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Upper limb fractures (Clavicle (Management (Conservative Broad arm sling,…

- - - - Conservative
        Collar and cuff sling
      - Surgery
        If displaced or fragmented, may need
        internal fixation or radial head excision
  - - - Pathophysiology
        Osteoporotic, post-menopausal women
        Fall on outstretched hand
        Distal fragment has dorsal angulation
        and displacement ('dinner fork' deformity)
      - Diagnosis
      - Management
        
        Conservative
        Immobilise in backslap plaster of paris
        
        Surgical
        If displaced, manipulation under anaesthesia
        IV regional (Bier's block), GA
      - Complications
        Median nerve damage (Carpal tunnel)
        Tendon rupture (extensor pollicis longus)
        Malunion/non-union
        Complex regional pain syndrome
        Wrist OA
    - - Diagnosis
      - Management
        
        Conservative
        Immobilise in backslab plaster of paris
        
        Surgery
        Reduction under anaesthesia
        May require internal fixation to prevent palmar
        migration of the distal fragment
      - Pathophysiology
        Fall onto a flexed wrist
        Distal radius fragment angled
        anteriorly/palmarly
        Unstable, distal fragment impacted
    - - Diagnosis
      - Management
        
        Conservative
        Blackslab plaster of paris and sling
        
        Surgical
        May need external fixation
      - Pathophysiology
        Intra-articular fractures
        Involves dorsal (Barton's) or volar
        (reverse Barton's) distal radius
        Fragment tend to slip (unstable)
- - - - Examination
        Tender anatomical snuffbox and dorsal/palmar scaphoid
        Pain on longitudinal pressing of the thumbor flexion
        and ulnar deviation of the wrist
      - X-radiograph
        Special scaphoid views (AP, lateral, L oblique)
        May not be visible - repeat 2wk
    - - Conservative
        Wrist splint
        Scaphoid plaster of paris or splint
  - - - Management
        Splint with neighbour strapping
    - - Pathophysiology
        Crush injuries, often open
      - Management
        If closed, trephine nail to relieve swelling; may need amputation
        Manage open fractures accordingly
    - - Pathophysiology
        Spiral/oblique often have a rotational deformity
      - Management
        Usually ORIF
  - - - Clinical presentation
        Deformity and swelling
      - Diagnosis
      - Pathophysiology
        Fall onto thumb or blow to closed fist
        Fracure through base f thumb and radial subluxation
        Small fragment left attached to trapezium
        Unstable
      - Management
        Undisplaced, POP
        Displaced, needs MUA/fixation
- - - - Conservative
        Sling
      - Surgery
        If open, pathological or complex
        or neurovascular involvement
  - - - Conservative
        Moajority of cases
        Splinting with a brace and sling
      - Surgery
        Nails, plates
  - - - Conservative
        Avoid flexing elbow >90 degrees
        Above elbow back slab plaster of parisand sling
      - Surgical
        If angulated, may need reduction under GA
        If displaced posteriorly, may need ORIF
- - - - Conservative
        Above elbow backslab
        plaster of Paris at 90 degrees
      - Surgery
        If displaced or joint involvement, ORIF
  - - - Conservative
        If undisplaced, above elbow plaster of paris
        elbow flexed to 90 degrees and forearm mid-supination
      - Surgical
        If displaced/angulated, ORIF
  - - - Diagnosis
      - Management
        Analgesia
        Immobilise in POP backslab
        Refer for ORIF
      - Pathophysiology
        Fracture radius and dislocation of
        distal radio-ulnar joint
    - - X-radiograph
      - Pathophysiology
        Fracture of ulnar with dislocation of
        proximal radial head
        Forced pronation of forearm (fall on pronated)
      - Management
        Analgesia
        Temporary immobilise backslab POP
        Refer for ORIF
    - - Clinical presentation
        Deformity, pain
      - Diagnosis
        Need full length images of both bones from elbow to wrist
      - Pathophysiology
        If one forearm bone fractures,
        often dislocation/fracture in other
        Often displaced and rotated
      - Management
        Analgesia and immobilisation
        ORIF