Team Member Role(s) Profile
Paul Banaszkiewicz Paul Banaszkiewicz Segment Author
SattAR Sattar Alshriyda Section Editor

An anterior "Pucker" sign may be shown as part of a viva question.

It's significance has to be recognised

It's presence suggests that the proximal fragment has penetrated brachialis and the anterior fascia of the elbow

As such reduction may be difficult and the surgeon has to be aware of the possibility of requiring to perfrom an open reduction of the fracture from the front.

A milking maneuver can be performed by manipulating the soft tissue over the fragment to pull the soft tissue away from the proximal fragment rather than simply applying traction on the bones,which may not allow reduction of a buttonholed proximal fragment 

A pink pulseless hand last eaten at 6pm (or 8pm).Can't get the patient into theatre as too many general surgical emergency cases are being done

Four fractured necks of femur already on tomorrows trauma list

What to do-"I want to do the case this evening" 

  • Pink pulseless hand
  • White pulseless hand