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Orthopaedics > Upper Limb Trauma > Flashcards

Upper Limb Trauma Flashcards

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1
Q

M/C fracture at birth and in newborn babies

A

Clavicle fracture

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2
Q

How does a patient show up with clavicle fracture?

A

Patient presents supporting the injured side with opp arm, pushing elbow up

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3
Q

Sites of Clavicle fracture

A
  1. Lateral (15%)
  2. Middle (80%)
  3. Medial (5%)
    M/C site: Lat 1/3rd (flat) and med 2/3rd (Tubular)
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4
Q

Displacing forces in Clavicle #

A

Lat fragment: Pulled down (Wt. of arm + pectoralis)
Med fragment: Pulled up (SCM + Trapezius)

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5
Q

Complications of Clavicle #

A
  1. Malunion (M/C): D/t displacement
  2. Neurovascular injury: Brachial plexus, subclavian vessels
  3. Non union (very rare)
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6
Q

Conservative management of Clavicle #

A
  1. Fracture of 8 bandage
  2. Arm sling/arm pouch
  3. Combination of both
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7
Q

Surgical indications of Clavicle #

A
  1. Open clavicle fracture
  2. Massive displacement
  3. Acromioclavicular joint involved
  4. Neurovascular injury
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8
Q

Types of Anterior dislocation

A
  1. Subcoracoid (M/C)
  2. Subclavicular
  3. Pre glenoid
  4. Intrathoracic
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9
Q

What is Anterior dislocation of shoulder joint?

A

Head of humerus dislocated anteriorly

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10
Q

Presentation of Anterior dislocation of shoulder

A
  1. Abduction and external rotated -> Loss of abduction and internal rotation
  2. Arm by side of body
  3. Loss of shoulder contour -> Flattened
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11
Q

Mechanism of injury of Anterior dislocation of shoulder

A
  1. H/o trauma
  2. Fall on outstretched hand
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12
Q

Acute anterior dislocation
Just study

A

Emergency -> Requires immediate reduction

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13
Q

Nerve injury in Anterior dislocation of shoulder

A

Axillary nerve injury (M/C)

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14
Q

Clinical examination of Anterior dislocation of shoulder

A
  1. Hamilton’s ruler test
  2. Duga’s test
  3. Callaway’s test
  4. Axillary nerve injury
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15
Q

What is Hamilton’s ruler test?

A

Ruler over lat epicondyle of humerus touches acromion

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16
Q

What is Duga’s test?

A

Difficulty in touching C/L shoulder

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17
Q

What is Callaway’s test?

A

In Anterior dislocation, there is inc in girth of affected shoulder

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18
Q

Axillary nerve injury leads to

A

Loss of:
1. Motor function of deltoid, trees minor
2. Sensory function: Regimental badge sign (Lat aspect of upper arm)

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19
Q

Techniques to treat Anterior dislocation of shoulder

A
  1. Modified Kocher’s technique
  2. Stimson’s technique
  3. Hippocratic technique
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20
Q

What is Modified Kocher’s technique?

A

Mnemonic: TEAM
1. Traction
2. External fixation
3. Adduction
4. Medial/internal rotation

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21
Q

What is Stinson’s technique?

A

Patient prone -> Heavy object tied to dislocated limb -> Hang limb at the edge of table/bed -> Gradual traction overcomes muscle spasm -> Reduction

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22
Q

What is Hippocratic technique?

A

Countertraction: With foot
Traction: With arm

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23
Q

Complications of Anterior dislocation of shoulder

A
  1. Bankart lesion (M/C)
  2. Hill-Sachs lesion
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24
Q

What is Bankart lesion?

A

Ant dislocation -> Glenoid labrum tears anteroinferiorly at 4-6 o’clock -> Laxity of inf glenohumeral ligament -> Dec in stability -> Recurrent dislocations

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25
What is Bony Bankart lesion?
Avulsion fracture of anteroinf glenoid, along with a Bankart
26
What is Hill-Sachs lesion?
Recurrent dislocation -> Head of humerus repeatedly hits ant glenoid rim -> Indentation on posterolateral surface
27
M/C complication of shoulder dislocation
Recurrent dislocation
28
M/C early complication of shoulder dislocation
Axillary nerve injury
29
M/C late complication of shoulder dislocation
Recurrent shoulder dislocation
30
Mechanism of injury in posterior dislocation of shoulder
1. High velocity muscular movement > In seizures > High voltage electric shock > Electroconvulsive therapy 2. Fall on outstretched hand 3. Trauma
31
Attitude of limb in Posterior dislocation of shoulder
1. Adducted and internally rotated: Loss of abduction and ext rotation 2. Shoulder contour: Not lost 3. Pain +
32
X ray of Post dislocation of shoulder
Light bulb/Electric bulb sign
33
Mechanism of injury in Inferior dislocation of shoulder
Hyperabduction
34
Attitude of limb in Inferior dislocation of shoulder
Arm by the side of the head (AKA luxatio erecta)
35
What is Shaft of humerus #?
Fracture b/w surgical neck of humerus and supracondylar area
36
Complication of Shaft of humerus #
Radial nerve injury (Closely associated with shaft)
37
Management of Shaft of humerus #
Conservative: U slab/Hanging cast (Needs to be erect) Surgical: ORIF with plates + screws
38
Site of Holstein-Lewis fracture
Junction of upper 2/3rd and lower 1/3rd of humerus
39
Holstein-Lewis fracture causes which nerve entrapment?
Radial nerve
40
Entrapment of Radial nerve causes
Wrist drop + Thumb drop + Finger drop + Sensory loss
41
Management of Holstein-Lewis #
Cock up splint (Dynamic > Static)
42
Type of fracture of Lat condyle # of elbow
Intra articular/ # of necessity
43
Type of # of Supracondylar # of elbow
Extra articular
44
3 point bony relationship in fractures around elbow
Lat epicondyle #: Disturbed Supracondylar #: Maintained
45
Salter-Harris classification type in fractures around elbow
Lat epicondyle #: Type IV Supracondylar #: Type I/II
46
Complications in Lat epicondyle #
1. Elbow stiffness 2. Non union d/t: > Pull by common extensor group of muscles > Compromised vascularity 3. Damage to lat growth plate: Growth of med > lat condyle > Cubitus valgus deformity > Stretching of med elbow structures -> Tardy ulnar nerve palsy (Develops over weeks-months)
47
Mechanism of injury in Supracondylar fracture
Fall on an outstretched hand -> Hyperextension injury
48
Types of supracondylar # based on displacement
1. Extension type (M/C): Post displacement d/t pull of triceps 2. Flexion type: Ant displacement (Rare)
49
Gartland classification of Supracondylar #
Type I: Undisplaced (Fracture line may not be visible); Sail/fat pad sign Type II: 1. Ant cortex: Breached 2. Post cortex: Intact (Incomplete fracture) Type III: Displaced complete fracture; Fish tail sign
50
What is Fat pad/Sail sign?
Hematoma around fracture pushes away fat -> Sail shaped lucency around supracondylar area
51
What is Baumann’s angle?
Angle to determine adequate fracture reduction
52
What is Dunlop traction used for?
For temporary stabilisation of fracture
53
Management of Supracondylar #
Undisplaced #: Conservative Displaced #: Surgery
54
Early complications of Supracondylar #
Neurovascular: 1. Vessel injury: M/C -> Brachial artery > Compartment syndrome > Volkmann Ischemic contracture 2. Nerve injury: M/C -> Ant interosseous > Median > Radial
55
Late complications of Supracondylar #
1. Malunion (M/C) -> Cubitus virus/gunstock deformity (Dec in carrying angle) 2. Myositis ossificans
56
Most imp sign in Compartment syndrome
Pain on passive stretch
57
Clinical features of Compartment Syndrome Just study
1. Pain on passive stretch 2. Puffiness (Swelling) 3. Pallor 4. Paraesthesia 5. Paralysis (Late sign) 6. Pulselessness (Very late sign)
58
Investigation of Compartment syndrome
Compartment pressure using manometer (Useful in unconscious patient) Normal: <10 mmHg Compartment syndrome: >30 mmHg
59
Treatment of Compartment syndrome
Immediate removal of dressing/cast -> Fasciotomy (If no symptomatic improvement)
60
What is Fasciotomy?
Longitudinal incisions on superficial and deep compartments Wound left open till pressure falls
61
What is Volkmann’s Ischemic Contracture?
Untreated compartment surgery can lead to fibrosis of forearm muscles (D/t Ischemia)
62
Treatment of Volkmann’s Ischemic Contracture
Mild: Turn buckle splint (Passive stretching) Moderate: Max page (muscle sliding) operation Severe: Bone shortening
63
What is Gunstock/cubitus varus deformity?
Happens d/t malunion of supracondylar # D/t medial tilt + internal rotation of distal fragment
64
Treatment of Gunstock/cubitus varus deformity
Modified French osteotomy
65
Pathogenesis of Myositis Ossificans
Massage of fracture -> Fracture Hematoma dislodges -> Settles inside muscle -> Bone forms inside muscle -> Restriction of movement
66
M/C muscle involved in Myositis Ossificans
Brachialis
67
What happens in Olecranon fracture?
Fracture fragment gets pulled by triceps
68
Treatment of Olecranon fracture
Tension band wiring with K-wire
69
What is Elbow dislocation?
Ulno-humerus dislocation
70
M/C type of Elbow dislocation
Posterior/posterolateral
71
M/C nerve injured in Elbow dislocation
Ulnar nerve
72
Mechanism of injury in Pulled elbow
In children <5 years: Unossified smaller radial head in larger annular ligament -> Axial traction of extended and pronated elbow -> Radial head pulled out of annular ligament
73
Attitude of limb in Pulled elbow
Extended elbow and pronated forearm
74
Treatment of Pulled elbow
Self limiting If painful: 1. Flex elbow and forcefully supinate forearm 2. Hyperpronation (Not recommended)
75
Terrible (Hotchkiss) triad of elbow
1. Post elbow dislocation 2. Coronoid fracture 3. Radial head fracture
76
What is Monteggia fracture?
Fracture of upper 1/3rd ulna + Proximal RUJ disruption (Radial head dislocation)
77
BADO classification of Monteggia fracture
Based on Radial head dislocation: Type I: Anteriorly Type II: Posteriorly Type III: Laterally Type IV: Anteriorly + fracture of radius
78
Complication of Monteggia fracture
M/C injured nerve: Post interosseous nerve (Branch of Radial nerve)
79
What is Galeazzi/Reverse Monteggia/Piedmont fracture?
Fracture of Radius + DRUJ disruption/TFCC injury
80
What is Piano Key sign in Galeazzi fracture?
Ulna lifted distally -> Goes down when pressed upon
81
Types of Wrist fractures
1. Colle’s # 2. Smith’s # 3. Chauffeur’s #
82
Extra articular wrist fractures
Colle’s and Smith’s fracture
83
Intra articular fracture of wrist
Chauffeur’s fracture
84
What is Colle’s fracture?
Fracture of distal end of radius at corticosteroid-cancellous junction Distal fragment displaced dorsally (Away from thumb)
85
Displacements of Colle’s fracture
Mnemonic: DILS 1. Dorsal tilt/shift 2. Lateral tilt/shift 3. Impaction (Causes dinner fork deformity) 4. Supination
86
Treatment of Colle’s fracture
1. Colle’s/Hand shaking cast (Conservative) 2. Surgery
87
What is Colle’s cast?
Below elbow cast Position: Pronation, Ulnar deviation, Palmar flexion of wrist
88
Complications of Colle’s fracture
1. Malunion: Dinner fork deformity 2. Sudeck’s dystrophy/complex regional pain syndrome/reflex sympathetic dystrophy fracture 3. Rupture of extensor pollicis longus tendon 4. Carpal tunnel syndrome: Median nerve compression 5. Non union (Rare)
89
What is seen in Sudeck’s dystrophy?
Tense swelling Shiny skin Tingling and numbness Paraesthesia Anhidrosis (Kind of like tightening of skin)
90
What is Smith’s fracture?
Extra-articular # of distal end of radius with volar displacement Garden spade deformity
91
Mechanism of injury in Smith’s fracture
Fall on an outstretched hand with wrist in flexion
92
What is Chauffeur’s fracture?
AKA Hutchinson’s/Backfire fracture Isolated radial styloid fracture
93
Mnemonic of Carpal bones Just study
She Looks Too Pretty, Try To Catch Her Scaphoid: M/C fracture Lunate: M/C dislocated Triquetrum Pisiform: Smallest Trapezium Trapezoid Capitate: Largest Hamate
94
M/C site of Scaphoid fracture
Waist of Scaphoid Other 2 parts: Tubercle and Proximal pole Age group: Young adults
95
Mechanism of injury in Scaphoid fracture
Fall on an outstretched hand
96
Clinical feature of Scaphoid #
Pain/swelling in anatomical snuff box
97
Investigation of Scaphoid fracture
1. X ray: > Oblique view (Best) > AP (Not visible) > Lateral (Not visible) 2. MRI: For fractures not visible on X ray
98
Complications of Scaphoid fracture
1. Non union (M/C) 2. Avascular necrosis of proximal pole of Scaphoid
99
Treatment of Scaphoid fracture
Undisplaced fracture: POP applied in glass holding position Displaced fracture: ORIF + with Herbert screw
100
What is Scapho-lunate ligament injury?
Ligament injury -> Scapho-lunate dissociation Terry Thomas sign
101
What is Base of 1st metacarpal #?
Intra-articular fracture of trapezio-metacarpal joint Displacing forces: Abductor pollicis longus (APL) pull
102
Types of Base of 1st metacarpal #?
1. Bennet’s fracture 2. Rolando’s fracture
103
What is Bennet’s fracture?
Partial displaced fracture
104
What is Rolando’s fracture?
Complete comminuted (T/Y shaped) fracture with no displacement
105
What is Boxer’s fracture?
Fracture of 5th metacarpal
106
Difference b/w Mallet’s and Jersey finger
Mallet’s finger: D/t hyperflexion injury Jersey finger: D/t hyperextension injury
107
Mechanism of injury of Mallet finger
Hyperflexion injury -> Injury to extensor digitorum communis tendon (Tear/avulsed) -> Flexion of DIP
108
Mechanism of injury of Jersey finger
Hyperextension injury -> Injury to FDP tendon (Tear/avulsed) -> Extension at DIP
109
Mallet finger on examination
Extension at DIP: 1. Passively + 2. Actively - (Needs support to extend)
110
Jersey finger on examination
Flexion at DIP: 1. Passively + 2. Actively - (Needs support to flex)
111
Treatment of Mallet finger
Mallet/Stax splint

Orthopaedics (12 decks)

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