Falling on outstretched hands/arms/wrists...

[whitcoatsyndrom]

Is there any trend on whether the question (uworld in particular) implies falling forward or backward. It makes a difference in regards to locations of shoulder injuries and some of these questions dont seem to specify direction...am i missing something?

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[Ionian]

Is there any trend on whether the question (uworld in particular) implies falling forward or backward. It makes a difference in regards to locations of shoulder injuries and some of these questions dont seem to specify direction...am i missing something?

You just have to base your decision on the symptoms presented.

Falling on a outstretched hand doesn't seem to be specific to any one thing.

I believe I've see the answer to "falling on an outstretched hand" = Colles fracture, Mid-shaft fracture, shoulder dislocation, and I think maybe clavicle fracture too?

 

[dyspareunia]

And scaphoid.

 

[Lavan]

The shoulder dislocation will always be anterior on Step-type questions unless the patient is having a seizure or has been hit by lightening (in which case it can be posterior). Fall on outstretched hand questions, at least from my memory, more often involved the hand (scaphoid fracture, lunate dislocation) more than the arm, and I would definitely know those facts as being the "most common" injuries. Anything else I'd think they'd have to provide you additional clinical information.

 

[thehundredthone]

There is a rough rule of thumb from hearsay, based on age: children = clavicle, adults = scaphoid, elderly = Colles.

 

[Handinhand]

Anecdotally, I know from years of racing downhill mountain bikes that it definitely can fracture your clavicle, as it happens all the time with guys going over their handle bars and throwing their arms out to protect their fall. Colle's fracture is also very common.

Is this really important for Step 1 though? It seems like fractures are only important if their associated with a possible neuro deficit so they can ask you which nerve/artery/vein is liekly damaged. I've not seen any questions that just say "so and so feel onto X extremity in Y position -- which bone did they fracture?"

 

[dyspareunia]

Anecdotally, I know from years of racing downhill mountain bikes that it definitely can fracture your clavicle, as it happens all the time with guys going over their handle bars and throwing their arms out to protect their fall. Colle's fracture is also very common.

Is this really important for Step 1 though? It seems like fractures are only important if their associated with a possible neuro deficit so they can ask you which nerve/artery/vein is liekly damaged. I've not seen any questions that just say "so and so feel onto X extremity in Y position -- which bone did they fracture?"

From a qbank: Patient falls on outstretched hand and has some minor swelling, minor pain near wrist, but nothing severe. Normal X-ray. Most common complication?


--> Avascular necrosis secondary to scaphoid fracture. Snuffbox would've been a dead giveaway, but it was not mentioned.