20. Perilunal luxation and fracture of the scaphoid bone. Therapy of Bennett’s fracture. Metacarpal and phalangeal fractures.

Question 1

What is a perilunar luxation?

Answer 1

perilunar dislocation= LUNATE STAYS IN POSITION while carpal bones dislocate

lunate dislocation= lunated forced ventrally or dorsally while carpal bones remain aligned

Question 2

How can you diagnose perilunal luxation?

Answer 2

Symptoms
ass with median nerve injury
* acute onset carpal tunnel syndrome
Imaging
* X-ray

Question 3

How can you treat perilunal luxation?

Answer 3

If it is a simple dislocation without fracture and no signs of carpal tunnel syndrome
• reduced in a CLOSED manner → splint / cast the hand If it is more severe:
• Pins or screws / plate
• Long arm cast

Question 4

How can you diagnose fracture of the scaphoid bone?

Answer 4

Symptoms
* Pain in the movement of the thumb
* SYMPTOM OF NONUNION → gradual in crease in pain
Imaging
* X-ray (may not show fracture for several days)
* CT

Question 5

How can you treat fracture of the scaphoid bone?
list some complication

Answer 5

non-displaced: cast immobilization

mild displaced: Percutaneous screw fixation

significant displacement: ORIF

DANGER OF avascular NECROSIS of distal half of scaphoid!!!
Scaphoid debridement: incase of non-union , removal of scar tissue to allow fresh bone surface to heal

Question 6

What is Bennett’s fracture?

Answer 6

intrarticular Fracture of the base of the first metacarpal bone (thumb)

Question 7

What is the therapy of Bennett’s fracture?

Answer 7

< 1 mm dislocation:
* Closed reduction followed by immobilization in a thumb spica cast.

1 - 3 mm dislocation:
* CRPP Closed reduction followed by pecutaneous pin fixation with K-wire
and the thumb is placed in a spica cast for immobilization

> 3 mm dislocation:
* ORIF open reduction, internal fixation and the thumb is placed in a spica splint

Question 8

How can you treat metacarpal fractures?

Answer 8

Metacarpal head:
* Anatomic reduction
* percutaneous pinning (may be required)

Metacarpal neck:
* Reduced closed (most)
* percutaneous pins or plate fixation for unstable fracture

Metacarpal shaft:
* nondisplaced → reduced and splinted
* Closed reduction and percutaneous pinning
* Open reduction and plate fixation

Question 9

How can you treat phalangeal fractures?

Answer 9

Usually minimaly displaced, outer reduction and splinted

Question 10

What is the boxer’s fracture?

Answer 10

Fracture of the fifth metacarpal