Orthopaedics
Upper Limb Fractures
Upper limb fractures for MBBS and NEET-PG: clavicle, humerus, supracondylar, Colles, Smith, Monteggia and Galeazzi injuries with nerves at risk, mapped to NMC codes OR2.1 to OR2.6.
MedNext Academy | 3 min read
Upper Limb Fractures
Upper limb fractures for MBBS and NEET-PG: clavicle, humerus, supracondylar, Colles, Smith, Monteggia and Galeazzi injuries with nerves at risk, mapped to NMC codes OR2.1 to OR2.6.
This chapter covers the common fractures and dislocations of the shoulder girdle, arm, forearm, wrist and hand. It works through the mechanisms of injury, the classic deformities and eponyms, the nerves and vessels at risk, and the principles that decide between conservative and operative treatment.
High-yield: Upper Limb Fractures
- Most clavicle fractures occur at the junction of the middle and outer thirds and are managed conservatively with an arm sling.
- A surgical neck of humerus fracture threatens the axillary nerve, tested over the regimental badge area and by deltoid function.
- A midshaft humerus fracture endangers the radial nerve in the spiral groove and produces wrist drop.
- A supracondylar fracture of the humerus in children risks injury to the brachial artery and the median nerve, and Volkmann ischaemic contracture is the feared late complication.
- The Gartland classification grades paediatric supracondylar fractures and guides the need for reduction and pinning.
- A fall on the outstretched hand is the classic mechanism for scaphoid, distal radius and radial head fractures.
- A scaphoid fracture gives tenderness in the anatomical snuffbox and risks avascular necrosis and non-union because its blood supply enters distally.
- A Colles fracture is a distal radius fracture with dorsal displacement giving the dinner fork deformity, typically in an osteoporotic elderly woman after a fall.
- A Smith fracture is the reverse of a Colles, with volar displacement of the distal fragment.
- A Monteggia injury is a fracture of the proximal ulna with dislocation of the radial head.
- A Galeazzi injury is a fracture of the distal radius with dislocation of the distal radioulnar joint.
- A Bennett fracture is an intra-articular fracture-dislocation at the base of the first metacarpal.
- An elbow dislocation is usually posterior and must be checked for associated fracture and neurovascular injury before and after reduction.
- The three bony points of the elbow, the two epicondyles and the olecranon, form an equilateral triangle in flexion; a disturbed triangle suggests dislocation rather than a supracondylar fracture.
Named forearm and wrist injuries
- **Colles:** Distal radius, dorsal displacement, dinner fork deformity, elderly osteoporotic patient.
- **Smith:** Distal radius with volar displacement, the reverse of a Colles.
- **Monteggia:** Proximal ulna fracture with radial head dislocation.
- **Galeazzi:** Distal radius fracture with distal radioulnar joint dislocation.
NMC competencies in this chapter
- **OR2.1:** Fractures of the clavicle and around the shoulder
- **OR2.2:** Fractures of the humerus and associated nerve injuries
- **OR2.3:** Supracondylar fracture of the humerus and its complications
- **OR2.4:** Fractures around the elbow and forearm bones
- **OR2.5:** Fractures of the distal radius: Colles and Smith
- **OR2.6:** Fractures of the carpus, metacarpals and phalanges
Frequently Asked Questions
Which nerve is at risk in a midshaft humerus fracture?
The radial nerve, which runs in the spiral groove against the bone. Injury produces wrist drop with loss of extension at the wrist and fingers.
Why is a scaphoid fracture prone to non-union?
Its blood supply enters from the distal end and runs backwards, so a fracture across the waist can cut off the proximal pole, leading to avascular necrosis and non-union.
What is the difference between Colles and Smith fractures?
Both are distal radius fractures. A Colles has dorsal displacement and a dinner fork deformity, while a Smith has volar displacement and is the reverse pattern.
Why is a supracondylar fracture in children dangerous?
It can injure the brachial artery and median nerve, and untreated ischaemia can lead to Volkmann ischaemic contracture, a fixed flexion deformity of the forearm and hand.
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