Upper Limb Trauma Flashcards
where is the proximal humerus most commonly fractured
at the surgical neck
in a proximal humerus fracture, which way is the humeral shaft usually displaced?
why?
medial displacement due to the pull of the pectoralis major muscle
what is an avulsion fracutre
fracture where a tendon pulls off a piece of bone
treatment of minimally displaced proximal humerus fracture
conservative with a sling
treatment of persistently displaced proximal humerus fracture
Internal fixation - plate/wires/IM nail
- position of displaced fractures may improve once muscle spasm settles so only persistently displaced fractures require surgery
how are intra-articular humeral head splitting fractures treated
shoulder replacement
what type of shoulder dislocation is more common: anterior or posterior?
anterior
how might an anterior shoulder dislocation occur
- excessive external rotational force
- fall onto back of shoulder
what is a Bankart lesion?
detachment anterior glenoid labrum and capsule in an anterior shoulder dislocation
what is a Hills-Sachs lesion
impaction fracture of posterior humeral head
- seen in an anterior shoulder dislocation
- posterior humeral head impacts on anterior glenoid – impaction fracture
what nerve might be damaged in an anterior shoulder dislocation
Axillary nerve
classical sign of axillary nerve damage
loss of sensation to regimental badge patch area
what does this Xray show
anterior shoulder dislocation
management of anterior shoulder dislocation
closed reduction under anaesthetic
sling for 2-3 weeks
who is more at risk of recurrent anterior shoulder dislocations after their first one:
a) young patients
b) old patients
young patients (<20 years old) have 80% chance of re-dislocation
older patients (>30 years old) habve only 20% chance of re-dislocation, which decreases with advancing age
what is recommended following an anterior shoulder dislocation in a patient <20 years old
shoulder stabilisation through a bankart repair (can be arthroscopic or open)
what causes a posterior shoulder dislocation
posterior force on an adducted + internally rotated arm
what does this Xray show?
A posterior shoulder dislocation - light bulb sign
how are acromioclavicular joint injuries managed?
conservatively with a sling followed by phsyio
what two mechanisms can cause humeral shaft fracutres?
what type of fractures does each mechanism cause?
- Direct trauma (e.g. RTA) – transvere / comminuted
- Fall – oblique / spiral
what is a comminuted fracture
fracture where there is more than 2 bone fragements
up to what level of angulated can be accepted in humeral shaft fractures
30 degrees
what nerve can be damaged in a humeral shaft fracture
radial nerve
presentation of radial nerve damage
wrist drop
loss of sensation 1st doral web space
how are most humeral shaft fractures treated
functional humeral brace
- pushes fragments into aligment + provides stability
how are distal intra-articular humerus fractures treated
ORIF
what fracture occurs with fall onto point of elbow
olecranon fracture
how can a simple avulsion olecranon fracture be treated
Tension band wiring
how can a comminuted olecranon fracture be treated
ORIF
What sign may be seen on lateral Xray of undisplaced radial head/neck fracture
fat pad sign
- triangle anterior to distal humerus
in what direction does the elbow dislocate
posteriorly
- occur from a FOOSH
Management of an elbow dislocation
closed reduction + sling (1-3 weeks)
what is a nightstick fracture?
how does it occur?
fracture of the ulnar shaft from direct blow
what is a monteggia fracture
fracture of the unla with dislocation of the radial head at the elbow
how is a monteggia fracture managed
ORIF
What is a Galeazzi fracture
fracture of the radius with dislocation of the ulna at the wrist
how is a Galeazzi fracture managed
ORIF
What is a colles fracture
exra-articular distal radial fracture with dorsal displacement
- FOOSH
- dinner fork deformity
what other fracture can occur with a Colles fracture
fracture of ulnar styloid
how can a Colles fracture that is:
a) minimally displaced
b) angulated past neutral
a) splintage
b) manipulation - percutaneous wires/ ORIF may be opted for if still unstable
what nerve can be compressed in a Colles fracture
Median Nerve
what tendon can rupture in a colles fracture
extensor pollicus longus
what is a smiths fracture
fracture of distal radias with volar displacement
- Fall onto flexed wrist
how are smiths fractures managed
all fractures undergo ORIF with plates + screws as they are highly unstable
what is a bartons fracture
intra-articular fracture of distal radius involving dorsal / volar rim, carpal bones sublux with the displaced rim fragment
what are the two classifications of bartons fracture
- volar bartons fracture (intra-articular smiths fracture)
- dorsal bartons fracture (intra-articular colles fracture)
- both require ORIF
Tender anatomical snuff box suggests a fracute of what?
scaphoid
how many Xrays are taken if a scaphoid fracture is suspected?
4 (AP, lateral, 2 oblique)
treatment of undisplaced scaphoid fracture
plaster cast 6-12 weeks
what is there a risk of with scaphoid fractures?
Avascular necrosis
spilt cup sign on Xray
lunate dislocation
what is mallet finger
avulsion of extensor tendon at DIP
- caused by forced flexion of extended DIP
- sports ball injury
presentation of mallet finger
pain
drooped DIP
inability to extend at DIP
Treatment of mallet finger
mallet splint holding DIP in extension for 4 weeks
what is a Bennets fracture
intra-articular fracture of 1st carpometacarpal joint
what is a Boxers fracture
fracture of 5th metacarpal neck
