Upper limb injuries 2

Question 1

This deck covers

Answer 1

Scaphoid fractures

Bennet’s fracture

Ulnar collateral ligament of thumb

Boxer’s injuries

Flexor tendon injuries

Question 2

What causes scaphoid fractures?

Answer 2

Falls onto outstretched hand (FOOSH)

Sports

RTAs

Question 3

Describe the typical symptoms of a Scaphoid fracture

Answer 3

Pain along radial aspect of wrist & base of thumb

Loss of grip & pinch strength

Question 4

What are the big signs of scaphoid fracture

Answer 4

Pain on palpation of anatomical snuffbox

Pain on telescoping the thumb

Question 5

How are scaphoid fractures investigated?

Answer 5

MRI is the best

Xray will do the trick - but needs to be repeated at 2 weeks

Question 6

What complication is associated with scaphoid fractures?

Explain why this can occur

Answer 6

Fractures of proximal 1/3rd risk AVN of the scaphoid

Because its got a stupid retrograde blood supply

Also a risk of non-union

Question 7

How are scaphoid fractures treated?

Answer 7

Cast for 6 weeks

If displaced or non-union = surgery

Question 8

Ulnar collateral ligament injury of the thumb involves the ulnar collateral ligament funnily enough

What does this ligament do?

Answer 8

Resists radial movement of the thumb

This ligament lies across the MTP joint of the thumb

Question 9

How is the Ulnar collateral ligament of the thumb damaged?

Is it just the ligament that is damaged?

Answer 9

Damaged by excessive radial force

Aka Gamekeepers thumb (often happened after firing a gun)

Akaka skiiers thumb (yanky pole)

Can involve the ligament only - or involve avulsion of a bit of bone (either metacarpal or the phalanx)

Question 10

Describe the presentation for UCL injury

What features on examination would be in keeping

Answer 10

Acute pain in the thumb following the injury

Weak pinch grip

Tenderness on ulnar side of thumb

Joint opens under radial stress

Question 11

How is UCL thumb injury treated

Answer 11

Splint or cast (conservative treatment)

If bad - repair ligament

If avulsed bone - fixate it

Question 12

What is a Bennet’s fracture?

What mechanism causes it?

Answer 12

Intra-articular fracture at the base of the 1st metacarpal (thumb)

Axial compression on a slightly flexed CMC joint - so occurs when falling on outstretched hand (FOOSH) or in boxing

Question 13

In Bennet’s fractures - the metacarpal of the thumb is displaced

Why is this?

Answer 13

Displacement due to proximal pull from abductor pollicis longus (therefore unstable)

Question 14

How are Bennet’s fractures treated?

Answer 14

Reduction followed by casting +/- wires

If unhappy - then screw fixation

Question 15

What hand injuries are commonly seen after fights?

Answer 15

Boxer’s fracture

Fight bites - punch on exposed teeth may lead to fragments penetrating the MCP joint which can lead to nasty septic arthritis

Question 16

What is a Boxer’s fracture?

What bones does it typically affect?

Is there any displacement? If so - which way?

Answer 16

Fracture of the neck of the metacarpal

Usually the little or ring finger

Often volar (palmar) displacement

Question 17

How are Boxer’s fractures treated?

Answer 17

Pretty much always conservatively - cast or splint

Reduction & wiring indicated if displacement is silly - ie visible bulge in the palm

Plates used very rarely

Question 18

How do flexor tendon injuries occur?

Who does it most commonly happen to?

Answer 18

Knife lacerations

(drunk people cooking food is like the 3rd biggest cause)

Males > females

Young adults

Question 19

What is the approach to management of flexor tendon injuries?

Answer 19

Repair surgically & early

Early movement reduces likelihood of adhesions