Upper Limb Trauma

Question 1

What bone in the hand is most likely to fracture?

After what circumstances is fracture most likely to take place?

Answer 1

Scaphoid

FOOSH (falling onto outstretched hands)

Question 2

How would a scaphoid injury present?

Answer 2

Post FOOSH or RTA (road traffic accident)

Swelling around base of thumb/wrist
Tenderness in anatomical snuffbox
Tenderness when trying to extend thumb

Question 3

All scaphoid fractures are visible on XR. True or false?

What should be done if fracture not visible on XR?

Answer 3

False

4 views are often needed if scaphoid fracture suspected
If cannot see fracture but suspect - fit brace for 10 days and then get back in for further xray

Question 4

Why are more proximal scaphoid fractures more susceptible to avascular necrosis?

Answer 4

Poor blood supply

Question 5

How long can a patient expect to be in a cast for scaphoid fracture?

Answer 5

4-6 weeks

Question 6

What is involved in de-gloving?

Answer 6

Loss of skin and all soft tissue down to the level of the fascia

Question 7

What is a subungual haematoma?

How is this treated?

Answer 7

Haematoma (bruise) underneath the nail bed

Trephine - pierce hole in nailbed

Question 8

What fracture is most common in boxing?

Answer 8

Neck of 5th metacarpal

Question 9

How are finger fractures usually treated if little rotation?

Answer 9

“buddy strap” strapping of finger to neighbouring finger

Question 10

How does a patient present with mallet finger?

What causes it?

How is it treated?

Answer 10

Dropping of the DIPJ joint, pain and an inability to extend DIPJ

Avulsion fracture (when tendon comes unattached)

Mallet splint for min. 4 weeks - 24/7

Question 11

How should a PIPJ dislocation be treated if not delayed presentation?

Answer 11

Pull back into place and buddy strap

Question 12

How do you manage any preserved amputated parts of limbs?

Answer 12

Place in moist gauze and then surround by ice

Question 13

If a patient presents with a boxing fracture and an open wound. What has likely caused this?

You see a colleague go to suture it up in A&E. Why should you intervene?

Answer 13

Tooth from punching someone in face

This needs to be washed out in theatre as could potentially have oral organisms in it

Question 14

What needs to be done for complete or signficiant partial tendon injuries?

Answer 14

Surgical repair

Question 15

A penetration injury to which side of the hand would risk damage to the digital arteries and nerves?

Answer 15

Palmar - they run alongside flexor tendons

Question 16

A winged scapula is due to damage to what muscle?

This will cause a difficulty in what arm movement?

Answer 16

serratus anterior

abduction