CME rapid Fire xrays Upper limb xrays.pdf

Rapid fire

1. Upper limb fracture
-QnA+ rapid firing
series 1 (adult)
TanCC

2. Question 1
•What are the common types of FOOSH injury?
a)Collarbone (clavicle) fracture
b)Distal radius fracture
c)Radial or ulnar styloid fracture
d)Radial head fracture
e)Hook of hamate fracture
f)Scaphoid fracture
T,T,T,T,T

3. Question 2
Describe the x-ray, indication for referral/ operation?
What is the risk factor for non union?

4. Question 3
Regarding clavicle fracture
a)Fractures of the middle third of the clavicle are most common
b)Proximal third clavicle fractures are often high-mechanism
injuries and can be associated with intrathoracic trauma
c)In type I distal clavicle fracture, the coracoclavicular ligament
intact
d)In type II distal clavicle fracture, an downward displacement of
the proximal aspect of clavicle
e)Type III distal clavicle fractures are extra-articular fracture
T,T,T,F,F

6. Question 4
Describe the fracture
Complication?

10. Holstein–Lewis fracture
a spiral fracture of the distal one-
thirdof the humeral shaft
commonly associated with
neuropraxia of the radial nerve
(22% incidence)

11. Question 5

13. Q6: Classified distal radius fractures according to eponyms and
synonyms, which required operation?

18. Q7 Identify the pathology
MCQ
A.Anterior fat pad (which is intra-articular and intrasynovial)
B.Posterior fat pad sign can be normal
C.Usual present in supracondylar fracture in paeds
D.Uncommon in adult, especially in radial head fracture
E.If present, fracture cannot be rule out
F,F,T,F,T

24. Q8 In radial head injury
MCQ
a.Intra-articular injury
b.Medial collateral ligament is most commonly injured (up to 80% on
MRI)
c.Associated with posterior interosseous nerve injury
d.Terrible triad (olecranon fracture, radial head fracture, coronoid
fracture)
e.Essex-Loprestiinjury (radial head fracture + proximal radioulnar joint
(PRUJ) + interosseous membrane injury)
T, F, T, F, F

29. Type of instability occurs with an Essex-
Loprestiinjury of the elbow
•loss oflongitudinal stabilityoccurs with
Essex-Loprestiinjury pattern
•radial head fracture+DRUJ
injury+interosseous membrane
disruption
•radial head must be fixed or replaced to
restore stability, preventing proximal
migration of the radius and ulnocarpal
impaction

30. Distal Radial Ulnar Joint (DRUJ) Injuries
A: AP showswidening of the DRUJ
B: lateral showsdorsal displacement
primary stabilizers:
volar and dorsal radioulnar ligaments

31. Symptoms:
-pain and instabilitywith acute DRUJ dislocation
> associated with open distal radius fractures
-dorsal wrist pain andlimitedpronosupinationwith post-traumatic arthritis
Examination:
-post-traumatic arthritis
-snapping and crepitus
-proximal rotation of the forearm with compression of the ulna against the
radius elicits pain
decreased grip strength
Associated conditions:
-ulnar styloid and distal ulna fractures
-TFCC tears
-ulnar impaction syndrome
-Essex-Loprestiinjuries
-Galeazzi fractures
Piano-key Sign Test
specificity of 0.96 and a sensitivity of 0.59
https://youtu.be/KuFEaWj1Nso

33. Disruption -indicates carpal subluxation or dislocation

35. Q9: A 20 years old man fall in outstretch hand with dorsiflexion
and complain pain over radial aspect of left wrist.
What is the suspected fracture? What examination can assist
in your diagnosis?

36. https://www.youtube.com/watch?v=LCrq3wt_TVk
87-100% sensitivity and 74% specificity

38. Q10: for scaphoid #
a.Scaphoid Fractures are the most common carpal bone
fracture
b.> 60% of scaphoid bone is covered by articular cartilage
c.Transverse fracture patterns are considered more stable than
vertically or obliquely oriented fractures
d.SNAC (Scaphoid NonunionAdvanced Collapse) is an early
complication
e.major blood supply is superficial palmar arch (branch of volar radial
artery)
T,T,T,F,F

43. Q11
What is the percentage union rate with cast immobilization in
minimally displaced scaphoid waist fractures?
List 4 risk factors for scaphoid non-union
-vertical oblique fracture pattern,
-displacement >1mm,
-advancing age,
-nicotine use
-scaphoid fractures with<1mm displacement haveunion rate of 90%

44. Q12

45. What is the sign?

49. Q13: A golfer complain of wrist acute pain after
striking a ball.
Further examination noted pain over hypothenar
eminence.
You order a AP, scaphoid, lateral view
What is the suspected fracture?

51. Guyon Canal Syndrome

55. QUESTION 14
Perilunatedislocationnormal Lunate dislocation

57. Perilunate/ lunate dislocation
Symptoms:Patients can sometimes have unremarkable or subtle exams.
Tenderness to palpation or swelling on the volar aspect of the wrist.
Diagnostic Imaging:
•Disruption of Gilula’sarcs on AP.
•The lunate may appear as a “piece of the pie
•Perilunatedislocation: The lunate is in line with radius but the capitate appears
dislocated.
•Lunate dislocation: Capitate and radius are in line, the lunate is not (spilled teacup)
Treatment:
•Check for sensation and function of the median nerve.
•Reduce with longitudinal traction and wrist extension.
•Apply pressure on the volar aspect of the wrist in dorsal direction with flexion.
•Place in sugar tong and arrange for 1-2 day follow-up if reduction is successful.

58. Q extra: What is the sequence of events that
occur in a lunate dislocation?
a.scapholunate ligament disrupted -->
b.disruption of capitolunatearticulation -->
c.disruption of lunotriquetral articulation -->
d.failure of dorsal radiocarpal ligament -->
e.lunate rotates and dislocates,usually into carpal tunnel

59. QUESTION 15
A 30 years old man, complaint of left thumb pain after fell down at home
Describe the X-ray.
What is the mechanism of injury?
How would you manage this patient?

60. BENNETT FRACTURE
•Intra-articularfracture/dislocation of base of 1st metacarpal
characterized by volarlip of metacarpal based attached to anterior
oblique ligament
•ligament holds this fragment in place
•small fragment of 1st metacarpal continues to articulate with trapezium

61. BENNETT FRACTURE
Pathoanatomy
•lateral retraction of distal 1st
metacarpal shaft byAPL and
adductor pollicis
•shaft pulled into adduction (AP)
•metacarpal base supinated(APL)

62. BENNETT FRACTURE

63. BENNETT FRACTURE

64. QUESTION 16
•What is Rolando fracture?

65. ROLANDO FRACTURE

66. QUESTION 17
Reverse Bennett fracture
-fracture-dislocation of the base of the 5
th
metacarpal
bone.
-pathologically and radiographically analogous to
theBennett fractureof the thumb.
-unstable due to unopposedextensor carpiulnarispull
on the fracture fragment, which causes migration and
subluxation of the fragment.
-It is the most common base of metacarpal fracture

67. Q 18
•22 year old p/w pain over right hand, he was in an argument and due
to his frustration he punched the wall with a closed fist
•o/e swelling on the dorsum of the hand with tenderness to palpation
on the dorsal metacarpal joint of the 5th digit of the right hand
•tenderness upon palpation on the volar surface of that region with
evidence of ecchymosis. Neurovascular status of the hand is intact
•Treatment?
•Complication
Boxer fracture
Non-operative: splinting vs closed reduction (pseudo-clawing (MCP joint
hyperextension and PIP joint flexion); significant angulation of the 5th metacarpal #
Opertive: surgical intervention: open metacarpal neck #, neurovascular impairment
Joint stiffness (most common)

70. Q19: Described the injury and associated injury