Upper limb trauma Flashcards by Jamie Craig

what is the most likely pathophysiology of a prox humerus fracture

osteoporosis with fall on outstretched hand or shoulder

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humeral surgical neck fractures most common displace medially/laterally

medially - due to pec major

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what muscles attach to greater tuberosity

supraspinatus, infraspinatus, teres major

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what muscles attach to lesser tuberosity

subscapularis

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management of a minimally displaced humeral neck fracture

sling with gradual mobilisation

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management of a displaced humeral neck fracture

wait until there is less muscle spasm

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

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management of a comminuted humeral neck fracture

can have disappointing results

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

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compications of comminuted fracture of surgical neck humerus

AVN, chronic pain, osteoarthritis

difficult ROM in arthroplasty

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complications of displaced fracture of surgical neck humerus

stiffness, chronic pain, failure of fixation

more common in older patients

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

false - anterior is

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why may an anterior shoulder dislocation occur

excess external rotation or fall to back of shoulder

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what is a bankart lesion and what may it occur in

anterior shoulder dislocation

where there is detachment of anterior glenoid and capsule

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what nerve may be damaged in anterior shoulder dislocation

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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presentation of anterior shoulder dislocation

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

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diagnosis and investigation of anterior shoulder dislocation

x rays - 2 planes

may see greater tuberosity/surgical neck fracture

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management of anterior shoulder dislocation

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

80%

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

20%

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

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

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

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

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what type of injury may cause posterior shoulder dislocation

fall on adducted and internally rotated arm

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features clinically and radiologically of posterior shoulder dislocation

palpable humeral head posterior
light bulb sign
set special laterals

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management of posterior shoulder dislocation

closed reduction and immobilisation

physiotherapy

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what ligaments are disrupted in ACJ subluxation/dislocation

subluxation - acromioclavicular ligaments

dislocation - acromioclavicular ligaments and coracoclavicular

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management of ACJ subluxation/sprain/dislocation

conservative management or surgical if there is chronic pain

direct trauma to humeral shaft causes what fracture pattern

transverse/comminuted

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

spiral/oblique

what angulation is acceptable in a humeral shaft fracture

up to 30 degrees

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

wrist drop and lost sensation in first dorsal web space

management of humeral shaft fracture

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

describe an olecranon fracture

fall to point of elbow with triceps contraction

management of olecranon fracture?

most ORIF to restore articular surface and triceps function | some tension band wiring if a simple transverse avulsion fracture

radiological/clinical findings of a radial head/neck fracture

fat pad sign with lateral elbow pain on pronation/supination

management of radial head/neck fracture

minimal/undisplaced - sling and exercise | operative if block to full extension - ORIF for big part or excision if not good enough to fix

what is a nightstick fracture and how may it be managed

fractured ulnar shaft, usually direct block | conservative but ORIF offers easier return to function with less risk non-union

management of fracture both bones forearm?

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

what is a monteggia fracture and how is it managed

fracture of ulna with dislocated radial head | ORIF of ulna which reduces radial head

what is a galeazzi fracture and how is it managed

fracture of radius with dislocated ulna at DRUJ | ORIF for radius which reduces ulna head

what is a colles fracture

extra-articular fracture distal radius with dorsal displacement/angulation

management of a colles fracture

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

complications of colles fracture and managemetn

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

what is a smith fracture and how is it managed

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

complications of a smith fracture

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

what is a bartons fracture and how is it managed

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

management of a comminuted intra-articular distal radius fracture

external fixation | wires

presentation of scaphoid fracture

pain and tenderness in anatomical snuff box | FOOSH

radiological features of a scaphoid fracture?

4 views to check for fracture | if not visible at all the reimage in 2 weeks and treat as a clinical scaphoid fracture

management of a scaphoid fracture?

plaster cast 6-12 weeks

complications scaphoid fracture

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

volar penetrating hand injuries risk damage to?

flexor tendons, digital nerves and arteries

dorsal penetrating hand injuries risk damage to?

extensor tendons

what is mallet finger

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

presentation and management of mallet finger

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

what is also at risk in flexor tendon injury

digital nerve/artery

how should flexor tendon injuries be splinted?

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

management of phalangeal fractures?

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

management of interarticular digital fractures?

small screws/K wires

management of 3,4,5 metacarpal fractures?

conservative

what is a boxers fracture and how is it managed

5th metacarpal neck fracture with punching | neighbour strapping of affected digit and check rotation as may need manipulated with K wires before strapping

what is a fight bite and how is it managed

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