Hand and Wrist Injuries 1

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 Fractures Deformities Radial Shortening  Loss of Radial Tilt (A/P view)  “Dorsal Angulation” (lateral view)  MUN Orthopedics Distal Radius Fractures Reduction Traction/Correction of Deformity  radius = ulna  radial styloid 1 cm distal  articular surface at least neutral angulation  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  MUN Orthopedics Distal Radius Fractures Complications 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  MUN Orthopedics