Upper Limb Trauma

	Shoulder Dislocation
	Features   Pain Loss of movement Characteristic shoulder contour Positive Hamilton's ruler test Complications   Damage to circumflex axillary nerve & paralysis of deltoid Axillary artery damage Treatment   Must perform X-Ray to exclude humeral fracture Reduction, using either Kocher's technique, of manipulation under anaesthesia Brace for 3 weeks Physiotherapy

Brachial Plexus Lesions

Features   Supraclavicular lesion - Erb's palsy Infraclavicular lesion - Klumpke's palsy Treatment   Refere to neurologist / neurosurgeon

Clavicular Fracture

Features   Pain Loss of shoulder function Complications   Right subclavian artery rupture Lung damage (haemothorax, pneumothorax) Treatment   Figure of eight brace providing traction for 6 weeks Heals with no loss of function, but obvious deformity Physiotherapy

	Humeral Shaft Fracture
	Features   Pain Bruising Swelling Complications   Radial nerve lesion Treatment   External cast Physiotherapy

	Supracondylar Fracture
	Features   Transverse fracture of distal humerous with distal fragment tilted posteriorly Pain Swelling Complications   Volkmann's ischaemic contracture - ischaemia --> muscle necrosis --> fibrous tissue formation --> finger contraction Brachial artery damage - Feel radial pulse Median nerve lesion - usually temporary Treatment   Open reduction under anaesthesia External cast Physiotherapy

	Olecranon Fracture
	Features   Humerus splits olecranon at norrowest point Do not mistake for monteggia fracture Avulsion fracture from triceps muscle is common Treatment   Internal fixation Physiotherapy

	Monteggia Fracture
	Features   Do not mistake for olecranon fracture Fracture of ulna with radial head dislocation Treatment   Must be internally fixed Physiotherapy

	Galeazzi Fracture
	Features   Do not mistake for Colle's fracture Fracture of radius with subluxation of inferior radio-ulnar joint Treatment   Must be internally fixed Physiotherapy

	Greenstick Fracture
	Features   Only occurs in children One cortex buckles, while the other may fracture No displacement occurs Treatment   Open reduction and internal fixation Physiotherapy

Colles' Fracture

Features   Transverse fracture of distal radius, with dorsal displacement of distal fragment Dinner fork deformity of distal forearm   Within 1 inch of wrist joint Posterior angulation Posterior displacement Radial deviation Supination Associated with avulsion fracture of ulnar syloid process Complications   Sudeck's atrophy   Hand becomes stiff, blue & cold Sensory & autonomic dysfunction Treatment - ensure movement of fingers & shoulder Median nerve lesion Extensor Pollicis Longus rupture - thumb drop Treatment   Closed reduction External cast - from elbow to metacarpophalangeal joints Must return the next day to ensure proper movement and no swelling Return in 1 week to observe any dislocation of the fracture Physiotherapy

	Smith's & Barton's Fracture
	Features   Smith's fracture - reverse Colles' fracture, occuring when landing with wrist in flexion Barton's fracture - Smith's fracture, with fracture line entering wrist joint Do not mistake for Colle's fracture Treatment   Internal fixation - Ellis plate Physiotherapy

Scaphoid Fracture

Features   Swelling & tenderness in anatomical snuff box Pain on hyperextension Not seen by X-Rays easily, if suspected treat for it & repeat X-Ray in 1 week Complications   Avascular necrosis of proximal fragment, in proximal pole or waist scaphoid fractures --> osteoarthritis Treatment   External cast - immobilizing joint above & below (wrist & metacarpophalangeal joints), for 6 weeks Physiotherapy

	Bennett's Fracture
	Features   Fracture through 1st metacarpal (of thumb), with fracture line entering carpometacarpal joint Complications   Very unstable --> mal union --> loss of thumb function Treatment   Reduction External fixation (scaphoid cast) or internal fixation Physiotherapy