Wrist and Elbow Trauma - Colles, Smith, Scaphoid, Monteggia, Galeazzi, Nerve Palsy, Epicondylitis, Bursitis, Supracondylar Flashcards
Colles fracture
-MOI
-presentation
-investigations
-management
-complications
Older females with osteoporosis => FOOSH
Low energy trauma - prolonged CS, smoking, low BMI
High energy trauma - younger people
FOOSH
-wrist pain, swelling => dinner fork deformity, dorsal displacement of radius
-median paraesthesia and weakness
AP, L film
-transverse fracture of distal radius
-dorsal displacement and angulation of distal radial fragment
CR, immobilise in plaster
ORIF if
-unstable
-10deg+ dorsal angulation
-comminuted
-CR unsuccessful
Bone heals in 6wks => repeat Xray to ensure adequate unions
Malunion
Neurovascular damage
-Median - weakness, loss of thumb/1st finger flexion
-Vascular compromise
OA
Smith’s fracture
-MOI
-presentation
-investigations
-management
-complications
Falling with flexed wrist
Volar angulation of distal radial fragment = garden spade
AP, L film
CR, immobilise in plaster
ORIF, EF if needed
Bone heals in 6wks => repeat Xray to ensure adequate unions
Malunion
Neurovascular damage
-Median - weakness, loss of thumb/1st finger flexion
-Vascular compromise
OA
Scaphoid
-MOI
-presentation
-investigations
-management
-complications
FOOSH on extended, radially deviation wrist
-contact sports, high-energy trauma
Pain along radial aspect of wrist, base of thumb
Loss of pinch strength
Max tenderness on anatomical snuffbox, scaphoid tubercle
Pain on longitudinal compression of thumb
Pain on ulnar deviation of wrist
AP, L, scaphoid views
2nd line - MRI
Suspected or confirmed
-immobilise with Futuro splint or below elbow backslab
ORTHO REFERRAL
-7-10days further review if inconclusive
Undisplaced - 6-8wk casting
Displaced waist/proximal pole fracture - surgical repair
Non-union => pain, early OA
AVN
Monteggia
-MOI
-presentation
-investigations
-management
-complications
Proximal 1/3 ulna fracture + proximal radial head dislocation
FOOSH + forced pronation
Pain, swelling at elbow
PIN (branch of radial) => wrist, finger extension affected
-no paper or thumbs up
AP, L elbow wrist, forearm
CR, immobilisation
ORIF
PIN neuropathy
Malunion
Galeazzi
-MOI
-presentation
-imaging
-management
-complications
Distal 1/3d radial fracture + distal radioulnar dislocation
FOOSH + rotation
Bruising, swelling, tender lower forearm
AP, L elbow forearm wrist
ORIF
PIN, R neuropathy
Malunion
General fracture management
Immobilise fracture
Monitor and document NVS especially
-before and after reduction and immobilisation
Tetanus prophylaxis
For open fractures
-thorough debridement and lavage within 6hrs of injury
-IV broad spec ABx
Nerve function assessment
-median
-radial (PIN)
-ulnar
-AIN
Median - rock
Phalen (inverse prayer hands) - carpal tunnel
-numb median distribution
Tinel (tap median nerve at wrist) - carpal tunnel
-tingling, electric shock like in median distribution
Radial (PIN) - paper
Ulnar - scissors
Froment’s sign - hold paper between thumb and 1st finger and gently pull away
-ulnar palsy if thumb flexed if adductor pollicis weak
AIN - ok
Carpal tunnel syndrome
-risk factors
-presentation
-investigations
-management
Risk factors
-wrist fracture/dislocation
-RA, gout
-DM, hypothyroid, pregnant
-repetitive wrist action
Numb, tingling worsened by wrist flexion, extension
Worse at night
Thenar atrophy => weak grip strength, difficulty with fine motor tasks
Tinel + Phalen
6wks - night wrist splints, NSAIDS, activity modification
-can consider CS
Surgery if conservative measures fail
Cubital tunnel syndrome
-risk factors
-presentation
-investigations
-management
Risk factors
-OA, past trauma to elbow
Compression of ulnar nerve at elbow
-4th-5th finger intermittent => constant tingling
-weakness, muscle wasting
Clinical diagnosis
Avoid aggravating activity
Physio
CS injection
Surgery if resistant
Lateral and medial epicondylitis
-presentation of each
-management
Lateral (tennis) - repetitive strain from wrist and elbow extension+supination
-pain, tender lateral epicondyle
-acute pain for 6-12wks
Medial (golf) - repetitive strain from wrist and elbow flexion+pronation
-pain, tender medial epicondyle
-ulnar nerve involvement - tingling, numb
Avoid muscle overload
SImple analgesia (NSAIDS)
Physio
Consider CS injection
Olecranon bursitis
-risk factors
Inflammation from
-repetitive mild trauma - leaning on desk
-gout, RA,
Infective - Saureus
Swelling over olecranon
-tender, red
If infective - swelling over hours-days, tender, red, warm, fever
Movement painless until bursa compressed in full flexion
Clinical diagnosis - no concerns about septic arthritis
-if likely to be septic => aspiration, microscopy and culture
Conservative
-activity modification - avoid repeated pressure on elbow
-ice 15-20mins/day, compression, elevation to reduce inflammation and pain
-NSAIDS or paracetamol - short term analgesia
ABx if septic
If severe fluid accummulation causing disconfort - aspirate considered
Supracondylar fracture
-structures at risk
-presentation
-investigations
-classification of injury
-management
-complications
MOST COMMON PEDIATRIC FRACTURE - 5-7y/o
FOOSH with elbow in extension => fracture of distal humerus
Gross deformity
Swelling
Limited elbow ROM
Assess nerve function
-median - rock
-radial - paper
-ulnar - scissors
-AIN - ok - MAIN NERVE AT RISK
Assess for vascular compromise
-prolonged CRT
-pulse check
AP, L Xray
-posterior fat pad sign
-displacement of the anterior humeral line - should normally intersect middle 1/3d of captellum
Gartland classification
I undisplaced
II displaced with intact posterior cortex
III displaced in 2-3 planes
IV displaced with complete periosteal disruption
NV compromise => IMMEDIATE CLOSED REDUCTION
-secured with K wires
Open - OR with percutaneous pinning
I - above elbow cast in 90deg
II, III, IV - closed reduction and percutaneous K wires
AIN palsy - most common after initial injury
Ulnar palsy - most common after surgical intervention
Malunion
Cubitus varus deformity
Volkmann’s contracture - vascular compromise and ischemia of forearm flexors fibrose and form contracture
