upper limb fractures

Question 1

fall onto extended outstretched hands

Answer 1

Colles’ fracture

• ‘dinner-fork’ deformity
• classic 3 features:
  
  1. transverse fracture of the radius
  2. 1 inch proximal to radio-carpal joint
  3. dorsal displacement and angulation

Question 2

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

Answer 2

Volar angulation of distal radius fragment (Garden spade deformity)

Question 3

fist fight

Answer 3

Bennett’s fracture

• Intra-articular fracture at the base of the thumb metacarpal
• Impact on flexed metacarpal, caused by fist fights
• X-ray: triangular fragment at the base of metacarpal

Question 4

fall on outstretched hand with forced pronation

Answer 4

Monteggia’s fracture

• Dislocation of the proximal radioulnar joint in association with an ulna fracture
• Needs prompt diagnosis to avoid disability

Question 5

fall on the hand with a rotational force superimposed on it

Answer 5

Galeazzi fracture

• Radial shaft fracture with associated dislocation of the distal radioulnar joint
• On examination, there is bruising, swelling and tenderness over the lower end of the forearm.
• X Rays reveal the displaced fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint.

Question 6

• Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
• Fall onto extended and pronated wrist

Answer 6

Barton’s fracture

Question 7

fall onto outstretched hand (tubercle, waist, or proximal 1/3)

Answer 7

Scaphoid fractures

• commonest carpal fractures.
• surface of scaphoid is covered by articular cartilage with small area available for blood vessels (fracture risks blood supply)
• forms floor of anatomical snuffbox
• risk of fracture associated with fall onto outstretched hand (tubercle, waist, or proximal 1/3)
• main physical signs: are swelling and tenderness in the anatomical snuff box, and pain on wrist movements and on longitudinal compression of the thumb.
• Ulnar deviation AP needed for visualization of scaphoid
• Immobilisation of scaphoid fractures difficult

Question 8

fall on the outstretched hand

Answer 8

Radial head fracture

• common in young adults.
• On examination, there is marked local tenderness over the head of the radius, impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).