-
8/7/2019 Hand and Wrist Injuries 1
1/17
MUN Orthopedics
HAND &WRIST INJURIES
-
8/7/2019 Hand and Wrist Injuries 1
2/17
MUN Orthopedics
Distal Radius Fractures
elderly vs. young
intra vs. extra-articular acceptable reduction
follow-up
-
8/7/2019 Hand and Wrist Injuries 1
3/17
MUN Orthopedics
Distal Radius Fractures
Deformities
Radial Shortening
Loss ofR
adial Tilt (A/P view) Dorsal Angulation (lateral view)
-
8/7/2019 Hand and Wrist Injuries 1
4/17
MUN Orthopedics
Distal Radius Fractures
Reduction
Traction/Correction of Deformity
radius = ulna radial styloid 1 cm distal
articular surface at least neutral
angulation
-
8/7/2019 Hand and Wrist Injuries 1
5/17
MUN Orthopedics
Distal Radius Fractures
When to Refer?
unable to acheive reduction
unable to maintain reduction in cast intra-articular
fractures
acute carpal tunnel syndrome
open fractures
-
8/7/2019 Hand and Wrist Injuries 1
6/17
MUN Orthopedics
Distal Radius Fractures
Complications
malunion
compartment syndrome nerve entrapment
tendon rupture
loss of motion
-
8/7/2019 Hand and Wrist Injuries 1
7/17
MUN Orthopedics
Distal Radius Fractures
osteotomy to correct malunion
DR
UJ reconstruction tendon reconstruction
-
8/7/2019 Hand and Wrist Injuries 1
8/17
MUN Orthopedics
Scaphoid Fractures
most commonly fractured carpal bone
5-12 % nonunion rate when in doubt;cast
may take 12 weeks to heal
-
8/7/2019 Hand and Wrist Injuries 1
9/17
MUN Orthopedics
Wrist Dislocations
perilunate fracture - dislocations
bewarethe displaced scaphoid fracture
require surgical treatment
best seen on lateral view
rarely possible to reduce without GA
-
8/7/2019 Hand and Wrist Injuries 1
10/17
MUN Orthopedics
Metacarpal Fractures
shaft = rotational deformity
neck = angulation deformity base = usually intraarticular
-
8/7/2019 Hand and Wrist Injuries 1
11/17
MUN Orthopedics
Boxers Fractures
neck of 5th
controversy re acceptable reduction palmar prominence
loss of knuckle
cast position
-
8/7/2019 Hand and Wrist Injuries 1
12/17
MUN Orthopedics
Bennetts Fracture
base of thumb metacarpal
APL pulls on larger fragment unstable & frequently require
pinning
-
8/7/2019 Hand and Wrist Injuries 1
13/17
MUN Orthopedics
Skiers Thumb
ulnar collateral ligament avulsion
with or without bone fragment ?? stability
compare to other side
less pain often more unstable
stable 6 weeks cast immobilisation
-
8/7/2019 Hand and Wrist Injuries 1
14/17
MUN Orthopedics
Phalanx fractures
shaft = rotation
base of fifth often hard to see on Xray clinical examination
critical
check nail bed orientation
Xray healing later than clinical
-
8/7/2019 Hand and Wrist Injuries 1
15/17
MUN Orthopedics
Phalanx fractures
intraarticular = trouble
oblique condyle fracture oftendisplaces;even after couple of
weeks
PCP or ORIF
-
8/7/2019 Hand and Wrist Injuries 1
16/17
MUN Orthopedics
Phalanx fractures
chip fractures
F
DP avulsion Volar plate injuries(PIP joint dislocation)
FDP > 10 days not salvageable
-
8/7/2019 Hand and Wrist Injuries 1
17/17
MUN Orthopedics
Phalanx fractures
PIP joint sprains may swell > 1year
extension block splint buddy-tape
rare comminuted fractures require
surgery
isolated digit lateral view
