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Hand and Wrist Injuries 1

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					                  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

				
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posted:4/15/2008
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