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MB2 Rheumatology and Orthopaedics > Upper limb trauma > Flashcards

Upper limb trauma Flashcards

1
Q

what is the most likely pathophysiology of a prox humerus fracture

A

osteoporosis with fall on outstretched hand or shoulder

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2
Q

humeral surgical neck fractures most common displace medially/laterally

A

medially - due to pec major

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3
Q

what muscles attach to greater tuberosity

A

supraspinatus, infraspinatus, teres major

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4
Q

what muscles attach to lesser tuberosity

A

subscapularis

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5
Q

management of a minimally displaced humeral neck fracture

A

sling with gradual mobilisation

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6
Q

management of a displaced humeral neck fracture

A

wait until there is less muscle spasm

if persistent then internal fixing with IM nail or plates and screws

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7
Q

management of a comminuted humeral neck fracture

A

can have disappointing results

shoulder arthroplasty can be effective but there are issues with attaching tuberosities and rotator cuff muscles

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8
Q

compications of comminuted fracture of surgical neck humerus

A

AVN, chronic pain, osteoarthritis

difficult ROM in arthroplasty

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9
Q

complications of displaced fracture of surgical neck humerus

A

stiffness, chronic pain, failure of fixation

more common in older patients

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10
Q

true/false - posterior dislocation of glenohumeral joint is more common

A

false - anterior is

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11
Q

why may an anterior shoulder dislocation occur

A

excess external rotation or fall to back of shoulder

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12
Q

what is a bankart lesion and what may it occur in

A

anterior shoulder dislocation

where there is detachment of anterior glenoid and capsule

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13
Q

what nerve may be damaged in anterior shoulder dislocation

A

axillary artery
passes through quadrangular space
can be damaged as well as
all other brachial plexus nerves can also be damaged

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14
Q

presentation of anterior shoulder dislocation

A

lost symmetry - arm held adducted and lost roundness
lost badge patch sensation
rotator cuff tear

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15
Q

diagnosis and investigation of anterior shoulder dislocation

A

x rays - 2 planes

may see greater tuberosity/surgical neck fracture

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16
Q

management of anterior shoulder dislocation

A

closed reduction under sedation and anaesthetic
neurovas assessment before/after
sling 2/3 weeks then physio
if alcoholic may need open management
if fracture greater tuberosity then may settle but ORIF if displaced
surgical neck fractures need operative management

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17
Q

chance of recurrent dislocation in pt <20 for ant shoulder dislocation

A

80%

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18
Q

chance of recurrent dislocation in pt >30 for ant shoulder dislocation

A

20%

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19
Q

how may an anterior shoulder dislocation be fixed operatively in recurrent dislocation

A

bankart repair with reattachment of labrum and capsule - arthroscopic or open

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20
Q

management of anterior shoulder dislocation in those with ligament laxity
what are the possible causes of the ligament laxity

A 
ehlers-danlos
marfans 
GLL
open tightening but results variable 
physiotherapy to strengthen the rotator cuff muscles
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21
Q

what type of injury may cause posterior shoulder dislocation

A

fall on adducted and internally rotated arm

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22
Q

features clinically and radiologically of posterior shoulder dislocation

A

palpable humeral head posterior
light bulb sign
set special laterals

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23
Q

management of posterior shoulder dislocation

A

closed reduction and immobilisation

physiotherapy

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24
Q

what ligaments are disrupted in ACJ subluxation/dislocation

A

subluxation - acromioclavicular ligaments

dislocation - acromioclavicular ligaments and coracoclavicular

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25
Q

management of ACJ subluxation/sprain/dislocation

A

conservative management or surgical if there is chronic pain

26
Q

direct trauma to humeral shaft causes what fracture pattern

A

transverse/comminuted

27
Q

fall with or without twisting to humeral shaft causes what fracture pattern

A

spiral/oblique

28
Q

what angulation is acceptable in a humeral shaft fracture

A

up to 30 degrees

29
Q

what nerve damage is most likely in humeral shaft fracture and how may it present

A

wrist drop and lost sensation in first dorsal web space

30
Q

management of humeral shaft fracture

A

most conservative with humeral brace
internal fixation with IM nail or plates/screws for polytrauma/faster recovery
non union needs bone graft and plating

31
Q

describe an olecranon fracture

A

fall to point of elbow with triceps contraction

32
Q

management of olecranon fracture?

A

most ORIF to restore articular surface and triceps function

some tension band wiring if a simple transverse avulsion fracture

33
Q

radiological/clinical findings of a radial head/neck fracture

A

fat pad sign with lateral elbow pain on pronation/supination

34
Q

management of radial head/neck fracture

A

minimal/undisplaced - sling and exercise

operative if block to full extension - ORIF for big part or excision if not good enough to fix

35
Q

what is a nightstick fracture and how may it be managed

A

fractured ulnar shaft, usually direct block

conservative but ORIF offers easier return to function with less risk non-union

36
Q

management of fracture both bones forearm?

A

ORIF with plates and screws due to instability and anatomic reduction
in children a minimally angulated fracture may be managed with plaster, or an angulated one with MUA and plaster
if still unstable after reduction then use IM nail

37
Q

what is a monteggia fracture and how is it managed

A

fracture of ulna with dislocated radial head

ORIF of ulna which reduces radial head

38
Q

what is a galeazzi fracture and how is it managed

A

fracture of radius with dislocated ulna at DRUJ

ORIF for radius which reduces ulna head

39
Q

what is a colles fracture

A

extra-articular fracture distal radius with dorsal displacement/angulation

40
Q

management of a colles fracture

A

splintage but if angulation is any past neutral then manipulate
if unstsble post reduction consider ORIF or wires

41
Q

complications of colles fracture and managemetn

A

median nerve compression - reduction may fix or surgical decompression
EPL rupture, needs tendon transfer

42
Q

what is a smith fracture and how is it managed

A

volar displaced or angulated fracture distal radius
fall on flexed wrist
all need ORIF

43
Q

complications of a smith fracture

A

grip strength and wrist extension reduced if there is malunion with excess volar angulation

44
Q

what is a bartons fracture and how is it managed

A

intra articular distal radius fracture with carpal bones subluxing displaced fragment
requires ORIF

45
Q

management of a comminuted intra-articular distal radius fracture

A

external fixation

wires

46
Q

presentation of scaphoid fracture

A

pain and tenderness in anatomical snuff box

FOOSH

47
Q

radiological features of a scaphoid fracture?

A

4 views to check for fracture

if not visible at all the reimage in 2 weeks and treat as a clinical scaphoid fracture

48
Q

management of a scaphoid fracture?

A

plaster cast 6-12 weeks

49
Q

complications scaphoid fracture

A

non union - screw fixation and bone graft
displaced - compression screw
avascular necrosis - partial/total wrist fusion may be needed if symptomatic

50
Q

volar penetrating hand injuries risk damage to?

A

flexor tendons, digital nerves and arteries

51
Q

dorsal penetrating hand injuries risk damage to?

A

extensor tendons

52
Q

what is mallet finger

A

avulsion of extensor tendon in terminal phalanx and caused by forced flexion of extended DIPJ

53
Q

presentation and management of mallet finger

A

drooped DIPJ, cannot extend DIPJ
pain
mallet splint to hold DIPJ extended for 4 weeks

54
Q

what is also at risk in flexor tendon injury

A

digital nerve/artery

55
Q

how should flexor tendon injuries be splinted?

A

flexed position with elastic traction to allow active extendion and passive flexion

56
Q

management of phalangeal fractures?

A

neighbour strapping or splint

if significantly displaced or angulated then MUA with ring block and if unstable then K wires/fixation with small screws

57
Q

management of interarticular digital fractures?

A

small screws/K wires

58
Q

management of 3,4,5 metacarpal fractures?

A

conservative

59
Q

what is a boxers fracture and how is it managed

A

5th metacarpal neck fracture with punching

neighbour strapping of affected digit and check rotation as may need manipulated with K wires before strapping

60
Q

what is a fight bite and how is it managed

A

laceration of hand from tooth
can penetrate MCPJ and disrupt extensor tendon and cause septic arthritis
explore and wash out in theatre

MB2 Rheumatology and Orthopaedics (22 decks)

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