1. Trauma and Overuse: Hand and Wrist Flashcards
Most common carpal bone fracture.
Scaphoid Fracture
most susceptible to AVN and Non-Union.
Proximal Pole
The first sign ofAVN =
Sclerosis (the dead bone can’t turn over / recycle)
Most common fracture site
Waist
Fixation screw is need if the displacement is > __ mm?
> 1mm.
The SL ligament is composed of 3 parts.
What is the most important part for carpal stability?
Volar
Dorsal
Middle
Dorsal Band being the most important for carpal stability (opposite o f luno-triquetral which is volar
This deformity results from angulation of the proximal and dista fragments - in the settingofawaist fracture.
Humpback Deformity
Can progress to progressive collapse and non-union.
is an atraumatic AVN of the scaphoid
“Prieser Disease”
occurs with injury (or degeneration via CPPD) to the S-L ligament.
SLAC Wrist (Scaphoid-Lunate Advanced Collapse)
occurs with a scaphoid fracture.
SNAC Wrist (Scaphoid Non-Union Advanced Collapse)
the scaphoid always wants to rotate in flexion - what ligmanets is the only thing holding it back?
Scaphoid-lunate ligament
Scapholunate Ligament Tear
The 3 parts of the Scapholunate Ligament Tear
volar, dorsal, and middle
The dorsal Schapolunate ligaments tear =
Sacphoid and lunate migrate away
Just remember the scaphoid wants to ___ and the lunate wants to extend ____.
Scaphoid = Flex (volar)
Lunate = extend (dorsal)
The only thing holding them back is their ligamentous attachment to each other.
Widening of the SL angle - with dorsiflexion of the lunate.
DISI (Dorsal Intercalated Segmental Instability)
Normal Scaphoid- Lunate Angle
30-60 degrees
Schaphoild-lunate angl ein DISI?
“Radial sided iniurv”
DISI (Dorsal Intercalated Segmental Instability)
volar-flexion (palmar-flexion)
instability
VISI (Volar Intercalated Segmental Instability)
“Ulnar sided iniury” (lunotriquetral side), the lunate no longer has the stabilizing force of the lunotriquetral ligament and gets ripped volar with the scaphoid
VISI (Volar Intercalated Segmental Instability)
Narrowing of the SL angle - with volar-flexion of the lunate & scaphoid.
VISI (Volar Intercalated Segmental Instability)
What are the carpal dislocation?
the Lunate stays put - it’s the carpal bones around the lunate (“peri lunate bones”) that move.
Peri-lunate dislocation is associated with what fractures?
Scaphoid fracutre
Lunate and capitate lose radial alignement
Carpal dislocation
Associated with Triquetro-Lunate interosseous ligament disniption
Mid-carpal dislocation is associated with what fracture?
Triquetral Fracture
Lunate moves, others stay
Lunate dislocation
It happens with a Dorsal radiolunate ligament injury
Lunate dislocation
“Most severe Carpal Dislocation”
Lunate dislocation
Dislocations around the lunate are described in two flavors
Lessare Arc
Greater Arc
Vulnerable zone with pure ligament injury
Lesser Arc
Vulnerable zone associated with fractures
Greater arc
Described by saying “trans” the name of the fracture then the dislocation. Example “Trans-scaphoid, peri-lunate dislocation”
Ligament free part of the carpal bones
Space of Poirier
Ligament free (“poor”) area, that is a site of weakness
Which synovial spaces normally communicate ?
The answer is pisiform recess and radiocarpal joint.
