M3-UPPER EXTREMITIES

BASEBALL/MALLET FINGER

DESC: a dorsal intra-articular avulsion fracture at the base of the distal phalanx. The injured fingers look deformed and have soft tissue swelling associated with them

ETI: The mechanism of injury (MOI) is a forcible flexion of an extended finger.

TREAT: Most injuries of this type can be treated non-surgically, with a splint to immobilize the fracture.

COMP: Deformity of the bone if not treated. Decreased range of movement of the finger.

BOXER’S FRACTURE

DESC: fracture that occurs at the neck of the 5th metacarpal, sometimes the 4th metacarpal is affected.

ETI: The mechanism of injury (MOI) is an impact with a closed fist.

TREAT: Surgical interventions with “K-wires” are common. Depending on the fracture, immobilization with a cast can be used.

COMP: Bone deformity resulting in a rotational deformity of the phalanx.

BENNETT’S FRACTURE

DESC: oblique intra-articular fracture of the base of the first metacarpal.

ETI: The mechanism of injury (MOI) can be a direct impact along the long axis and hyperextension or abduction of the thumb or axial force applied directly to the metacarpal as in a fist fight.

TREAT: Reduction and fixation. Pins or K-wires are usually used.

COMP: Decreased range of motion of the joint with pain and early onset of arthritis.

LUNATE DISLOCATION

DESC: loss of articulation with both the capitate and the radius, a spilled "teacup" effect

ETI: The mechanism of injury for lunate dislocations is forceful dorsiflexion of the wrist, for example on a FOOSH.

TREAT: Reduction and immobilization is required. Surgical intervention is often needed to stabilize the carpal bones to promote healing.

COMP: Arthritis and instability of the wrist

SCAPHOID FRACTURE

DESC: Swelling and tenderness are common to the ‘snuff box’ area (base of the first metacarpal).  It is the most common carpal bone to fracture

ETI: The mechanism of injury is a FOOSH (Fall On Out-Stretched Hand) or a direct blow to the area.

TREAT: treated by immobilizing wrist area with a cast

COMP: can take up to 2 years to heal. If not identified early, avascular necrosis

COLLE’S FRACTURE

DESC: This type of fracture of the distal radius is within 3-5 cm from the wrist joint with dorsal displacement of the distal fragment

ETI: The mechanism of injury is a FOOSH (Fall On Out Stretched Hand) with the wrist hyperextended, or in dorsiflexion.

TREAT: Reduction (putting it back into correct alignment and apposition) and immobilization is required

COMP: Complex regional pain syndrome, deformity of the bone with loss of range of motion, weak grip, or nerve compression.

SMITH’S FRACTURE

DESC: The distal radial fragment is displaced anteriorly.

ETI: The mechanism of injury is a force applied to the posterior aspect of the wrist that causes palmar (anterior) displacement of the distal fragment.

TREAT: Reduction and immobilization of the fracture.

COMP: A weak grip, ongoing pain, deformity of bone and resulting reduction in the range of motion

GALEAZZI FRACTURE

DESC: type of fracture dislocation. It involves a fracture of the distal one third (or middle third) of the radius along with a dislocation or subluxation of the radioulnar joint.

ETI: Blunt trauma to the arm usually by falling on an outstretched hand with the forearm in pronation

TREAT: Surgical fixation with reduction of fracture and stabilization of radioulnar joint.

COMP: There is an increased risk of compartment syndrome with severe fractures. Nonunion or malunion are also possible complications

MONTEGGIA FRACTURE

DESC: fracture of the ulnar shaft with anterior dislocation of the radial head. 

ETI: The mechanism of injury is a fall on outstretched hand with the forearm in pronation.

TREAT: Reduction and immobilization.

COMP: Deformity and angulation of the bone. Non-union of the ulnar shaft. Radioulnar synostosis. Compartment syndrome.

RADIAL HEAD FRACTURE

DESC: difficult to diagnose. Patients usually have pain and swelling at the injury site.

ETI: The mechanism of injury is a Fall On Outstretched Hand

TREAT: Simple fractures are usually splinted or casted. Surgical interventions may be required for severe cases.

COMP: Stiffness and loss of mobility of the joint. Early intervention for range of motion (ROM) is encouraged to avoid these symptoms.

OLECRANON FRACTURE

DESC: the triceps muscle separates the fragment from the ulna

ETI: The mechanism of injury is a fall onto a moderately flexed elbow.

TREAT: Surgical intervention is often required.

COMP: Ongoing pain and loss of full extension of the elbow. Non-union of fragments.

ELBOW DISLOCATION

DESC: usually rupture the capsule and ligaments surrounding the elbow.  Associated fractures with posterior elbow dislocations most often involve the coronoid process of the ulna

ETI: The mechanism of injury is a fall onto an extended elbow

TREAT: Reduction and immobilization for 10-14 days.  Surgical intervention is necessary for dislocations with associated fractures of the elbow

COMP: Decreased range of motion of the elbow joint.  The possibility of recurrent dislocations due to weakened ligaments.

ELBOW JOINT FRACTURE

DESC: The fat pad around a normal elbow joint is not visible. Any trauma to the elbow joint results in a joint effusion which displaces the fat pad.

ETI: The mechanism of the injury is a trauma to the elbow joint.

TREAT: Fracture has to be stabilized.

COMP: all the complications of a fracture can occur.

HUMERUS FRACTURE

DESC: There is a high incidence of metastatic involvement leading to pathological fractures

ETI: The mechanism of injury usually is a trauma to the bone by falling or a direct impact as in a motor vehicle accident

TREAT: Reduction and immobilization of the fracture. Surgical intervention may be necessary to stabilize the fragments.

COMP: Deformity

PROXIMAL HUMERUS FRACTURE

DESC: prone to avulsion fractures due to the numerous ligaments and muscles attached to the humeral head

ETI: In the under-twenty age group, epiphyseal separations are the most common injury.  In the over-twenty age group, fractures are caused by severe trauma.  For those sixty years of age and older, injuries are often due to the presence of osteoporosis.

TREAT: Reduction and immobilization. Surgical intervention may be required if the fracture is severe.

COMP: Arthritis. Recurrent dislocations.

ANTERIOR SHOULDER DISLOCATIONS

DESC: one where the humeral head lies anteriorly to the scapula.

ETI: he mechanism of injury is a force that is applied to the arm when there is an external arm rotation and abduction.

TREAT: Reduction of the injured shoulder.

COMP: Hill Sachs lesion. This lesion occurs when the humeral head sustains a fracture during an anterior dislocation

POSTERIOR SHOULDER DISLOCATION

DESC: rare because of the structure of the shoulder.

ETI: The mechanism of injury is an axial loading of an extended arm with internal rotation.

TREAT: Reduction of the dislocation

COMP: Recurrent posterior subluxation. Hill Sach's lesions.

ACROMIOCLAVICULAR JOINT

DESC: has a complex soft tissue support system. The normal joint space is 3 to 7 mm

ETI: The mechanism of injury usually is a trauma such as a fall onto the shoulder

TREAT: Immobilization of the shoulder with a sling. Surgical intervention may be required for more severe injuries.

COMP: Degenerative changes and arthritis to joint. Ongoing pain with decreased range of movement.

CLAVICLE FRACTURE

DESC: the sternocleidomastoid muscle retracts the medial fragment in a superior direction while the weight of the upper limb pulls the distal fragment in a downward direction

ETI: The mechanism of injury in most cases is a FOOSH.

TREAT: Reduction and immobilization is difficult to maintain due to the pull of the sternocleidomastoid muscles.

COMP: Some malunion is common in clavicular fractures. Healing occurs rapidly.