Enhance your knowledge with our comprehensive guide and curated study materials.
Case:
A 24-year-old boxer presents with swelling and pain over the dorsum of his hand after a fight. X-ray shows a fracture at the neck of the 5th metacarpal bone.
Questions & Explanations:
Q1. What is the name of this fracture?
→ Boxer’s fracture.
Q2. Why is the 5th metacarpal particularly prone to this fracture?
→ Because of its relative mobility and exposure during clenched fist blows.
Q3. What functional deficit may result?
→ Weakness of grip and loss of prominence of the little finger knuckle.
Q4. How is it different from Bennett’s fracture?
→ Bennett’s fracture involves the base of the 1st metacarpal with dislocation at the carpometacarpal joint of thumb.
Q5. Why are fractures of the scaphoid clinically important?
→ Because of risk of avascular necrosis of the proximal fragment.
1. Clavicle fracture
Case: A 10-year-old boy falls on his shoulder; X-ray shows fracture at the junction of medial 2/3 and lateral 1/3 of clavicle.
Q: Which muscle displaces the medial fragment upwards?
A: Sternocleidomastoid.
2. Congenital absence of clavicle
Case: A child can approximate both shoulders in front of the chest.
Q: What condition is this?
A: Cleidocranial dysostosis.
3. Scapular winging
Case: A young patient after trauma shows protrusion of medial border of scapula when pushing against a wall.
Q: Which nerve is injured?
A: Long thoracic nerve (serratus anterior paralysis).
4. Acromioclavicular dislocation
Case: Following a rugby injury, a player has step deformity at the shoulder.
Q: Which joint is injured?
A: Acromioclavicular joint.
5. Surgical neck fracture of humerus
Case: Middle-aged woman with fall presents with inability to abduct the arm beyond 15°.
Q: Which nerve is injured?
A: Axillary nerve.
6. Midshaft fracture of humerus
Case: A patient presents with wrist drop after road traffic accident.
Q: Which structure is injured in spiral groove?
A: Radial nerve (with profunda brachii artery).
7. Supracondylar fracture (child)
Case: 8-year-old child with swollen elbow after fall on outstretched hand. Fingers appear pale and pulseless.
Q: Which artery is at risk?
A: Brachial artery → may lead to Volkmann’s ischemic contracture.
8. Medial epicondyle fracture
Case: A boy sustains elbow injury; later he cannot adduct his fingers.
Q: Which nerve is injured?
A: Ulnar nerve.
9. Colles’ fracture
Case: Elderly woman falls on outstretched hand. X-ray shows fracture 2 cm above wrist joint with dorsal displacement of distal radius.
Q: What deformity results?
A: Dinner fork deformity.
10. Smith’s fracture
Case: A man falls on the back of his hand; distal fragment of radius displaced anteriorly.
Q: What is the name of this fracture?
A: Reverse Colles’ fracture (Smith’s fracture).
11. Monteggia fracture-dislocation
Case: Fracture of proximal ulna with dislocation of radial head.
Q: Which movement is most affected?
A: Supination and pronation of forearm.
12. Boxer’s fracture
Case: Young man with pain and swelling after punching wall; X-ray shows fracture at neck of 5th metacarpal.
Q: Name this fracture.
A: Boxer’s fracture.
13. Bennett’s fracture
Case: Motorcyclist with fracture at base of 1st metacarpal involving carpometacarpal joint.
Q: Which movement of thumb will be impaired?
A: Opposition.
14. Scaphoid fracture
Case: 22-year-old student falls on outstretched hand; pain in anatomical snuffbox.
Q: What is the complication of this fracture?
A: Avascular necrosis of proximal fragment.
15. Lunate dislocation
Case: Wrist injury; X-ray shows forward displacement of lunate.
Q: Which nerve may be compressed?
A: Median nerve.
16. Mallet finger
Case: A cricket player presents with drooping of distal phalanx after ball impact.
Q: What structure is injured?
A: Extensor tendon avulsion with distal phalanx fracture.
17. Jersey finger
Case: A rugby player unable to flex distal phalanx of ring finger after sudden pull.
Q: What structure is injured?
A: Flexor digitorum profundus tendon from distal phalanx.
18. Sesamoid fracture (thumb)
Case: Pain at metacarpophalangeal joint of thumb, X-ray shows fracture of sesamoid.
Q: What function will be affected?
A: Opposition and pinch grip.
For deeper understanding and correlation, students can refer to:
BD Chaurasia’s Human Anatomy, Vol. 1 (Upper Limb & Thorax) → Osteology section (Clavicle to Sesamoid bones).
Gray’s Anatomy: The Anatomical Basis of Clinical Practice → detailed osteology of upper limb.
Last’s Anatomy: Regional and Applied → applied and surgical anatomy of upper limb bones.
Clinical Orthopaedics textbooks for fracture patterns, mechanisms, and management.
Radiology references (CT/MRI atlases) for bone surface markings and fracture imaging.
Get the full PDF version of this chapter.
Continue with Google