Upper limb fractures

Question 1

Colles’ fracture

Answer 1

Fall onto extended outstretched hands

Features
- transverse fracture of the radius
- 1 inch proximal to the radio-carpal joint
- dorsal displacement and agulation

Question 2

Smith’s fracture

Answer 2

Volar angulation of distal radius fragment

Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

Question 3

Bennet’s fracture

Answer 3

Intra-articular fracture at the base of the thumb metacarpal

Impact on flexed metacarpal, caused by fist fights

Xray: triangular fragment at the base of metacarpal

Question 4

Monteggia’s fracture

Answer 4

Dislocation of the proximal radioulnar joint in association with an ulna fracture

Fall on outstretched hand with forced pronation

Needs prompt diagnosis to avoid disability

Question 5

Galeazzi fracture

Answer 5

Radial shaft fracture with associated dislocation of the distal radioulnar joint

Occur after fall on the hand with a rotational force superimposed on it

Bruising, swelling and tenderness over the lower end of the forearm

Question 6

Barton’s fracture

Answer 6

Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation

Fall onto extended and pronated wrist

Question 7

Scaphoid fractures

Answer 7

Most common carpal fracture

Fall onto outstretched hand

Swelling and tenderness in anatomical snuff box and pain on wrist movements and on longitudinal compression of the thumb

Ulnar deviation AP needed for visualization of scaphoid

Question 8

Radial head fracture

Answer 8

Common in young adults

Caused by fall on the outstretched hand

Marked local tenderness over the head of the radius

Impaired movements at the elbow

Sharp pain at lateral side of elbow at the extremes of rotation