Upper limb trauma Flashcards
what is the most likely pathophysiology of a prox humerus fracture
osteoporosis with fall on outstretched hand or shoulder
humeral surgical neck fractures most common displace medially/laterally
medially - due to pec major
what muscles attach to greater tuberosity
supraspinatus, infraspinatus, teres major
what muscles attach to lesser tuberosity
subscapularis
management of a minimally displaced humeral neck fracture
sling with gradual mobilisation
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
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
compications of comminuted fracture of surgical neck humerus
AVN, chronic pain, osteoarthritis
difficult ROM in arthroplasty
complications of displaced fracture of surgical neck humerus
stiffness, chronic pain, failure of fixation
more common in older patients
true/false - posterior dislocation of glenohumeral joint is more common
false - anterior is
why may an anterior shoulder dislocation occur
excess external rotation or fall to back of shoulder
what is a bankart lesion and what may it occur in
anterior shoulder dislocation
where there is detachment of anterior glenoid and capsule
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
presentation of anterior shoulder dislocation
lost symmetry - arm held adducted and lost roundness
lost badge patch sensation
rotator cuff tear
diagnosis and investigation of anterior shoulder dislocation
x rays - 2 planes
may see greater tuberosity/surgical neck fracture
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
chance of recurrent dislocation in pt <20 for ant shoulder dislocation
80%
chance of recurrent dislocation in pt >30 for ant shoulder dislocation
20%
how may an anterior shoulder dislocation be fixed operatively in recurrent dislocation
bankart repair with reattachment of labrum and capsule - arthroscopic or open
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
what type of injury may cause posterior shoulder dislocation
fall on adducted and internally rotated arm
features clinically and radiologically of posterior shoulder dislocation
palpable humeral head posterior
light bulb sign
set special laterals
management of posterior shoulder dislocation
closed reduction and immobilisation
physiotherapy
what ligaments are disrupted in ACJ subluxation/dislocation
subluxation - acromioclavicular ligaments
dislocation - acromioclavicular ligaments and coracoclavicular
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
