Upper Limb Trauma Flashcards
Are the majority of proximal humerus fractures high or low energy injuries?
The majority are low energy injuries in osteoporotic bone due to FOOSH or directly onto the shoulder!
Which is more common:
a) fracture of the surgical neck
or
b) fracture of the anatomical neck?
The fracture of the surgical neck…
with medial displacement of the humeral shaft due to pull of the pectoralis major muscle (must remember this bit to get the mark)
The consultant tells you about a patient with a minimally displaced proximal humerus fracture and asks you how best to manage them?
Conservatively
with a sling
and gradual return to mobilsation.
With displaced fractures the position often improves once muscle spasm settles.
A patient has a head splitting fracture of the humerus.
What are you going to tell them?
They probably will need a shoulder replacement
Unless the consultant thinks they’re young enough with good enough bone quality to avoid it.
Anterior shoulder dislocation is much more common than posterior dislocation
T/F
TRUE
posterior shoulder (gleno-humeral) dislocations only account for 2-5% of all shoulder dislocations
What movements would cause traumatic anterior shoulder dislocation?
- excessive external rotation force
- or a fall onto the back of the shoulder
- or a seizure (watch for bilateral dislocations
The senior registrar announces the patient who presented with unilateral shoulder pain after excessive external rotational force has a Bankart lesion.
What does this mean?
Anterior shoulder dislocation often results in detatchment of the anterior glenoid labrum and capsule
This is a.k.a. a Bankart lesion
How does a Hill-Sachs lesion occur?
The posterior humeral head can impact on the anterior glenoid producing an impaction fracture of the posterior head
What nerves and arteries can be affected by an anterior shoulder dislocation?
The axillary nerve can be stretched as it passes through the quadrilateral space
whilst other nerves of the brachial plexus
as well as the axillary artery can be stretched or compressed.
Patient presents with loss or roundness on the left shoulder. Their left arm is held in an adducted position and is supported by their right hand.
What is your current DDx?
Shoulder (gleno-humeral) dislocation
What investigation is required to confirm a suspected shoulder dislocation?
X-Rays confirm the diagnosis
if there is any doubt, X-Rays can be taken in two planes
What fractures are worth watching out for in a shoulder dislocation?
Fractures of the surgical neck and greater tuberosity
What patient group is likely to present late with a shoulder dislocation and therefore require open reduction rather than the standard closed reduction?
Alcoholics
What connective tissue disorders can cause generalised ligametnous laxity/hypermobility?
Ehlers-Danlos syndrome
Marfan’s syndrome
These patients tend to have atraumatic multidirectional dislocations which can be painful- some can voluntarily dislocate as a “party-piece”
What movement causes a posterior shoulder dislocation?
A posterior force
on the adducted
and internally rotated arm
A patient has the “light bulb” sign on X-Ray.
What has happened?
They’ve suffered a posterior shoulder dislocation
The excessively internally rotated humeral head looks symmetrical like a light bulb on an AP view
Very generally, how do you aim to manage shoulder dislocations?
- closed reduction
- sling
- physio
What is the most common mechanism of injury for an acromioclavicular joint injury?
a fall onto the point of the shoulder
(they’re a fairly common sporting injury)
How would you normally manage an ACJ injury?
Conservatively
with a sling for a few weeks
followed by physio
Who would get surgery for ACJ injury?
Those with chronic pain
althoguh some surgeons advocate early reconstruction for younger athletes with dislocation- it’s controversial
What are the three extents to which the ACJ can be injured?
- Sprained
- Subluxed (partially dislocated)
- acromioclavicular ligaments are ruptured
- Dislocated
- coracoclavicular ligaments (conoid and trapezoid ligaments) are also disrupted
What are the main MoI causing humeral shaft fractures?
And how do these MoI result in different humeral shaft fractures?
- direct trauma- e.g. RTA
- transverse or comminuted fractures
- fall +/- twisting injury
- oblique or spiral fractures
What is this presentation known as?
What has happened to the finger?
Pic shows MALLET FINGER
…it’s an avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by
forced flexion of the extended DIPJ, often from a ball at sport
