Clinical Correlations & Surface Anatomy

Why is the clavicle the most commonly fractured bone?

Because it acts as the only bony connection between the upper limb and the axial skeleton, transmitting forces from the limb to the trunk.

Observe and label

Where do clavicle fractures most commonly occur?

At the junction of the medial two-thirds and lateral one-third.

Why does the medial fragment elevate after a clavicle fracture?

Because it is pulled superiorly by the sternocleidomastoid muscle.

Why does the lateral fragment drop after a clavicle fracture?

Because of the weight of the upper limb and the pull of gravity.

Match each fracture site with the nerve at risk:

• Surgical neck

• Radial groove

• Supracondylar

• Medial epicondyle

Fracture	Nerve
Surgical neck	Axillary
Radial groove	Radial
Supracondylar	Median
Medial epicondyle	Ulnar

Observe and label

Which fracture commonly injures the axillary nerve?

A fracture of the surgical neck of the humerus.

Which fracture commonly injures the radial nerve?

A fracture involving the radial groove.

Which fracture commonly injures the median nerve?

A supracondylar fracture.

Which fracture commonly injures the ulnar nerve?

A fracture of the medial epicondyle.

What is a Colles fracture?

A fracture of the distal radius, usually following a fall onto an outstretched hand.

Observe and label

What deformity is characteristic of a Colles fracture?

A dinner fork (silver fork) deformity.

Which additional injury commonly accompanies a Colles fracture?

An avulsion fracture of the ulnar styloid process.

Why is the radial styloid position important?

Normally it lies distal to the ulnar styloid.

Loss of this relationship suggests a Colles fracture.

Which carpal bone is most commonly fractured?

The scaphoid.

Observe and label

Where do most scaphoid fractures occur?

At the waist of the scaphoid.

Why can a scaphoid fracture lead to avascular necrosis?

Because the proximal fragment has a poor retrograde blood supply.

Why can early X-rays appear normal in a scaphoid fracture?

The fracture line may only become visible after 10–14 days due to bone resorption.

Which carpal bone contains a hook?

The hamate.

Which structures are at risk in a hook of hamate fracture?

• Ulnar nerve

• Ulnar artery

Which bony landmark forms the point of the shoulder?

The acromion.

Which humeral landmark can be palpated just inferior to the acromion?

The greater tubercle.

Which two distal forearm landmarks are easily palpable?

• Radial styloid

• Ulnar styloid

Which carpal bone is easily palpated on the medial side of the wrist?

The pisiform.

Which projection of the hamate can be palpated clinically?

The hook of the hamate.

Which tendon lies within the intertubercular sulcus?

The tendon of the long head of biceps brachii.

Match the landmark with its clinical significance:

• Clavicle

• Surgical neck

• Radial groove

• Medial epicondyle

• Scaphoid

• Radial styloid

• Hook of hamate

Landmark	Clinical relevance
Clavicle	Most commonly fractured bone
Surgical neck	Axillary nerve injury
Radial groove	Radial nerve injury
Medial epicondyle	Ulnar nerve injury
Scaphoid	Avascular necrosis risk
Radial styloid	Landmark altered in Colles fracture
Hook of hamate	Ulnar nerve and artery injury

Which fractures are associated with each nerve?

• Axillary

• Radial

• Median

• Ulnar

Nerve	Associated fracture
Axillary	Surgical neck
Radial	Radial groove
Median	Supracondylar
Ulnar	Medial epicondyle

Rapid Upper Limb Clinical Review (Condition - Key fact):

• Clavicle fracture

• Surgical neck fracture

• Radial groove fracture

• Supracondylar fracture

• Medial epicondyle fracture

• Colles fracture

• Scaphoid fracture

• Hook of hamate fracture

Condition	Key fact
Clavicle fracture	Most common fracture at junction of medial 2/3 and lateral 1/3
Surgical neck fracture	Axillary nerve injury
Radial groove fracture	Radial nerve injury
Supracondylar fracture	Median nerve injury
Medial epicondyle fracture	Ulnar nerve injury
Colles fracture	Distal radius + dinner fork deformity
Scaphoid fracture	Waist fracture → avascular necrosis risk
Hook of hamate fracture	Ulnar nerve & artery injury

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