Upper-Extremity Fractures & Dislocations – Emergency Medicine Review

A comprehensive set of question-and-answer flashcards covering mechanisms, clinical features, imaging, classifications, management, and complications of upper-extremity fractures and dislocations commonly seen in emergency medicine.

What are the three most common sites of clavicular fracture?

Mid-shaft (69–85%), lateral third (12–28%), medial third (3–6%).

Name three common mechanisms that cause a clavicle fracture.

Fall on an outstretched hand, direct blow to the clavicle, birth trauma.

Which portion of the clavicle is the thinnest and lacks muscular/ligamentous attachment?

The mid-portion.

List four classic clinical features of a clavicle fracture.

Arm slumped inward/downward, swelling and tenderness, limited ROM, palpable crepitus or tenting.

What is the best initial imaging test for suspected clavicle fracture?

X-ray with AP and 45° cephalic tilt (dedicated clavicle series).

When is CT/MRI indicated for a clavicle fracture?

When associated injuries are suspected or plain radiographs are inconclusive.

Typical conservative treatment for most clavicle fractures involves what device and duration?

Simple shoulder sling for 4–6 weeks.

Give two indications for operative fixation of a mid-shaft clavicle fracture.

Excessive shortening >2 cm, comminuted or totally displaced fracture.

Which patient demographics most commonly sustain scapular fractures?

Patients involved in high-energy trauma; overall they are rare (0.4–0.9% of fractures).

Name the seven anatomic sites of scapular fracture (A-G).

A Body, B Glenoid rim, C Intra-articular glenoid, D Neck, E Acromion, F Spine, G Coracoid.

Most scapular fractures are treated how?

Conservatively with sling, ice, and analgesics.

Which associated injuries must be considered with scapular fracture?

Ipsilateral lung injury, rib fractures, thoracic cage trauma.

What percentage of shoulder dislocations are anterior?

Approximately 95%.

State two predisposing lesions that lead to recurrent anterior shoulder dislocation.

Bankart lesion (anteroinferior labrum tear) and Hill-Sachs lesion (posterolateral humeral head indentation).

Which radiographic view shows the ‘light-bulb sign’ and what does it indicate?

Axillary or scapular lateral view; diagnostic of posterior shoulder dislocation.

Describe the arm position typically seen in anterior shoulder dislocation.

External rotation with slight abduction; humeral head palpable below coracoid.

Name two common closed-reduction techniques for anterior shoulder dislocation.

Kocher’s maneuver, Stimson’s gravity method (10-15 lb weight).

Continuous monitoring of which nerve/artery is essential before and after shoulder reduction?

Axillary nerve and axillary artery.

List two late complications of shoulder dislocation.

Joint stiffness/osteoarthritis and chronic instability.

Which four anatomic parts define Neer’s classification of proximal humerus fractures?

Anatomic neck, surgical neck (shaft), greater tuberosity, lesser tuberosity.

Differentiate Neer one-part versus two-part fracture.

One-part: none displaced; Two-part: one part displaced, fracture line involves ≥2 parts.

Humeral shaft fractures are divided by location into which thirds?

Proximal, middle, and distal thirds.

Which nerve is at greatest risk in mid-shaft humeral fractures?

Radial nerve.

State two absolute indications for surgical management of a humeral shaft fracture.

Open fracture or displaced fracture that cannot be reduced.

What is the most common pediatric elbow fracture?

Supracondylar fracture of the distal humerus.

Gartland Type II supracondylar fracture description.

Angulated displacement with intact posterior cortex (partial cortical contact).

List three radiographic signs used to assess supracondylar fractures on lateral elbow X-ray.

Anterior humeral line, anterior/posterior fat pad sign, Baumann’s angle on AP.

Normal Baumann’s angle value and deformities if abnormal.

≈ 90°;

Early limb-threatening complication of supracondylar fracture.

Compartment syndrome or brachial artery injury.

Volkmann’s ischemic contracture is characterized by what three clinical findings?

Refusal to open hand, severe pain with passive finger extension, disproportionate forearm pain.

Which three nerves should always be documented in upper-limb neurovascular exams after injury?

Radial, median (including AIN), and ulnar nerves.

Mechanism of radial head fractures.

FOOSH with elbow extended and forearm pronated causing radial head impaction on capitellum.

Mason–Hotchkiss Type III radial head fracture management.

Operative—usually excision or ORIF because it is comminuted and displaced.

Most common age group and direction of elbow dislocation.

Young (10-20 yrs); posterior dislocation.

Name two fractures commonly associated with elbow dislocation.

Radial head fracture and coronoid process fracture.

Define Monteggia fracture-dislocation.

Fracture of proximal third ulna with dislocation of radial head at elbow.

What is the definitive treatment for Monteggia fractures?

Open reduction and internal fixation (ORIF) of the ulna; radial head usually reduces spontaneously.

Define Galeazzi fracture-dislocation.

Distal third radial shaft fracture with dislocation of distal radioulnar joint.

Standard management of Galeazzi injury.

ORIF of the radius and repair/stabilization of distal radioulnar joint.

Which forearm fractures can often be managed closed in children but require surgery in adults?

Diaphyseal fractures of radius and ulna.

Describe a Colles’ fracture deformity.

Dorsally angulated distal radius producing a ‘dinner-fork’ appearance.

Smith fracture is also known as what?

Reverse Colles—ventral (palmar) displacement of distal radius.

Classic clinical deformity seen in Smith fracture.

‘Garden spade’ deformity.

Which carpal bone is fractured most often?

Scaphoid.

Key physical finding indicating scaphoid fracture.

Tenderness in the anatomic snuffbox.

Initial emergency department management for suspected scaphoid fracture with normal X-ray.

Immobilize in short-arm thumb-spica splint and arrange follow-up imaging.

Why do scaphoid fractures frequently require surgical pinning?

Risk of non-union and avascular necrosis due to retrograde blood supply.

List three complications of humeral fractures.

Brachial artery injury, radial nerve palsy, avascular necrosis of humeral head.

What late complication can develop after shoulder immobilization called ‘frozen shoulder’?

Adhesive capsulitis.

Name two surgical fixation options for unstable mid-shaft clavicle fractures.

Tension band wiring and clavicular plate fixation.

Indications for open treatment of shoulder dislocation.

Failed closed reduction, fracture-dislocation, displaced Bankart lesion, recurrent instability.

Describe the Kocher maneuver sequence (four steps) for shoulder reduction.

Elbow flexed 90°, external rotation, adduction across chest, internal rotation.

Which imaging modality is most helpful to evaluate associated injuries of scapular fractures?

CT scan.

What defines a Type A distal humerus fracture in the AO classification?

Extra-articular fracture.

Which pediatric nerve injury is most common with supracondylar fractures?

Median nerve or its branch AIN.

Explain the fat pad sign in elbow radiographs.

Elevation of anterior/posterior fat pads indicating joint effusion, often occult fracture.

Preferred splint position after successful elbow dislocation reduction.

Long-arm posterior splint with elbow at 90° flexion.

What mechanism typically produces a posterior shoulder dislocation?

Uncoordinated muscle contraction as in seizure or electrical shock.

Describe the light-bulb sign.

Circular humeral head appearance on AP film due to internal rotation in posterior dislocation.

Which classification is used for comminution of humeral shaft fractures?

Type A (no comminution), B (butterfly fragment), C (comminuted).

Common conservative treatment for non-displaced humeral shaft fracture.

Hanging arm cast followed by functional brace.

Define a Type II Mason radial head fracture.

Displaced >2 mm or angulated; may act as mechanical block.

Primary stabilizing ligament preventing elbow valgus laxity often injured with radial head fractures.

Medial (ulnar) collateral ligament.

Explain the significance of the ulnar nerve in supracondylar injuries.

Late palsy may indicate mal-union (cubitus valgus) or nerve entrapment.

Which wrist fracture management involves closed reduction and casting for 4–6 weeks?

Colles’ fracture.

Indication for external fixation in humeral fractures.

Open fractures with soft-tissue damage or poly-trauma.

Give two associated injuries to screen for in clavicle fractures that extend medially.

Pneumothorax and vascular injury (subclavian).

Describe the Stimson gravity method for shoulder reduction.

Patient prone, arm hanging off table with 10-15 lb weight; gentle traction over 20–30 min.

What is the pathognomonic palpation finding in anterior shoulder dislocation?

Empty glenoid fossa with palpable humeral head inferior to coracoid.

Mechanism causing most distal radial fractures in elderly women.

Low-energy FOOSH on osteoporotic bone (Colles’).

Why are pediatric radial neck fractures more common than head fractures?

Cartilaginous head and thinner neck in children absorb force differently.

Most forearm fractures unite in what time frame?

8–12 weeks.

Describe the ‘dimple sign’ in supracondylar fractures.

Skin puckering due to proximal fragment piercing brachialis muscle; indicates severe displacement.

List three late complications of elbow trauma.

Stiffness, mal-union, post-traumatic arthritis.

What fracture should be suspected with pain over the anatomical snuffbox despite normal initial X-rays?

Occult scaphoid fracture.

Explain tension band wiring principle for bone fixation.

Converts tensile forces into compression at fracture site during muscle contraction.