Upper Limb Trauma

Question 1

where is the proximal humerus most commonly fractured

Answer 1

at the surgical neck

Question 2

in a proximal humerus fracture, which way is the humeral shaft usually displaced?

why?

Answer 2

medial displacement due to the pull of the pectoralis major muscle

Question 3

what is an avulsion fracutre

Answer 3

fracture where a tendon pulls off a piece of bone

Question 4

treatment of minimally displaced proximal humerus fracture

Answer 4

conservative with a sling

Question 5

treatment of persistently displaced proximal humerus fracture

Answer 5

Internal fixation - plate/wires/IM nail

• position of displaced fractures may improve once muscle spasm settles so only persistently displaced fractures require surgery

Question 6

how are intra-articular humeral head splitting fractures treated

Answer 6

shoulder replacement

Question 7

what type of shoulder dislocation is more common: anterior or posterior?

Answer 7

anterior

Question 8

how might an anterior shoulder dislocation occur

Answer 8

1. excessive external rotational force
2. fall onto back of shoulder

Question 9

what is a Bankart lesion?

Answer 9

detachment anterior glenoid labrum and capsule in an anterior shoulder dislocation

Question 10

what is a Hills-Sachs lesion

Answer 10

impaction fracture of posterior humeral head

• seen in an anterior shoulder dislocation
• posterior humeral head impacts on anterior glenoid – impaction fracture

Question 11

what nerve might be damaged in an anterior shoulder dislocation

Answer 11

Axillary nerve

Question 12

classical sign of axillary nerve damage

Answer 12

loss of sensation to regimental badge patch area

Question 13

what does this Xray show

Answer 13

anterior shoulder dislocation

Question 14

management of anterior shoulder dislocation

Answer 14

closed reduction under anaesthetic

sling for 2-3 weeks

Question 15

who is more at risk of recurrent anterior shoulder dislocations after their first one:

a) young patients
b) old patients

Answer 15

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

Question 16

what is recommended following an anterior shoulder dislocation in a patient <20 years old

Answer 16

shoulder stabilisation through a bankart repair (can be arthroscopic or open)

Question 17

what causes a posterior shoulder dislocation

Answer 17

posterior force on an adducted + internally rotated arm

Question 18

what does this Xray show?

Answer 18

A posterior shoulder dislocation - light bulb sign

Question 19

how are acromioclavicular joint injuries managed?

Answer 19

conservatively with a sling followed by phsyio

Question 20

what two mechanisms can cause humeral shaft fracutres?

what type of fractures does each mechanism cause?

Answer 20

1. Direct trauma (e.g. RTA) – transvere / comminuted
2. Fall – oblique / spiral

Question 21

what is a comminuted fracture

Answer 21

fracture where there is more than 2 bone fragements

Question 22

up to what level of angulated can be accepted in humeral shaft fractures

Answer 22

30 degrees

Question 23

what nerve can be damaged in a humeral shaft fracture

Answer 23

radial nerve

Question 24

presentation of radial nerve damage

Answer 24

wrist drop

loss of sensation 1st doral web space

Question 25

how are most humeral shaft fractures treated

Answer 25

functional humeral brace - pushes fragments into aligment + provides stability

Question 26

how are distal intra-articular humerus fractures treated

Answer 26

ORIF

Question 27

what fracture occurs with fall onto point of elbow

Answer 27

olecranon fracture

Question 28

how can a simple avulsion olecranon fracture be treated

Answer 28

Tension band wiring

Question 29

how can a comminuted olecranon fracture be treated

Answer 29

ORIF

Question 30

What sign may be seen on lateral Xray of undisplaced radial head/neck fracture

Answer 30

fat pad sign - triangle anterior to distal humerus

Question 31

in what direction does the elbow dislocate

Answer 31

posteriorly - occur from a FOOSH

Question 32

Management of an elbow dislocation

Answer 32

closed reduction + sling (1-3 weeks)

Question 33

what is a nightstick fracture? how does it occur?

Answer 33

fracture of the ulnar shaft from direct blow

Question 34

what is a monteggia fracture

Answer 34

fracture of the **unla** with dislocation of the radial head at the elbow

Question 35

how is a monteggia fracture managed

Answer 35

ORIF

Question 36

What is a Galeazzi fracture

Answer 36

fracture of the **radius** with dislocation of the ulna at the wrist

Question 37

how is a Galeazzi fracture managed

Answer 37

ORIF

Question 38

What is a colles fracture

Answer 38

exra-articular distal radial fracture with dorsal displacement - FOOSH - dinner fork deformity

Question 39

what other fracture can occur with a Colles fracture

Answer 39

fracture of ulnar styloid

Question 40

how can a Colles fracture that is: a) minimally displaced b) angulated past neutral

Answer 40

a) splintage b) manipulation - percutaneous wires/ ORIF may be opted for if still unstable

Question 41

what nerve can be compressed in a Colles fracture

Answer 41

Median Nerve

Question 42

what tendon can rupture in a colles fracture

Answer 42

extensor pollicus longus

Question 43

what is a smiths fracture

Answer 43

fracture of distal radias with volar displacement - Fall onto flexed wrist

Question 44

how are smiths fractures managed

Answer 44

all fractures undergo **ORIF** with plates + screws as they are highly unstable

Question 45

what is a bartons fracture

Answer 45

intra-articular fracture of distal radius involving dorsal / volar rim, carpal bones sublux with the displaced rim fragment

Question 46

what are the two classifications of bartons fracture

Answer 46

1. volar bartons fracture (intra-articular smiths fracture) 2. dorsal bartons fracture (intra-articular colles fracture) - both require ORIF

Question 47

Tender anatomical snuff box suggests a fracute of what?

Answer 47

scaphoid

Question 48

how many Xrays are taken if a scaphoid fracture is suspected?

Answer 48

4 (AP, lateral, 2 oblique)

Question 49

treatment of undisplaced scaphoid fracture

Answer 49

plaster cast 6-12 weeks

Question 50

what is there a risk of with scaphoid fractures?

Answer 50

Avascular necrosis

Question 51

spilt cup sign on Xray

Answer 51

lunate dislocation

Question 52

what is mallet finger

Answer 52

avulsion of extensor tendon at DIP - caused by forced flexion of extended DIP - sports ball injury

Question 53

presentation of mallet finger

Answer 53

pain drooped DIP inability to extend at DIP

Question 54

Treatment of mallet finger

Answer 54

mallet splint holding DIP in extension for 4 weeks

Question 55

what is a Bennets fracture

Answer 55

intra-articular fracture of 1st carpometacarpal joint

Question 56

what is a Boxers fracture

Answer 56

fracture of 5th metacarpal neck