Fractures

Question 1

Clavicle

Answer 1

> Mostly from fall onto shoulder or outstretched hand
Care for neurovascular structures nearby
(Brachial plexus and subclavian artery)
Usually mid shaft > lateral > medial ]

Management:
> Conservative (if not significantly displaced)
- Sling
- Physio = early mobs and load as appropriate

> Surgery (if badly displaced)
- similar physio afterwards

Question 2

Proximal Humerus

Answer 2

> more common in women and elderly

Classification
- how many fragments are displaced ie 0 = 1 fracture, 2 = 3 part fracture etc.

Management

• Collar and Cuff for 2-3 weeks
• Progressive active management (slow progress particularly in elderly
• Surgery if v. severe
• Possible to develop adhesive capsulitis due to reduced RoM + function

Question 3

Distal Radius Fracture

Answer 3

> Generally from fall of outstretched hand
> Colles Fracture (most common)
- Extra-articular 
- Posteriorly displaced distal radius
> Smith's 
- Extra-articular
- Anteriorly displaced distal radius 
> Barton's 
- Intra-articular (associated dislocation of RCJ)

> Management

• Splint/Cast
• K-wire (fixes but hooks left external for removal in 4-6 weeks)
• MUA to realign
• Physiotherapy (mobilisation, strength, function focus)

Question 4

Scaphoid Fractures

Answer 4

> 70% of carpal fractures (waist>proximal pole>distal pole)
Mechanism is usually FOOSH
Proximal aspect has poor blood supply so risk of avascular necrosis and non-union
Diagnosis
- 1/4 not seen on initial X ray (immobilise + re-x-ray in 10-14 days)
Presentation
- Pain over anatomical snuffbox (especially on palpation)
Management
- Cast
- Surgery
- Physio post immobilisation (mobility then strength + function)

Question 5

ORIF (Open reduction, internal fixation)

Answer 5

> Unstable/ displace fractures
Bones are reset then held in place by inter-medullary (IM) plates + screws
fixation remains unless it becomes problematic

Question 6

External fixation

Answer 6

> Severe open fractures/ infected non-unions/ malalignments/ poly traumas
rods are screwed into bone but stabilised by external structure
rehab with external fixation in place