and elbow joint

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17
Q

what are the accompanying injuries that can be caused by a humeral shaft fracture?

A

radial nerve -

causes wrist drop loss of sensation iN the 1st dorsal web space

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18
Q

how is a humeral shaft fracture managed?

A

mostly non-operative - functional humeral brave quicker recovery

  • internal fixation with IMN/plate and screws polytrauma
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19
Q

who gets supracondylar fractures of the elbow?

A

usually children

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20
Q

how are intra-articular distal humerus fractures managed?

A

ORIF

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21
Q

how are olecranon fractures managed?

A

common and usually occur with fall onto the point of the elbow with contraction of the triceps muscle
Mostly treated with ORIF

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22
Q

how are radial head and neck fractures managed?

A

Usually due to fall onto the outstretched arm
May see fat pad sign on X-ray

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23
Q

what gives the forearm fractures a ring like response?

A

the radius and ulna are connected proximally and distally by strong ligaments around the proximal and distal radio-ulnar joints (where supination and pronation occurs) if one bone fractures there is usually a fracture or dislocation involving the other bone

24
Q

what is a nightstick fracture?

A

fracture of the ulnar shaft
isolated fracture of the ulna

25
Q

who gets nightstick fractures?

A

due to a direct blow

26
Q

what is the management of a night stick fracture?

A

many cases - conservative management

ORIF for quicker return to function/ may reduce the risk of non-union

27
Q

how is fracture of both bones of the forearm managed?

A

In adults: ORIF with plates and screws

Children: plaster (if minimally angulated fractures)

28
Q

what is a monteggia fracture dislocation?

A

Fracture of the ulna with dislocation of the radial head at the elbow

29
Q

what is a galeazzi fracture dislocation?

A

Fracture of the radius with dislocation of the ulna at the distal radioulnar joint

30
Q

what is a colles fracture?

A

Extra-articular fracture of the distal radius within an inch of the articular surface and with dorsal displacement/angulation

Occurs due to a FOOSH with the wrist extended

Often there is an associated fracture of the ulnar styloid

Dinner fork deformity (X-ray)

31
Q

what are the complications associated with a colles fracture?

A

carpal tunnel syndrome
- EPL tendon rupture (need tendon transfer)

32
Q

what is a smith’s fracture?

A

an extra-articular fracture of the distal radius which is volarly displaced/angulated

33
Q

how is a smith’s fracture managed?

A

highly unstable can get reduction of grip strength and wrist extension ORIF with plate and screws

34
Q

what is a Barton’s fracture?

A

an intra-articular fracture of the distal radius involving the dorsal or volar rim where the carpal bones of the wrist joint sublux with the displaced rim fragment

35
Q

what is the management of a Barton’s fracture?

A

volar Barton’s fractures = intra-articular Smith’s fracture Dorsal Barton’s fracture - intra-articular Colles fracture ORIF

36
Q

what is a comminuted intra-articular distal radius fracture?

A

some distal radius fractures are so comminuted (high energy or poor bone quality) that stable fixation of the joint fragments is impossible external fixator is used - to restore shortening an hold the wrist in reasonable alignment and therefore limit functional deficit, can use supplementary wires

37
Q

how does a scaphoid fracture present?

A

usually after a FOOSH generally minimally displaced tenderness in the anatomic snuff box (between APB/EPB and EPL tendons)pain on compressing (telescoping) of the thumb metacarpal

38
Q

how to x-ray a scaphoid fracture?

A

scaphoid looks like a kidney bean a fracture is hard to see on x-ray
4 views are taken AP lateral 2 oblique views

5% of fractures only show up 2 weeks later after resorption of the fracture ends (1st stage of fracture healing)

39
Q

how is a scaphoid fracture diagnosed?

A

wrist is splinted and further x-ray (2 weeks later) until diagnosis is confirmed -

up til then it is called a ‘clinical scaphoid fracture’ can also do an MRI

40
Q

how is a scaphoid fracture managed?

A

Undisplaced - plaster cast (scaphoid cast = full cast including thumb) for 6-12 weeks Displaced - special compression screw

41
Q

what are the potential complications of a scaphoid fracture?

A

non-union (due to synovial fluid inhibiting fracture healing

  • use CT to check, treated with open reduction, screw fixation and bone grafting),

AVN (if symptomatic may need partial/total wrist fusion)

42
Q

what is the risk of penetrating volar hand injury?

A

risk of damage to the flexor tendon
digital nerves and arteries

43
Q

what is the risk of dorsal hand injuries?

A

risk of damage to the extensor tendons

44
Q

what is the management of extensor tendon injuries?

A

50% or more usually need surgical repair with splintage in extension for 6 weeks (any flexion within this period may cause failure of the repair)

45
Q

what is mallet finger?

A

avulsion of the extensor tendon from its insertion into the terminal phalanx caused by forced flexion of the extended DIPJ often by a ball in sport

46
Q

how does mallet finger present?

A

pain drooped DIPJ inability to extend at the DIPJ
injury may be just a tendinous avulsion or may have a bony fragment

47
Q

how is mallet finger managed?

A

mallet finger splint holding the DIPJ extended worn continuously for a minimum of 4 weeks

48
Q

what is the management of flexor tendon injuries in the finger?

A

partial divisions with flap of tendon - smoothed significant partial lacerations/complete tendon divisions - repair (need to preserve pulleys to avoid ‘bowstringing’ of the tendon) fingers are splinted in the flexed position (often with elastic traction to allow early active gentle extension and passive flexion to prevent stiffness and adhesions within the tendon sheath)

49
Q

what is the risk with flexor tendon injuries in the palm?

A

Risk of affecting interdigital nerves and arteries, can also affect median and ulnar nerves, and radial and ulnar arteries

50
Q

what is the risk of penetrating in the volar forearm?

A

Penetrating injuries carry a risk of injury to the wrist flexors: FCU and FCR, and the long flexors to the fingers and thumb Need repair

Loss of both radial and ulnar arteries require urgent surgical revascularisation

51
Q

how are fractures of the 3rd & 4th metacarpals treated?

A

treated conservatively 3rd and 4th have strong inter-metacarpal ligaments proximally and distally

  • so fractures are usually stable and there is minimal displacement
52
Q

how do fractures of the 5th metacarpals occur?

A

usually a punching injury

can tolerate 45 degree angulation without an affect on hand function

53
Q

how is a 5th metacarpal fracture managed?

A

strapping of the neighbour

54
Q

what is ‘fight bite’?

A

Punching injuries - can get ‘fight bite’, this is a laceration on the puncher’s hand from the person being punched’s tooth, can potentially penetrate the MCP joint and/or disrupt the extensor tendon, also cause infection leading to septic arthritis (fight bite should be washed out in theatre and NOT sutured closed in A&E)

55
Q

how do you manage dislocation?

A

do reduction, be aware of neurovascular structures surrounding it - check pulses and sensation (check this before AND after reduction)

56
Q

what is a dislocation?

A

complete loss of articular contact between 2 articular surfaces - bone pops out of joint dislocations may have associated fractures don’t want to leave a joint dislocation for a long period of time

Charis & Ellie vs Complete MSK (163 decks)

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