Common Upper Limb Injuries in Adults Fraser J Gill August 2015

Hand injuries

Zones of Hand Be particularly wary of Zone II injuries – “No Mans Land”

Subungal Haematoma

Nail Avulsion Management Options?

Tuft Fracture Management determined by displacement and whether open or closed

Mallet Finger Bony vs Non-bony

Phalangeal fractures Consider rotation, displacement, articular involvement and potential instability

Dislocated Fingers Reduction usually uncomplicated Assess stability, splint and always re-x-ray!

Fractured neck of 5 th metacarpal – “Boxer’s” fracture Significant angulation (up to 70°) acceptable

Fracture of base of thumb metacarpal “Bennett’s fracture”

Fracture of base of thumb metacarpal “Rolando fracture”

Ulnar Collateral Ligament Tear

Common Carpal Injuries

Scaphoid Fractures

Risk of avascular necrosis in fractures involving waist or proximal pole

Lunate Dislocation

Perilunate Dislocation

Lunate vs Perilunate Dislocation

Triquetral Fracture

Common Injuries of Wrist and Forearm

Fracture of distal radius “Colles’ Fracture” – Dorsal angulation and displacement

Fracture of distal radius “Smith’s’ Fracture” – Volar/Palmar angulation and displacement

Radial Styloid Fracture “Hutchison’s” or “Cheuffeur’s” Fracture (note also fracture of ulnar styloid)

Intra-articular fracture of the volar/palmar aspect of distal radius “Barton’s Fracture”; there is also a less common dorsal variant

Fractured Shaft of Radius and Ulna

Isolated fracture of ulnar shaft “Nightstick” Fracture: Classically a defensive injury

Galeazzi Fracture-Dislocation Complex Fracture of radial shaft with associated dislocation of ulnar head

Common Injuries of the Elbow

Fractured radial neck

Fractured radial head

Fracture of olecranon process

Dislocation of Elbow Joint Most commonly posterior Associated fractures may be only be evident on post-reduction x-ray

Monteggia Fracture-Dislocation Complex Fracture of ulnar shaft with associated dislocation of radial head

Common Humeral Fractures

Distal Humerus Fractures Much less common in adults compared to children Brachial artery and median/ulnar nerves at risk

Humeral Shaft Fractures Transverse vs Spiral Radial nerve is at risk

Common Shoulder Injuries

Anterior Glenohumeral Dislocation

Posterior Glenohumeral Dislocation Consider axillary projections if in doubt

Inferior Glenohumeral Dislocation “Luxatio Erecta” - Rare

Fractured Surgical Neck of Humerus

Fracture of Greater Tuberosity

Fractured Glenoid

Scapular Fracture High energy injury

Acromiooclavicular Disruption

Acromioclavicular Disruption

Clavicle Fractures (spot the other diagnosis)

Rotator Cuff Tears

Questions?? Summary: Examine and document findings Joints above and below injury Neurovascular status Seek advice Senior ED medical staff Nurses ENPs Orthopaedic practitioners Specialty colleagues Radiographers Remember patient advice leaflets