OR2.1-6 | Upper Limb Fractures — Glossary

Sudden onset median nerve compression in the carpal tunnel following distal radius fracture or wrist injury; presents with burning paraesthesia of the thumb, index, and middle fingers immediately post-injury; requires urgent carpal tunnel decompression.

A three-group classification of clavicle fractures by anatomical location: Group I (middle third, ~80%), Group II (lateral third, ~15%), Group III (medial third, ~5%); forms the basis of management decisions.

A fibrous band encircling the radial neck and holding the radial head within the radial notch of the ulna at the PRUJ; disrupted in Monteggia injuries allowing radial head dislocation.

Also called the arcuate artery of Laing; the principal blood supply to the humeral head, entering through the intertubercular groove; its disruption in four-part fractures produces the substrate for avascular necrosis.

A comprehensive alphanumeric classification of fractures used internationally: for distal radius, type A = extra-articular, type B = partial articular, type C = complete articular ('T' or comminuted); higher type = more complexity = higher operative threshold.

Ischaemic death of the articular segment of the proximal humerus due to disrupted blood supply; occurs in 13-34% of four-part fractures even after operative fixation; may progress to collapse and require salvage arthroplasty.

A terminal branch of the posterior cord (C5-C6) that winds around the surgical neck of the humerus in the quadrilateral space, supplying the deltoid and teres minor and the skin of the regimental badge area; the nerve most at risk in proximal humerus fractures and shoulder dislocations.

A classification of Monteggia fracture-dislocations by the direction of radial head dislocation: Bado type I (anterior, most common ~60%), type II (posterior), type III (lateral, common in children), type IV (anterior + both-bones fracture).

A shear fracture of the volar or dorsal rim of the distal radial articular surface, with the carpus subluxing along with the sheared fragment; always intra-articular and unstable; requires operative fixation.

Bone harvested from the patient (usually iliac crest) and transplanted to a non-union site; provides osteogenic cells, osteoconductive scaffold, and osteoinductive growth factors -- the biological gold standard for non-union treatment.

Fractures of both the radius and the ulna at the same level; functionally unacceptable even with mild malunion (restricts forearm rotation); requires dual-plate ORIF in adults.

The nerve network (C5-T1) forming the major peripheral nerves of the upper limb; passes through the costoclavicular space and may sustain traction injury in high-energy clavicle fractures.

The current standard non-operative immobilisation for clavicle fractures; supports the limb weight and relieves pain without attempting to hold any reduction, which cannot be maintained non-operatively.

A dorsal wrist splint holding the wrist in ~30-40 degrees of extension; maintains a functional position during radial nerve palsy recovery, preventing wrist flexion contracture and allowing functional hand use while awaiting nerve regeneration.

A simple sling that supports the forearm from a loop around the neck; the standard non-operative immobilisation for most proximal humerus fractures; early pendulum exercises are begun while still in the sling.

The most common distal radius fracture: dorsal angulation and dorsal displacement of the distal fragment, with radial shortening and dorsal tilt -- producing the 'dinner-fork deformity' on lateral view; occurs typically in elderly women after a fall on an outstretched hand.

A strong ligamentous complex (conoid and trapezoid ligaments) connecting the undersurface of the lateral clavicle to the coracoid process; its disruption in Neer type II fractures drives instability and non-union risk.

The extent of bony apposition at a fracture site on radiograph; complete loss (no overlap of cortical edges) is a key operative threshold and strong predictor of non-union in clavicle fractures.

A historical Colles fracture reduction position using forced palmar flexion and ulnar deviation; largely abandoned because it causes median nerve compression within the carpal tunnel; modern practice uses mild palmar flexion only.

A constitutive enzyme producing prostaglandins that protect the gastric mucosa and promote platelet aggregation; inhibited by non-selective NSAIDs, causing GI side effects; spared by selective COX-2 inhibitors.

An inducible enzyme upregulated at sites of inflammation; produces pro-inflammatory prostaglandins; selective COX-2 inhibitors (celecoxib, etoricoxib) target this isoform, reducing GI risk but increasing cardiovascular risk.

The lateral wrist profile of a Colles fracture -- the dorsal displacement and angulation of the distal fragment creates a step that resembles the curve of a dinner fork; a classical bedside radiological sign.

Drugs used in inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis) to alter disease course rather than just relieve symptoms; conventional DMARDs include methotrexate, sulfasalazine, hydroxychloroquine; biologics target specific cytokines (anti-TNF, anti-IL-6).

The articulation at the wrist between the distal ulna and the sigmoid notch of the radius, stabilised by the TFCC; the joint disrupted in Galeazzi injuries.

A prognostic subclassification of mid-shaft clavicle fractures by Robinson, subdividing by displacement and comminution; type 2B (displaced, comminuted) carries the highest non-union risk in the conservative group.

A calculated estimate of kidney function (mL/min/1.73 m2) used to stage chronic kidney disease; the key renal parameter for NSAID prescribing decisions: caution if eGFR 30-60, avoidance if eGFR <30.

Electrophysiological investigation of muscle electrical activity; used after 3-4 weeks of radial nerve palsy to confirm nerve continuity (neuropraxia vs axonotmesis vs neurotmesis) and provide prognostic information about spontaneous recovery.

A traditional immobilisation device that crosses between the shoulder blades; now largely abandoned as RCTs show no reduction advantage over a sling while causing axillary pressure sores.

The skin between the thumb and index finger on the dorsal surface; the autonomous sensory zone of the radial nerve; anaesthesia here after a humeral shaft fracture confirms radial nerve injury.

A combined ipsilateral fracture of the humeral shaft and both bones of the forearm (or individual forearm bones); creates a flail segment with no bony continuity from shoulder to hand; an absolute indication for operative fixation of both fractures.

A combined fracture of the clavicle and ipsilateral scapular neck (or AC disruption), creating an unstable shoulder girdle; operative clavicle fixation is generally required.

The typical low-energy mechanism for proximal humerus fractures in the elderly; the axial force transmitted through the extended elbow and wrist to the osteoporotic humeral head produces impaction or displacement.

A Neer fracture pattern in which all four proximal humeral segments (articular head, greater tuberosity, lesser tuberosity, shaft) are displaced; carries the highest AVN risk and often requires arthroplasty in elderly patients.

A prefabricated or custom sleeve applied around the upper arm; uses hydraulic pressure from soft tissues to stabilise humeral shaft fractures while allowing elbow and shoulder movement; the gold-standard non-operative device, achieving union in ~90% of closed fractures.

A fracture of the distal third of the radius associated with disruption of the distal radioulnar joint (DRUJ) at the wrist; the fracture is in the radius; the dislocation is at the wrist. Cannot be managed non-operatively in adults.

Use of a proton pump inhibitor (or H2 blocker) to protect the gastric mucosa from NSAID-induced erosion; indicated when prescribing NSAIDs to patients with past PUD, elderly patients, or those on concomitant aspirin, corticosteroids, or anticoagulants.

The lateral bony prominence of the proximal humerus to which supraspinatus, infraspinatus, and teres minor attach; displaced >5 mm in a two-part fracture disrupts the supraspinatus footprint and requires operative reduction.

A classification of open fractures into grades I (clean wound <1 cm), II (wound 1-10 cm, minimal contamination), IIIA (extensive soft tissue damage, adequate coverage), IIIB (inadequate coverage, periosteal stripping), and IIIC (arterial injury requiring repair); guides antibiotic choice and wound management.

A U-shaped plaster slab applied from the axilla, around the elbow, to the shoulder; relies on gravity for longitudinal traction to reduce and maintain humeral shaft alignment; used in the first 1-2 weeks before swelling subsides.

A rare proximal humerus fracture pattern in which the articular surface itself is split; virtually always associated with AVN and loss of articular congruity; arthroplasty is the treatment of choice.

Replacement of the humeral head with a stemmed prosthesis while retaining the native glenoid; used for four-part and head-splitting fractures in elderly patients; increasingly replaced by RTSA.

A spiral fracture of the distal third of the humerus at the level where the radial nerve pierces the lateral intermuscular septum; associated with a ~22% radial nerve injury rate, higher than mid-shaft fractures (~12%), due to the nerve's tethering at this anatomical choke point.

A specialised plate with a distal hook passing below the acromion; used for Neer type II lateral third fractures to counteract inferior displacement of the distal fragment.

A complex distal humerus fracture in which a vertical fracture line splits the condyles apart and a horizontal line separates them from the shaft ('T' or 'Y' pattern); requires ORIF with medial and lateral column plates in adults; ulnar nerve is at risk.

A fibrous sheet connecting the radius and ulna along their shafts; transmits forces between the two bones and maintains the separation required for forearm rotation; disrupted in high-energy forearm fractures.

Injection of a corticosteroid (methylprednisolone, triamcinolone) directly into a joint cavity to provide localised anti-inflammatory relief; effective for inflammatory and degenerative flares; contraindicated in joint infection; frequency limited to 3-4 per joint per year.

An elastic or titanium nail inserted through the anterior cortex and driven intramedullarly to engage the distal fragment; a less invasive alternative to plating but carries higher rates of nail migration and skin irritation.

A fibrous partition in the arm separating the anterior and posterior compartments; pierced by the radial nerve in the distal third of the humerus as it transitions from posterior to anterior; the nerve's tethering point in Holstein-Lewis fractures.

The medial bony prominence of the proximal humerus serving as the subscapularis insertion; displaced anteromedially by subscapularis pull in proximal humerus fractures.

The principle of using traction through ligaments to reduce fracture fragments indirectly; exploited in external fixation of comminuted distal radius fractures to restore radial length and alignment without open exposure.

A pre-contoured proximal humeral locking plate that provides angular stability in osteoporotic bone via threaded locking screws; the most common operative implant for proximal humerus ORIF in younger patients with adequate bone stock.

Healing of a fracture in an unacceptable position of deformity (shortening, angulation, or rotation) that causes functional or cosmetic impairment; clavicle malunion with >2 cm shortening causes a drooped shoulder and power deficit.

A fracture of the proximal ulna associated with dislocation of the radial head at the proximal radioulnar joint (within the elbow); the fracture is in the ulna; the dislocation is in the elbow. Classified by Bado into types I-IV by direction of dislocation.

A perioperative strategy combining analgesics from different drug classes (paracetamol + NSAID + opioid + regional block) to achieve superior pain control with lower doses of each drug and reduced side effects, particularly opioid-related.

A subclassification of lateral third (Allman Group II) clavicle fractures: type I (undisplaced, ligaments intact), type II (displaced, coracoclavicular ligaments ruptured, highest non-union risk), type III (intra-articular, involving the AC joint).

The mildest nerve injury grade (Seddon classification); focal conduction block with intact axon and no Wallerian degeneration; expected full recovery over weeks to months without surgery.

Failure of a fracture to achieve bony union within the expected healing period (typically defined clinically and radiologically at 4-6 months); in clavicle fractures it presents with persistent pain, mobility, and shoulder weakness.

Acute kidney injury caused by NSAID inhibition of prostaglandin-mediated afferent arteriolar vasodilation in the kidney; particularly significant in volume-depleted states, CKD, or elderly patients; NSAIDs should be avoided if eGFR <30 mL/min.

A drug class that inhibits cyclo-oxygenase (COX-1 and/or COX-2) enzymes, reducing prostaglandin synthesis; provides analgesia, anti-inflammatory, and antipyretic effects; major side effects include GI ulceration (COX-1 inhibition) and renal vasoconstriction.

A centrally acting analgesic and antipyretic with no clinically significant anti-inflammatory activity; the first-line analgesic for mild-to-moderate musculoskeletal pain; hepatotoxic in overdose; maximum dose 4 g/day in adults (3 g/day in elderly or alcohol users).

Early rehabilitation exercise for proximal humerus fractures and shoulder pathology; the patient leans forward and allows the arm to swing by gravity, gently circumducting the shoulder without active muscle contraction; prevents adhesive capsulitis.

Mucosal ulceration of the stomach or duodenum; a strong contraindication to NSAID prescribing without PPI co-prescription; NSAIDs inhibit COX-1 prostaglandins that maintain the protective gastric mucus layer.

Open reduction and internal fixation of the humeral shaft using a broad dynamic compression plate or limited-contact plate via an anterolateral or posterior approach; the most common operative technique for humeral shaft fractures.

Radial nerve deficit present at the time of fracture (before any manipulation); almost always a neuropraxia with 70-90% spontaneous recovery; managed expectantly with a cock-up splint and physiotherapy.

A branch of the brachial artery that accompanies the radial nerve in the radial groove; injury may accompany radial nerve damage in high-energy humeral shaft fractures.

A drug class (omeprazole, pantoprazole, lansoprazole) that irreversibly inhibits the gastric H+/K+-ATPase pump, reducing acid secretion; co-prescribed with NSAIDs in high-risk patients to prevent GI ulceration.

The articulation within the elbow between the radial head and the radial notch of the ulna, held by the annular ligament; the joint that dislocates in Monteggia injuries.

An anatomical space bounded by the teres major, teres minor, long head of triceps, and humeral shaft; transmits the axillary nerve and posterior humeral circumflex vessels; relevant to axillary nerve injury in proximal humerus fractures.

A shallow groove on the posterior surface of the humeral shaft through which the radial nerve and profunda brachii artery spiral from medial to lateral; the nerve is tethered here and vulnerable to fracture injury.

A terminal branch of the posterior cord of the brachial plexus (C5-C8, T1); runs in the radial groove of the posterior humerus; supplies all extensors of the wrist and fingers; injury at groove level causes wrist drop with preserved triceps function.

A malleable 3.5 mm plate contoured to the S-shape of the clavicle; placed on the superior surface for plate-and-screw fixation of displaced mid-shaft fractures.

The cutaneous territory of the axillary nerve over the lateral deltoid, approximately 4 cm in diameter, two finger-breadths below the acromion; loss of sensation here is the clinical hallmark of axillary nerve injury.

An arthroplasty in which the ball-and-socket orientation is reversed (glenosphere on glenoid, socket on humeral stem); does not depend on rotator cuff integrity and gives superior functional outcomes in elderly patients with four-part fractures or cuff-tear arthropathy.

The combination of asthma, chronic rhinosinusitis with nasal polyps, and aspirin/NSAID-induced bronchospasm; occurring in ~10% of asthmatics; an important contraindication to all non-selective NSAIDs.

Radial nerve deficit appearing after manipulation or reduction; suggests mechanical nerve entrapment at the fracture site; mandates prompt surgical exploration.

A subclass of NSAIDs (celecoxib, etoricoxib) that selectively inhibits COX-2 over COX-1; lower GI risk than non-selective NSAIDs but increased cardiovascular risk (thrombosis) due to prostacyclin inhibition without platelet thromboxane inhibition.

Protrusion of a fracture fragment acutely against the overlying skin without breach; indicates impending open fracture and mandates urgent surgical attention.

A distal radius fracture with volar (forward) angulation and volar displacement of the distal fragment -- the reverse of a Colles fracture; produces a 'garden-spade deformity'; results from a fall on the back of the hand.

The main arterial supply to the upper limb, passing deep to the clavicle through the costoclavicular space; laceration by a displaced clavicle fragment is a vascular emergency requiring urgent surgical repair.

The narrowest part of the proximal humerus just distal to the tuberosities; the most common site of two-part proximal humerus fractures; the axillary nerve traverses the quadrilateral space at this level.

A centrally acting analgesic with weak opioid agonist activity and noradrenaline/serotonin reuptake inhibition; step-2 WHO ladder analgesic; risks include seizures at high doses, serotonin syndrome when combined with SSRIs, and dependence with long-term use.

A fibrocartilaginous stabiliser of the DRUJ extending between the ulnar aspect of the distal radius and the base of the ulnar styloid; disruption in Galeazzi injuries causes DRUJ instability and ulnar head dorsal dislocation.

Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) used to quantify pain intensity on a 0-10 scale; a standardised tool for initial assessment and follow-up monitoring of treatment response; NRS >7 = severe pain requiring step-2 or step-3 analgesia.

A pre-contoured plate placed on the volar surface of the distal radius via a Henry approach; locking screws support the subchondral articular surface; the contemporary gold-standard operative device for displaced and intra-articular distal radius fractures.

A stepwise framework for analgesic prescribing: step 1 = non-opioids (paracetamol, NSAIDs), step 2 = mild opioids (codeine, tramadol) +/- step 1, step 3 = strong opioids (morphine) +/- step 1; originally for cancer pain, now adapted for musculoskeletal and post-operative pain.

Inability to extend the wrist against gravity due to paralysis of the wrist extensors (extensor carpi radialis longus, brevis, and extensor carpi ulnaris); the clinical hallmark of radial nerve injury at the level of the radial groove or proximal forearm.

A 15-degree cephalad-tilted X-ray that opens the acromioclavicular joint and eliminates scapular overlap; the standard radiograph for assessing lateral third clavicle fractures.