Upper Limb Trauma

Question 1

In a proximal humeral fracture, which specific anatomical part of the humerus is most likely to have been fractured?

Answer 1

Surgical neck

Question 2

What neurovascular structures are most likely to be damaged during trauma to the proximal humerus?

Answer 2

Axillary artery and nerve

Question 3

Wrist drop is a sign of damage to what nerve?

Answer 3

Radial nerve

Question 4

A fall onto the elbow with contraction of the triceps muscle describes the mechanism for what injury?

Answer 4

Olecranon fracture

Question 5

What is a nightstick fracture?

Answer 5

A fracture of the ulnar shaft

Question 6

What happens in a Monteggia fracture-dislocation?

Answer 6

A fracture of the ulna associated with dislocation of the radial head at the proximal radio-ulnar joint

Question 7

What happens in a Galeazzi fracture-dislocation?

Answer 7

A fracture of the radius associated with dislocation of the ulna at the distal radio-ulnar joint

Question 8

How are both Monteggia and Galeazzi fracture-dislocations treated?

Answer 8

ORIF (this usually results in reduction of the dislocation)

Question 9

How is a fracture involving both bones of the forearm treated?

Answer 9

ORIF

Question 10

The ‘fat pad’ sign on lateral x-rays of the elbow is a sign of what?

Answer 10

Radial head fracture

Question 11

What diagnosis should you suspect if there is lateral elbow pain on supination/pronation?

Answer 11

Radial head fracture

Question 12

Describe where a Colles’ fracture occurs?

Answer 12

A fracture of the radius, within one inch of the radio-carpal joint

Question 13

In what direction is the distal segment of bone displaced in a Colles’ fracture?

Answer 13

Dorsal

Question 14

A ‘dinner fork deformity’ describes what fracture of the distal radius?

Answer 14

Colles’ fracture

Question 15

What nerve may be affected by a Colles’ fracture?

Answer 15

Median nerve

Question 16

A specific complication of a Colles’ fracture is rupture of what tendon?

Answer 16

Extensor pollicis longus

Question 17

In what direction is the distal segment of bone displaced in a Smith’s fracture?

Answer 17

Volar

Question 18

What is the most likely mechanism of injury for a Colles’ fracture?

Answer 18

FOOSH with the wrist in extension

Question 19

What is the most likely mechanism of injury for a Smith’s fracture?

Answer 19

FOOSH with the wrist in flexion

Question 20

A Barton’s fracture describes a fracture of the distal radius (i.e. Colles’/Smith’s) with what associated injury?

Answer 20

Radiocarpal joint dislocation

Question 21

What is a Bennett’s fracture?

Answer 21

Intra-articular fracture of the first CMC

Question 22

Impact on a flexed metacarpal, usually caused by a fist fight, describes the mechanism of injury for which fracture?

Answer 22

Bennett’s fracture

Question 23

Swelling and tenderness over the anatomical snuffbox and pain on compression of the 1st metacarpal is suggestive of what injury?

Answer 23

Scaphoid fracture

Question 24

About 5% of scaphoid fractures are not visible on initial x-rays- how long will it take for these to show up?

Answer 24

2 weeks

Question 25

What are the two main complications that are likely to occur as a result of a scaphoid fracture?

Answer 25

Non-union and AVN

Question 26

Fracture of which metacarpal is most likely to occur as a result of a punching injury?

Answer 26

5th metacarpal

Question 27

How are metacarpal fractures treated?

Answer 27

Neighbour strapping and early mobilisation

Question 28

Which direction of shoulder dislocation is most common?

Answer 28

Anterior

Question 29

‘Lightbulb sign’ on an upper limb radiograph is most suggestive of what diagnosis?

Answer 29

Posterior shoulder dislocation

Question 30

Penetrating injuries to the volar hand risk damage to which structures?

Answer 30

Flexor tendons, digital nerves and arteries

Question 31

Penetrating injuries to the dorsal hand risk damage to which strutures?

Answer 31

Extensor tendons

Question 32

What x-ray views are required when assessing a patient for a scaphoid fracture?

Answer 32

AP, lateral and 2x obliques

Question 33

Which carpal bone dislocates most commonly? This injury is associated with compression of which nerve?

Answer 33

Lunate- median nerve compression

Question 34

In individuals with a scaphoid fracture, when will pain be worst?

Answer 34

On thumb abduction and gripping movements

Question 35

Convulsions and electrocutions are associated with which traumatic injury to the upper limb?

Answer 35

Posterior shoulder dislocations

Question 36

What injury is suggested by a history of weakness of pincer grip and pain/laxity on valgus stress of the thumb?

Answer 36

Ulnar collateral ligament injury

Question 37

Which neurovascular structure is most likely to be damaged in injuries involving the anatomical snuffbox?

Answer 37

Radial artery

Question 38

Injury to which nerve results in the formation of a claw hand?

Answer 38

Ulnar nerve