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MUN Orthopedics
HAND &WRIST INJURIES
MUN Orthopedics
MUN Orthopedics
Distal Radius Fractures
elderly vs. young intra vs. extra-articular “acceptable reduction” follow-up
MUN Orthopedics
Distal Radius FracturesDeformities
Radial Shortening Loss of Radial Tilt (A/P view) “Dorsal Angulation” (lateral view)
MUN Orthopedics
Distal Radius FracturesReduction
Traction/Correction of Deformity radius = ulna radial styloid 1 cm distal articular surface at least neutral
angulation
MUN Orthopedics
Distal Radius FracturesWhen to Refer?
unable to acheive reduction unable to maintain reduction in cast intra-articular fractures acute carpal tunnel syndrome open fractures
MUN Orthopedics
Distal Radius FracturesComplications
malunion compartment syndrome nerve entrapment tendon rupture loss of motion
MUN Orthopedics
Distal Radius Fractures
osteotomy to correct malunion DRUJ reconstruction tendon reconstruction
MUN Orthopedics
Scaphoid Fractures
most commonly fractured carpal bone 5-12 % nonunion rate when in doubt;cast may take 12 weeks to heal
MUN Orthopedics
Wrist Dislocations
perilunate fracture - dislocations beware the displaced scaphoid fracture require surgical treatment best seen on lateral view rarely possible to reduce without GA
MUN Orthopedics
Metacarpal Fractures
shaft = rotational deformity neck = angulation deformity base = usually intraarticular
MUN Orthopedics
Boxer’s Fractures
neck of 5th controversy re acceptable reduction palmar prominence loss of knuckle cast position
MUN Orthopedics
Bennett’s Fracture
base of thumb metacarpal APL pulls on larger fragment unstable & frequently require pinning
MUN Orthopedics
Skier’s 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
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
MUN Orthopedics
Phalanx fractures
intraarticular = trouble oblique condyle fracture often
displaces;even after couple of weeks PCP or ORIF
MUN Orthopedics
Phalanx fractures
“chip” fractures FDP avulsion Volar plate injuries(PIP joint dislocation) FDP > 10 days not salvageable
MUN Orthopedics
Phalanx fractures
PIP joint sprains may swell > 1year extension block splint buddy-tape rare comminuted fractures require
surgery isolated digit lateral view