Upper limb fractures
Colles' fracture
∑ Fall onto extended outstretched hands
∑ Described as a dinner fork type deformity
∑ Classical Colles' fractures have the following 3 features: Features of the injury
1. Transverse fracture of the radius
2. 1 inch proximal to the radio-carpal joint
3. Dorsal displacement and angulation
Smith's fracture (reverse Colles' fracture)
∑ Volar angulation of distal radius fragment (Garden spade deformity)
∑ Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
Bennett's fracture
∑ Intra-articular fracture of the first carpometacarpal joint
∑ Impact on flexed metacarpal, caused by fist fights
∑ X-ray: triangular fragment at ulnar base of metacarpal
Monteggia's fracture
∑ Dislocation of the proximal radioulnar joint in association with an ulna fracture
∑ Fall on outstretched hand with forced pronation
∑ Needs prompt diagnosis to avoid disability
Galeazzi fracture
∑ Radial shaft fracture with associated dislocation of the distal radioulnar joint
∑ Occur after a fall on the hand with a rotational force superimposed on it.
∑ On examination, there is bruising, swelling and tenderness over the lower end of the forearm.
∑ X Rays reveal the displaced fracture of the radius and a prominent ulnar head due to dislocation of the
inferior radio-ulnar joint.
Barton's fracture
∑ Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
∑ Fall onto extended and pronated wrist
Pott's fracture
∑ Bimalleolar ankle fracture
∑ Forced foot eversion
Scaphoid fractures
∑ Scaphoid fractures are the commonest carpal fractures.
∑ Surface of scaphoid is covered by articular cartilage with small area available for blood vessels (fracture
risks blood supply)
∑ Forms floor of anatomical snuffbox
∑ Risk of fracture associated with fall onto outstretched hand (tubercle, waist, or proximal 1/3)
∑ The main physical signs are swelling and tenderness in the anatomical snuff box, and pain on wrist
movements and on longitudinal compression of the thumb.
∑ Ulnar deviation AP needed for visualization of scaphoid
∑ Immobilization of scaphoid fractures difficult
Radial head fracture
∑ Fracture of the radial head is common in young adults.
∑ It is usually caused by a fall on the outstretched hand.
∑ On examination, there is marked local tenderness over the head of the radius, impaired movements at the
elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and
supination).
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Theme: Upper limb injuries
A. Pulled elbow
B. Fracture of the coronoid process
C. Scaphoid fracture
D. Moteggia fracture
E. Bennets fracture
F. Fracture of the shaft of the radius and ulnar
G. Galeazzi fracture
H. Fracture of the olecranon
I. Fracture of the radial head
Please select the most likely injury for the scenario given.
1. A 32 year old man presents with a painful swelling over the volar aspect of his hand after receiving a hard blow
to his palm. On examination, he experiences pain on moving the wrist and on longitudinal compression of the
thumb.
Scaphoid fracture
Scaphoid fractures usually occur as a result of direct hard blow to the palm or following a fall on the out-
stretched hand. The main physical signs are swelling and tenderness in the anatomical snuff box, and pain on
wrist movements and on longitudinal compression of the thumb
2. A 26 year old man presents to the emergency department with a swelling over his left elbow after a fall on an
outstretched hand. On examination, he has tenderness over the proximal part of his forearm, and has severely
restricted supination and pronation movements.
Fracture of the radial head
Fracture of the radial head is common in young adults. It is usually caused by a fall on the outstretched hand.
On examination, there is marked local tenderness over the head of the radius, impaired movements at the
elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).
3. A 56 year old lady presents with a painful swelling over the lower end of the forearm following a fall. Imaging
reveals a distal radial fracture with disruption of the distal radio-ulnar joint.
Galeazzi fracture
Galeazzi fractures occur after a fall on the hand with a rotational force superimposed on it. On examination,
there is bruising, swelling and tenderness over the lower end of the forearm. X- Rays reveal a displaced
fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint.
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Theme: Eponymous fractures
A. Smith's
B. Bennett's
C. Monteggia's
D. Colle's
E. Galeazzi
F. Pott's
G. Barton's
Link the most appropriate eponymously named fracture to the scenario described.
66. A 28 year old man falls on the back of his hand. On x-ray the he has a fractured distal radius demonstrating
volar displacement of the fracture.
Smith's
2
This is a Smith fracture (reverse Colle's fracture); unlike a Colle's this is a high velocity injury and may require
surgical correction. Note that Colles fractures are usually dorsally displaced
67. A 38 year old window cleaner falls from his ladder. He lands on his left arm and notices an obvious injury. An
x-ray and clinical examination demonstrate that has a fracture of the proximal ulna and associated radial
dislocation
Monteggia's
This constellation of injuries is referred to as a Monteggia's fracture
68. A 32 year old man falls from scaffolding and sustains an injury to his forearm. Clinical examination and x-ray
shows that he has sustained a radial fracture with dislocation of the inferior radio-ulna joint
Galeazzi
Isolated fracture of the radius alone can occur but is rare. Always check for associated injury
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Theme: Eponymous fractures
A. Smith's
B. Bennett's
C. Monteggia's
D. Colle's
E. Galeazzi
F. Pott's
G. Barton's
Which is the most likely eponymous fracture for the scenario given.
69. A 14 year old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the
right ankle.
Pott's
70. A 22 year old drunk man is involved in a fight. He hurts his thumb when he punches his opponent.
Bennett's
71. A 63 year nurse falls on an extended and pronated wrist. An x-ray shows a distal radial fracture with
radiocarpal dislocation
Barton's
