Elbow, Forearm, Humerus and Shoulder

Question 1

What is a Monteggia fracture-dislocation?

Answer 1

A proximal third ulna fracture with dislocation of the radial head.

Question 2

What is the most common type of Monteggia fracture-dislocation?

Answer 2

Anterior dislocation of the radial head (occurs in 70% of cases).

Question 3

What is another possible type of Monteggia fracture-dislocation?

Answer 3

Lateral dislocation of the radial head (25% of cases).

Question 4

What is a Galeazzi fracture-dislocation?

Answer 4

A distal third radius fracture with dislocation of the distal radioulnar joint (DRUJ).

Question 5

How are Galeazzi fractures classified?

Answer 5

By the position of the ulna:

• Palmar (volar) dislocation of the ulna
• Dorsal dislocation of the ulna

Question 6

How common are Galeazzi fractures?

Answer 6

They account for 3-7% of forearm fractures and are rare in children.

Question 7

What is the prevalence of Monteggia fractures among forearm fractures?

Answer 7

Uncommon, occurring in 1-3% of forearm fractures.

Question 8

What is the prevalence of Galeazzi fractures among forearm fractures?

Answer 8

Uncommon, occurring in 3-7% of forearm fractures.

Question 9

Why is it important to consider that the radius and ulna form a ‘bony ring’?

Answer 9

Because disruption at one site (e.g., a fracture) often results in injury at another site, making associated dislocations or fractures likely.

Question 10

What bones make up the elbow joint?

Answer 10

The humerus, radius, and ulna form the elbow, which acts as a hinge joint.

Question 11

What structures are found in the distal humerus?

Answer 11

Trochlea, Capitellum, Coronoid fossa, Olecranon fossa, Radial fossa, Medial epicondyle, Lateral epicondyle.

Question 12

What are the key parts of the proximal radius?

Answer 12

Radial head, Radial neck, Radial tuberosity.

Question 13

What are the key parts of the proximal ulna?

Answer 13

Olecranon process, Coronoid process, Radial notch, Trochlear notch, Elbow Fat Pads.

Question 14

What are the 2 fat pads of the elbow?

Answer 14

Anterior fat pad, Posterior fat pad.

Question 15

What does a visible posterior fat pad on an X-ray indicate?

Answer 15

A posterior fat pad sign suggests a possible occult fracture, often a radial head fracture in adults or a supracondylar fracture in children.

Question 16

What are the three key fat pads in the elbow?

Answer 16

Anterior fat pad, Posterior fat pad, Supinator fat pad.

Question 17

What is the radiological significance of a visible posterior fat pad?

Answer 17

A posterior fat pad sign suggests an occult fracture, commonly a radial head fracture in adults or a supracondylar fracture in children.

Question 18

Where is the supinator fat pad located?

Answer 18

Adjacent to the proximal radius, near the supinator muscle. A displaced supinator fat pad can indicate a radial head fracture.

Question 19

What is the anterior humeral line (AHL), and what does it indicate?

Answer 19

A line drawn along the anterior margin of the humerus, which should bisect the capitellum. If disrupted, it indicates a supracondylar fracture. Used in the lateral view only.

Question 20

What is the radiocapitellar line (RCL), and what does it indicate?

Answer 20

A line drawn along the neck of the radius, which should bisect the capitellum in all views. If misaligned, it suggests a radial head dislocation.

Question 21

What percentage of elbow fractures involve the radial head and neck in adults?

Answer 21

50% of elbow fractures involve the radial head and neck, making it the most common site.

Question 22

What is the second most common elbow fracture site in adults?

Answer 22

The olecranon, accounting for 20% of elbow fractures.

Question 23

What is a supracondylar fracture?

Answer 23

A fracture of the distal humerus just above the elbow joint, common in children.

Question 24

What is the most common cause of supracondylar fractures in children?

Answer 24

Fall on an outstretched hand (FOOSH).

Question 25

What are the two types of supracondylar fractures?

Answer 25

Extension-type (95%) – Distal fragment displaced posteriorly. Flexion-type (5%) – Distal fragment displaced anteriorly.

Question 26

What radiological sign helps diagnose a supracondylar fracture?

Answer 26

Disruption of the anterior humeral line (AHL) on a lateral X-ray.

Question 27

What is the significance of a posterior fat pad sign in children?

Answer 27

Indicates an occult supracondylar fracture, even if the fracture is not clearly visible.

Question 28

What is a major complication of supracondylar fractures?

Answer 28

Volkmann’s ischemic contracture due to brachial artery injury, leading to compartment syndrome.

Question 29

What nerve injuries are associated with supracondylar fractures?

Answer 29

Median nerve injury (most common) → Weak grip, loss of sensation in lateral palm. Radial nerve injury → Wrist drop. Ulnar nerve injury → Claw hand.

Question 30

How are supracondylar fractures managed?

Answer 30

Non-displaced (Type I) → Immobilization with a long-arm cast. Displaced (Type II/III) → Closed reduction + percutaneous pinning (CRPP) or open reduction if needed.

Question 31

What is the most common type of shoulder dislocation?

Answer 31

Anterior Shoulder Dislocation (95%)

Question 32

How is the humeral head displaced in an anterior shoulder dislocation?

Answer 32

Anteriorly, inferiorly, and medially, below the coracoid process

Question 33

What injuries commonly accompany an anterior shoulder dislocation?

Answer 33

Bankart lesion (15%) and Hill-Sachs deformity (80%)

Question 34

What happens in a posterior shoulder dislocation?

Answer 34

The humeral head is displaced posteriorly, losing articulation with the glenoid fossa

Question 35

What is a classic radiographic sign of a posterior shoulder dislocation?

Answer 35

Lightbulb sign – the humeral head appears more rounded

Question 36

What condition is a posterior dislocation often associated with?

Answer 36

Seizures

Question 37

How common are posterior shoulder dislocations?

Answer 37

2-4% of all shoulder dislocations

Question 38

What is Luxatio Erecta?

Answer 38

A rare form of inferior shoulder dislocation, caused by forced hyperabduction and extension of the arm

Question 39

How common is inferior shoulder dislocation (Luxatio Erecta)?

Answer 39

0.5-1% of all shoulder dislocations

Question 40

What is a Hill-Sachs lesion?

Answer 40

A depression-type fracture of the posterolateral articular surface of the humeral head caused by anterior shoulder dislocation.

Question 41

How does a Hill-Sachs lesion occur?

Answer 41

It is created when the humeral head passes over the edge of the anterior glenoid fossa during an anterior dislocation.

Question 42

Why are Hill-Sachs lesions clinically significant?

Answer 42

They predispose the patient to recurrent anterior dislocations.

Question 43

What is a Bankart lesion?

Answer 43

An injury to the anteroinferior glenoid labrum that occurs with an anterior glenohumeral dislocation.

Question 44

What imaging modality may be needed to assess the full extent of a Bankart lesion?

Answer 44

MRI

Question 45

How common is a Bankart lesion after an anterior shoulder dislocation?

Answer 45

Present in 15% of patients after dislocation.

Question 46

What are common causes of AC joint injuries?

Answer 46

Contact sports, FOOSH (fall on outstretched hand), or a fall onto the apex of the shoulder.

Question 47

What are the normal measurements for the AC and CC joints?

Answer 47

AC joint: 0.3-0.8 cm CC joint: 1.0-1.3 cm

Question 48

What is a key finding in rotator cuff tears (old injuries)?

Answer 48

Superior migration of the humeral head and flattening of the undersurface of the acromion.

Question 49

What does supraspinatus tendon calcification look like on imaging?

Answer 49

Amorphous, lobular calcification, often more pronounced than commonly seen.

Question 50

Where is supraspinatus tendon calcification typically located?

Answer 50

Just superior to the greater tuberosity of the humerus, where the tendon inserts.

Question 51

What is the most common site for clavicle fractures?

Answer 51

The middle third (approx. 75-80% of cases).

Question 52

How do the fragments of a clavicle fracture typically displace?

Answer 52

Medial fragment: Displaces upward due to the sternocleidomastoid muscle. Lateral fragment: Pulled downward by the weight of the limb.

Question 53

What are common causes of clavicle fractures?

Answer 53

Falls onto the lateral aspect of the shoulder or contact sports.

Question 54

In which population are proximal humerus fractures most common?

Answer 54

Elderly patients, often due to FOOSH (fall on outstretched hand) or direct trauma.

Question 55

What percentage of proximal humerus fractures are non-displaced?

Answer 55

85%.

Question 56

What are the four main fracture fragments in a proximal humerus fracture?

Answer 56

Greater tuberosity Lesser tuberosity Humeral head Humeral shaft

Question 57

How does CT help in assessing radial head fractures?

Answer 57

CT improves fracture detection, evaluates displacement and fragmentation, and helps identify associated injuries.

Question 58

What are the advantages of CT over X-rays in radial head fractures?

Answer 58

CT offers better visualization of subtle fractures, precise measurement of displacement, and detection of associated injuries.

Question 59

How does CT assist in surgical planning for radial head fractures?

Answer 59

CT, especially with 3D reconstruction, helps in understanding fracture patterns and planning fixation or arthroplasty.

Question 60

What associated injuries can CT help identify in radial head fractures?

Answer 60

CT can reveal coronoid fractures, ligamentous injuries (LCL complex), and Essex-Lopresti injuries.

Question 61

What is calcification of the supraspinatus tendon?

Answer 61

It is the deposition of calcium hydroxyapatite crystals within the tendon.

Question 62

What are the consequences of calcification of the supraspinatus tendon?

Answer 62

It leads to pain, inflammation, and restricted shoulder movement.