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upper limb injuries Flashcards

1
Q

What part of the clavicle is the most common location for fracture on the clavicle

A

Middle 1/3

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2
Q

What causes clavicle fractures

A

falling onto a shoulder or an outstretched hand

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3
Q

What is the treatment for clavicular fracture

A

The majority unite but:

Anaglesia is given

sling is provided for comfort for up to one month

Progressive mobilisation 2 weeks post fracture

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4
Q

When is surgery indicated in clavicular fractures

A

Some displaced fractures
open fracture
When the fracture threatens to become an open fracture through the skin
Neurovascular complication
When they have more than one trauma

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5
Q

What causes injury to the acromioclavicular joint

A

Fall onto the shoulder which causes the acromion and shoulder joint to separate

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6
Q

What is the treatment of acromio-clavicular strain

A

3-4 weeks in a sling with analgesics

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7
Q

What is the treatment of acromio-clavicular dislocation

A

Early fixation by pulling them down and hold the clavicle down until the joint scars together

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8
Q

What is the treatment of proximal humerus fractures

A

Sling and mobilise from 6 weeks

Operative management - fixation with plate or joint replacement

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9
Q

What nerve should be tested in shoulder dislocation

A

Axillary nerve - if it is damaged the deltoid muscle will not be functioning

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10
Q

how are shoulder dislocations diagnosed

A

2 views on X ray - many dislocations are missed by just doing from one view

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11
Q

What is the treatment of shoulder dislocation

A

Reduction in the dislocation under anaesthetic

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12
Q

What increases the risk of recurrence of shoulder dislocation

A

Younger age, male sex and participation in contact sports

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13
Q

What are the most common causes of posterior dislocation of the shoulder

A

Seizure
electrocution
Direct punch to the front of the shoulder

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14
Q

How is posterior dislocation of the shoulder diagnosed

A

When the passive external rotation is done, when the doctor tries to externally rotate the shoulder it will not rotate as much as the other arm

X-ray - at least 2 views

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15
Q

What is the most common fracture in elderly patients

A

distal radial fracture - commonly occurs in patients with osteoporosis

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16
Q

What commonly causes distal radial fracture

A

Falls

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17
Q

How is distal radial fracture treated if it is undisplaced

A

Splints/casts

18
Q

How is distal radial fracture treated if it is displaced

A

Reduce the displacement under anaesthetic then attach a cast with wires through the bone to lock the cast on

19
Q

What is the surgical treatment of distal radius fracture

A

Fixing the distal radius with a plate and screws

External fixator - pins into the radius above the wrist and pins into the metacarpal below the wrist - lock the external fixator to hold the position

20
Q

What are the complications of distal radial fracture repair

A

Malunion - bone heals in abnormal position

DRUJ pain – distal radial ulnar joint pain due to the joint not fit for the shortened radial bone – the radius shortening is a complication of fracture repair

EPL rupture – extensor pollicis longus rupture – runs across the fracture and into the thumb – the fracture damages its blood supply and then causes the tendon of it to rupture

Carpal tunnel syndrome – swelling due to the fracture which causes compression of the median nerve

CRPS – chronic regional prame syndrome – long term stiffness and pain and restriction of movement

21
Q

What is the most common fractured carpal bone

A

scaphoid

22
Q

Why are repeat x-rays done or MRI for scaphoid fracture

A

They are difficult to see on the initial x-ray

23
Q

What can cause non-union or avascular necrosis if the fracture is in the proximal third

A

Scaphoid fracture

24
Q

What is the most common cause of scaphoid fracture

A

falling onto outstretched hand

25
Q

How does scaphoid fracture present

A

Pain in the base of the thumb

Tenderness at the anatomical snuff box

Pain telescoping thumb - pulling and pushing thumb down and away from wrist

26
Q

What is the non surgical treatment of scaphoid

A

cast for 6 weeks

27
Q

What is the surgical treatment for scaphoid fracture

A

Fix with a single screw but if there is displacement, they are fixed immediately

28
Q

What causes ulnar collateral ligament injury of the thumb

A

Due to radial force - pulling the thumb radially (laterally)

29
Q

How does ulnar collateral ligament (UCL) injury of thumb present

A

Injury with a weak pinch grip

30
Q

What is found on examination in ulnar collateral ligament injury of the thumb

A

Tenderness on the ulnar side of the joint (medial side of thumb)

31
Q

How is UCL injury of the thumb treated

A

Splint/cast

Surgical - repair ligament
Fix avulsion fragment (broken part of bone fragment which came away when the UCL became injured)

32
Q

What is a Bennett’s fracture

A

Intra-articular fracture at the base of the first metacarpal (thumb)

33
Q

What causes Bennet’s fracture

A

Axial compression of slightly flexed carpo-metacarpal joint

e.g Falling on outstretched hand or boxing

34
Q

Why is there displacement in Bennet’s fracture

A

proximal pull from abductor pollicis longus

35
Q

How is Bennet’s fracture treated

A

The dislocation is reduced under anaesthetic

Apply a plaster cast which will hold it in position - wire can be added as extra support to lock the cast on
Screws can attach the bone to another bone

36
Q

What is a boxers fracture

A

Fracture of little finger - normally the neck of the metacarpal neck

37
Q

What is the treatment of boxer’s fracture

A

Strap the fingers together and mobilisation

May pull the bone back into position if it is very angulated and hold it into position

38
Q

What is the most common of flexor tendon injuries in the fingers

A

Knife laceration

39
Q

Who most commonly gets flexor tendon injuries in the fingers

A

Males
Young adults

40
Q

What is the treatment of flexor tendon injuries of the fingers

A

Repair surgically early

41
Q

What surgery of tendon injuries in the upper limb have worst prognosis

A

Within the flexor sheath where the FDS and FDP tendons are involved

42
Q
A

msk (36 decks)

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