🦴 Humeral Fractures and Injuries. ⚠️ Always document a neurovascular exam (radial, ulnar, median, axillary nerves + pulses) for all humeral fractures.

INJURY SITE	KEY POINTS (Mechanism + Pitfalls)	MANAGEMENT (ED + Follow-up)
Neck of Humerus	🤕 FOOSH, common in elderly. ⚡ Axillary nerve injury → “regimental badge” numbness, deltoid weakness.	🩹 Collar & cuff / U-slab. 📅 Fracture clinic. 🚨 Ortho if young/active (fixation).
Greater Tuberosity	📍 Fall onto shoulder/hand. ⚠️ Rotator cuff dysfunction, stiffness/impingement if displaced.	🩹 Collar & cuff. Avoid early abduction. 📅 Clinic – fixation if >5 mm displacement.
Shaft (mid-third)	🔄 Twisting → spiral #; 💥 blow → transverse #. ⚡ Radial nerve palsy (wrist drop). Rare in kids → consider NAI.	🩹 Hanging U-slab; some need ORIF/IM nail. 📅 Clinic. 🚨 Ortho if radial nerve injury.
Supracondylar (children)	🤸 FOOSH. ⚠️ Brachial artery injury, nerve palsy, compartment syndrome.	Undisplaced → POP 90°. Displaced → urgent MUA ± K-wires. 📅 Clinic if stable.
Lateral Epicondyle (children)	🤕 Fall. Rare. ⚠️ Non-union risk.	🩹 POP. 📅 Clinic; fixation if >2 mm displaced.
Medial Epicondyle (children)	⚡ Avulsion with dislocation. ⚠️ Ulnar nerve palsy.	🩹 POP. 🚨 Ortho if displaced/entrapped. 📅 Clinic otherwise.

📌 Exam Pearls:
– Neck → Axillary nerve.
– Shaft → Radial nerve (wrist drop).
– Supracondylar (kids) → vascular compromise.
– Always check for compartment syndrome.

🦴 Radius and Ulna Fractures

INJURY SITE	KEY POINTS (Mechanism + Pitfalls)	MANAGEMENT (ED + Follow-up)
Radial head & neck	🤕 FOOSH. ⚡ Check posterior interosseous nerve.	🩹 Collar & cuff. 📅 Clinic if displaced. ✅ Discharge if simple.
Shaft	🤕 FOOSH or 💥 blow. ⚡ Galeazzi = shaft # + DRUJ dislocation.	🩹 Above elbow POP ± MUA. 🚨 Ortho if Galeazzi. 📅 Clinic otherwise.
Distal metaphysis – Colles’	🤕 FOOSH (elderly). ⚡ Median nerve injury.	1️⃣ High-energy/intra-articular → urgent ortho. 2️⃣ Frail/low demand → POP. 3️⃣ Others → MUA + POP. 📅 Clinic vs 🚨 Ortho depending on position.
Distal metaphysis – Smith’s / Barton’s	🤕 FOOSH. ⚡ Median nerve risk.	🩹 Above elbow POP (wrist dorsiflexed). 🚨 Immediate ortho referral.
Styloid	🤕 FOOSH. Usually benign.	🩹 Below elbow POP. 📅 Clinic.
Buckle / Torus (children)	🤕 FOOSH. ⚠️ Missed fractures possible.	Stable → splint + discharge. Other → POP. 📅 Clinic if deformity. 🚨 Ortho if severe.
Olecranon	🤕 Fall on elbow. ⚠️ Open #, triceps displacement, ulnar nerve risk.	Hairline → POP. Displaced/open → 🚨 Ortho (washout/fixation). 📅 Clinic if simple.

📌 Exam Pearls:
– Radial head/neck → check PIN. – Shaft → think Galeazzi. – Colles’ → elderly + median nerve. – Smith’s/Barton’s → unstable. – Buckle (kids) → splint + discharge. – Olecranon → beware triceps pull & ulnar nerve.

✋ Hand Fractures and Injuries

INJURY SITE	KEY POINTS (Mechanism + Pitfalls)	MANAGEMENT (ED + Follow-up)
Triquetral #	🤕 Hyperextension. ✅ Full recovery expected.	🩹 Splint or POP. 📄 Discharge or 📅 clinic.
Lunate dislocation	🤕 FOOSH / 🚗 RTC. ⚠️ Easily missed (“spilled teacup”).	🩹 Splint/POP. 🚨 Ortho referral for reduction & fixation.
Bennett’s # (1st MC base)	👊 Blow or forced abduction. ⚠️ Unstable intra-articular.	🩹 POP if extra-articular. 🚨 Ortho if intra-articular/displaced.
UCL injury (Skier’s thumb)	🤕 Forcible abduction. ⚠️ Missed → permanent disability.	🩹 Scaphoid backslab. 🚨 Ortho if laxity/avulsion.
5th Metacarpal Neck (Boxer’s #)	👊 Punch. ⚠️ Infection risk (“fight bite”).	Closed ≤40° → buddy strap. Open/bite → washout + abx + buddy strap. 📄 Discharge or 🚨 Ortho.
5th MC Shaft	🤕 Trauma. ⚠️ Check rotation.	🩹 POP. 📅 Hand clinic.
Other Metacarpals	🤕 Direct blow. ⚠️ Shortening, rotation.	Buddy strap / POP / 🚨 Ortho depending on severity.
Phalanges	🤕 Simple undisplaced. ⚠️ May angulate/rotate.	Correct >10° under ring block. 🩹 Buddy strap. 📅 Hand clinic.
Terminal phalanx	🤕 Direct blow/laceration. ⚠️ Nail bed or open injury.	Closed → strap. Open → washout + abx. Nail bed injury → replace nail. 🚨 Ortho if severe.
Mallet finger	🤕 Forced flexion. ⚠️ Dropped fingertip.	🩹 Mallet splint ×6 weeks. 📄 Discharge or 📅 clinic if avulsion.
MCP/IP dislocations	🤕 Hyperextension. ⚠️ Associated # possible.	🔧 Reduce under LA. 🩹 Buddy strap. 📅 Clinic. 🚨 Ortho if irreducible.
Cuts & Bites	✂️ Risk to tendon, nerve, artery. 🐶 Bites → infection risk.	🧼 Irrigate, document neurology. Minor tendon (<1/3) → close. >2/3 tendon/artery/nerve → 🚨 Ortho. All bites → discuss with ortho.

📌 Exam Pearls:
– Boxer’s # → check for “fight bite”. – Bennett’s # → unstable → ortho. – Mallet finger → splint 6 weeks. – Lunate dislocation → look for “spilled teacup”. – UCL injury → test laxity carefully.

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Upper Limb fractures and injuries

🦴 Radius and Ulna Fractures

✋ Hand Fractures and Injuries

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