surg : ortho upperlimb

What is the most common mechanism of clavicle fracture?

Fall on the outstretched hand (less commonly direct blow or fall on the point of the shoulder)

Age of fracture clavicle

Children less than 10 years

How does a patient typically present with clavicle fracture?

Supports elbow with opposite hand, head tilted to affected side (like "mother suckling her child")

What does an X-ray show in clavicle fractures?

Displacement of the fracture

Why is fracture reduction not attempted in clavicle fractures?

Because reduction cannot be maintained even if achieved

What is the usual treatment for clavicle fracture?

Broad arm sling or figure-of-eight bandage for 3 weeks

What are the complications of clavicle fracture?

Malunion (common, not significant), Non-union (rare), Injury to subclavian vessels or brachial plexus, Costo-clavicular syndrome, Pleural or lung apex injury, Shoulder stiffness in elderly

Why is the shoulder joint prone to dislocation?

Shallow glenoid cavity, wide humeral head, weak ligaments/muscles, lax capsule, wide ROM

What are the types of shoulder dislocation?

Anterior (commonest), posterior, inferior (luxatio erecta)

What is the mechanism of anterior shoulder dislocation?

Fall on outstretched hand with arm abducted

What is the commonest position of anterior dislocation?

Subcoracoid

What is luxatio erecta?

Rare inferior dislocation when humeral head stays in infraglenoid position with full abduction

What are the clinical features of anterior dislocation?

Flattened shoulder, head felt in subcoracoid region, arm in slight abduction with loss of movement

What X-ray views are used in shoulder dislocation?

Anteroposterior and lateral views

How is anterior shoulder dislocation treated?

Urgent closed reduction under GA/sedation using traction-counter traction or Stimson's method

What are the complications of anterior dislocation?

Axillary nerve injury, supraspinatus avulsion, greater tuberosity/neck fracture, recurrent dislocation

How does recurrent dislocation present?

Repeats easily with minor activity (e.g. combing hair), patient may self-reduce

What causes recurrent shoulder dislocation?

Detachment of labrum and anterior capsule from glenoid

What is the Bankart operation?

Reattachment of the labrum to anterior glenoid rim

What causes posterior shoulder dislocation?

Epileptic fit or electric shock

What is the usual mechanism of surgical neck fracture?

Fall on outstretched hand (common in adults/elderly)

What are the fracture types at surgical neck?

Impacted or unimpacted

What muscles cause displacement in unimpacted fractures?

Upper fragment abducted by supraspinatus, lower fragment adducted by pectoralis major

What nerve is commonly injured in surgical neck fractures?

Axillary nerve → deltoid paralysis, loss of sensation over badge area

How are surgical neck fractures treated?

Impacted: arm sling; Unimpacted: closed reduction + pinning; Displaced: ORIF (plate and screws)

What are the causes of humeral shaft fracture?

Direct trauma or fall on outstretched hand

What types of fractures can affect the shaft of the humerus?

Transverse, oblique, comminuted, or segmental

What are the common complications of humeral shaft fractures?

Radial nerve injury, delayed union, non-union

What is the conservative treatment for humeral shaft fracture?

U-shaped plaster slab from acromion to elbow, then up to axilla

When is surgical fixation used in humeral shaft fracture?

ORIF with plate/screws or intramedullary nail if displaced or unstable

What age group commonly gets supracondylar fractures?

Children

Where exactly does a supracondylar fracture occur?

Just above the condyles of the humerus

Why is it considered a serious injury?

Risk of brachial artery injury

What are the types of supracondylar fractures?

Extension type (>90%) and Flexion type (<10%)

Mechanism of injury in extension type?

Fall on the outstretched hand → distal fragment displaced upward & backward

Mechanism of injury in flexion type?

Fall on the elbow tip → distal fragment displaced forward & upward

What clinical signs suggest supracondylar fracture?

Severe elbow pain/swelling, limited movements, step deformity, normal 3-point bony relationship, signs of neurovascular injury

How are supracondylar fractures diagnosed radiologically?

X-rays: AP and Lateral views

How is extension-type supracondylar fracture treated?

Closed reduction under GA, K-wire fixation, posterior plaster slab for 3-4 weeks, monitor radial pulse

What is the most common elbow dislocation?

Posterior dislocation

Mechanism of injury in posterior elbow dislocation?

Fall on the outstretched hand

What happens pathologically in posterior dislocation?

Radius & ulna displaced posterolaterally, anterior capsule torn, brachialis bruised

Clinical signs of posterior elbow dislocation?

Prominent olecranon, disrupted 3-point relationship, complete loss of motion

How is posterior elbow dislocation treated?

Traction + forward pressure on olecranon, posterior slab with elbow in 90° flexion

What is the complication of medial condyle fracture?

Ulnar nerve paralysis

What causes anterior elbow dislocation?

Rare, direct trauma

What is the mechanism of medial condyle fracture?

Fall on the outstretched hand

What is the mechanism and complication of lateral condyle fracture?

Fall on outstretched hand → complication: cubitus valgus & delayed ulnar neuritis

Treatment of lateral condyle fracture?

Reduction and internal fixation

Cause of radial head fracture?

Fall on outstretched hand

Clinical signs of radial head fracture?

Local pain, tenderness at radial head, limited pronation/supination

Treatment of radial head fractures?

Single fragment: fixation; Comminuted: excision

Causes of olecranon fracture?

Fall on elbow, direct trauma, sudden triceps contraction

Clinical signs of olecranon fracture?

Pain, bruising, palpable gap, inability to extend elbow

Treatment of olecranon fracture?

Internal fixation with wiring or lag screw

What causes vascular injury in elbow trauma?

Brachial artery damage → ischemia of forearm/hand

Which nerves may be injured in elbow fracture complication?

Median (esp. anterior interosseous), ulnar, radial

What is cubitus varus/valgus?

Malunion deformities after supracondylar fractures

What is Volkmann's ischemic contracture?

Fibrosis/shortening of forearm flexors due to ischemia → claw hand

Causes of Volkmann's contracture?

Tight plaster, compartment syndrome

Clinical signs of Volkmann's contracture?

Claw hand, weak grip, fixed length phenomenon

Differential diagnoses of claw hand?

Volkmann's contracture, combined median & ulnar nerve injury, Klumpke's palsy, RA, syringomyelia, poliomyelitis

How is Volkmann's contracture treated?

Early: physio/stretching/splint; Late: muscle slide surgery

What is myositis ossificans?

Post-traumatic bone formation in soft tissue due to hematoma + osteoblast invasion

Treatment of myositis ossificans?

Avoid massage; excise after 6 months if severe

Causes of elbow stiffness?

Immobilization, intra-articular fractures, myositis ossificans

Which elbow fractures are prone to non-union?

Olecranon, radial head, condylar/epicondylar

What is delayed ulnar nerve palsy and its cause?

Seen in lateral condyle non-union → progressive cubitus valgus + ulnar neuritis

What causes post-traumatic osteoarthritis of the elbow?

Improper reduction of intra-articular fractures

What is a Colles' fracture?

Fracture of the distal radius within 1 inch from wrist

Who commonly gets Colles' fracture?

Females >50 years old (osteoporosis)

What are the common pathological displacements in Colles' fracture?

Posterior displacement/tilt, upward displacement & impaction, lateral displacement, supination, ulnar styloid fracture

What is the classic deformity in Colles' fracture?

Dinner-fork deformity

What clinical features are seen in Colles' fracture?

Pain over distal radius, radial styloid elevated to ulnar styloid level, no crepitus in impacted fractures

How is Colles' fracture reduced?

Traction along axis to disimpact, palmar flexion + anterior pressure, ulnar pressure

What is the method of fixation for Colles' fracture?

Below elbow plaster cast for 6 weeks

What is recommended in aftercare of Colles' fracture?

Early finger mobilization and treat osteoporosis

Why is malunion common in Colles' fracture?

Posterior cortex comminution → redisplacement; plaster does not control supination

What are the complications of Colles' fracture?

Malunion, wrist/shoulder/finger stiffness, EPL tendon rupture, carpal tunnel syndrome, Sudeck's atrophy

What are features of Sudeck's atrophy?

Severe burning pain/swelling, muscle atrophy, stiffness, osteoporosis of carpal bones

What is a Smith's fracture?

Reverse of Colles' fracture with anterior displacement

What causes Smith's fracture?

Fall on dorsum of the hand

What is the deformity seen in Smith's fracture?

Garden-spade deformity

How is Smith's fracture treated?

Reduction + above elbow cast 6 weeks or internal fixation

What is the mechanism of injury in scaphoid fracture?

Fall on the outstretched hand

Why is scaphoid fracture at risk for complications?

Blood supply enters distal → proximal → risk of avascular necrosis of proximal fragment

What is a key clinical sign of scaphoid fracture?

Tenderness in anatomical snuffbox

How is a scaphoid fracture diagnosed?

Clinically, even if X-ray negative; repeat after 2 weeks or bone scan

How is a scaphoid fracture treated?

Long-arm thumb spica cast including thumb; immobilize until radiographic union

What are the complications of scaphoid fracture?

Avascular necrosis of proximal segment, non-union