18: Upper Limb Injuries

Question 1

which 1/3 of the clavicle is most commonly fractured?

Answer 1

middle 1/3

Question 2

clavicle fracture management

Answer 2

• analgesia
• sling: 3-4 weeks, progressive mobilisation from 2 weeks
• figure of 8 bandage
• surgery in minority of cases

Question 3

indications for surgery for clavicle fracture

Answer 3

• clavicle is displaced
• open fractures
• threatening the skin
• neurovascular complication
• polytrauma

Question 4

dislocation of acromioclavicular joint treatment

from sprain to complete dislocation

Answer 4

• sprains treated in sling for 3-4 weeks
• displaced AC joint dislocations may benefit from early fixation

Question 5

proximal humerus fractures management

Answer 5

• sling, mobilise from 6 weeks or
• surgical fixation with plate or
• joint replacement

Question 6

shoulder dislocation treatment

Answer 6

• acute-reduction under sedation/anaesthetic: methods-various, Hippocratic, Kocher’s
• high recurrence rate in younger males participating in contact sports

Question 7

what events can sometimes cause a posterior shoulder dislocation?

Answer 7

• seizure
• electrocution
• direct blow to front of shoulder (boxing)

Question 8

distal radial fracture treatment

Answer 8

Conservative:
- undisplaced: splint/casts
- displaced: reduce, cast +/- wires

Surgical:
- plate
- external fixator

Question 9

distal radial (Colles) fracture complications

Answer 9

• malunion
• DRUJ pain
• EPL rupture
• carpal tunnel syndrome
• Complex regional pain syndrome

Question 10

what is the most commonly fractured carpal bone?

Answer 10

scaphoid

Question 11

scaphoid fracture treatment

Answer 11

• cast for 6 weeks
• surgery if displaced or non-union

Question 12

the anatomical snuff box is a space bordered by?

anteriorly, posteriorly and proximally

Answer 12

• abductor pollicis longus and extensor pollicis brevis anteriorly
• extensor pollicis longus posteriorly
• radial styloid/radius proximally

Question 13

ulnar collateral ligament (UCL) injury of thumb treatment

Answer 13

• conservative: splint/cast
• operative: repair ligament, fix avulsion fragment

Question 14

describe a Bennett’s fracture

Answer 14

• inta-articular fracture at base of 1st metacarpal
• displaced due to proximal pull from abductor pollicis longus (therefore unstable)

Question 15

Bennett’s fracture treatment

Answer 15

• reduction
• maintenance reduction: plaster cast, +/- wire, screw fixation

Question 16

describe a Boxer’s fracture

Answer 16

• fracture of little finger metacarpal neck
• may also be the ring finger
• volar angulated

Question 17

which area of tendon injury in the hand had the worst prognosis and why?

Answer 17

• zone 2: within flexor sheath, usually both FDS and FDP tendons involved
• repair by secure low-profile sutures (Kessler technique)