week 6: upper limbs and hands trauma

Question 1

proximal humerus fractures are common, outline how they usually happen

Answer 1

osteoprotic patient, outstretched hand/ directly onto shoulder low energy

Question 2

most common pattern from humerus fracture is the medial displacement of the shaft, why

Answer 2

pull of the pectroralis muscle

Question 3

anterior or posterior shoulder dislocation, which is more common

Answer 3

anterior

Question 4

what should be looked for if the shoulder dislocation is from a seizure

Answer 4

bilateral dislocation

Question 5

Anterior shoulder dislocation often results in detachment of the anterior glenoid labrum and capsule known as a ___ ___ whilst the posterior humeral head can impact on the anterior glenoid producing an impaction fracture of the posterior head - ___ ____

Answer 5

bankart lesion

hill-sachs lesion

Question 6

principal sign of axillary nerve injry

Answer 6

loss os sesnsaition in the regimental badge area (just below deltoids

Question 7

in shoulder dislocation what 2 fractures may occur

Answer 7

surgical neck of humerus

greater tuberosity

Question 8

recurrent shoulder dislocations can be repaired by

Answer 8

bankart repair - reattachmen of torn labrrum and capsule by arthroscopic/open means

Question 9

how do posterior shoulder dislocations occur

Answer 9

posterior force on adducted + internally rotated arm

humeral head may be palpated posteriorly

Question 10

main x-ray finding for posterior shder dislo

Answer 10

light bulb sign

excessively internally rotated humeral head - looks like a light bulb at AP view

Question 11

if ACJ is subluxed, whihc ligament is ruptured? if fully dislocated which ligaments are ruptured

Answer 11

subluxation -= AC rupture

dislocation - Coracoclavicular ligaments (Conoid and trapezoid) + AC

Question 12

treatment for AC dislocation

Answer 12

conservative - sling for few weeks + physio

surgery only for chronic pain

Question 13

union rates are low for humeral shaft fractures t.f

Answer 13

false - 90%

due to mobility of ball ad socket joint + elbow joint = 30 deg angulation accepted

Question 14

which nerve is susceptible to injury in humeral shaft fractures? sign for this

Answer 14

radial nerve

dropped wrist, loss of sensation in first dorsal web space

Question 15

most intra-articular fractures require

Answer 15

ORIF + anatomic reduction and rigid fixation (minimises loss of function)

Question 16

avulsion

Answer 16

torn

Question 17

radial head/neck fractures can be difficult to spot on x-ray, what may be the only sign

Answer 17

fat pad at region of #

Question 18

direction of most elbow dislocations

Answer 18

posterior - fall on outstretched hand

Question 19

monteggia fracture

Answer 19

ulna fracture causes dislocation of radial head at elbow

Question 20

t/f monteggia fracture requires ORIF even in children

Answer 20

true

Question 21

galezzi fracture

Answer 21

fracture of radius + disloated ulna at distal radioulnar joint

Question 22

nightsick fracture

Answer 22

isolated fracture of ulna

Question 23

colles fracture (hand)

Answer 23

extraa-articular fracture of distal rsadius within an inch of the articular surgface and with dorsal displacement or angulation

oftn assoc fracture of ulna styloid

Question 24

nerve injiry which may accompany a colles fracture

Answer 24

median nerve compression - nerve stretched or bleed into carpal tunnel

Question 25

smiths fracture (hand)

Answer 25

volarly displaced/angulated extra-articular fracture of distal radius

usually occurs after falling onto the back of a flexed wrist

Question 26

all smith fractures shd unergo ORIF using plate and screws

Answer 26

highly unstable injuries

Question 27

bartons fracture (hand)

Answer 27

intra-articular # of distal radius inovling dorsal/volar irm (where carpal bones of wrist joint sublux with the displaced rim fragment)

Question 28

volar bartons fractures can be called an ___-__ ___ __ or a dorsal bartons fracture called __-___ __ __

Answer 28

intra-artiuclar smiths fracture

intra-articular colles fracture

Question 29

in suspected scaphoid fractures how many x-rays are required

Answer 29

4
AP
lateral
2 obloque

Question 30

scaphoid fractures can have problems with non-union, and AVN - why

Answer 30

non-union - synovial fluid inhibits fracture healing

AVN - blood supply is distally a branch of radial artery

Question 31

peri lunate dislocation

Answer 31

dislo of one ofcarpal bones around the lunate (another capral bone)

Question 32

`peri lunate dislocations occur from sev. high energy wrist impacts resulting in

Answer 32

hyperdorsiflexion

Question 33

scapho‐lunate dissociation occurs when the scapho‐lunate ligaments ruptures. This is shown by an increased gap between the scaphoid and lunate on the AP xray.

what occurs if left untrated

Answer 33

OA

Question 34

mallet finger

Answer 34

avulsion of extensor tendon from its insertion into terminal phalanx - caused by forced flexion of extended DIPJ

Question 35

signs of mallet finger

Answer 35

drooped DIPJ, inability to extend at DIPJ

Question 36

which 2 wrist flexors at risk in penetrating volar injuris

Answer 36

FCU
FCR
(long flexors of digits also)

Question 37

fracture associated with scrapping

Answer 37

5th metacarpal

neck = boxers fracture

Question 38

fight bite can occur in pnching injuries, explai

Answer 38

laceration sustained to the punchers hand from the punchees tooth
could penetrate MCPJ or disrupt extensor tendon

could lead to SA