Cortex - Adult trauma (upper limb) 2 Flashcards
What is the common mechanism of injury for distal radial fractures ?
A common injury sustained following a fall into an outstretched hand (FOOSH).
What is a colles fracture ?
An extra-articular fracture of the distal radius within an inch of the articular surface with dorsal displacement or angulation
What nerve is at risk of injury following a colles fracture ?
- The median nerve
- Note - this shows the link of how a colles fracture can result in carpal tunnel syndrome
What is a smiths fracture ?
It is a volarly displaced or angulated extra-articualr fracture of the distal radius
Colles and smiths fractures are similar how do they differ in the mechanism of injury ?
- Differ as colles fracture is due to FOOSH (fall onto an outstretched hand)
- Whereas it is falling onto the back of a flexed wrist
What is a bartons fracture ?
- They are intra-articular fractures of the distal radius involving the dorsal or volar rim, the carpal bones of the wrist joint sublux.
- Hence bartons fractures can be classified as volar (an intra-articular smiths fracture) or dorsal (an intra-articular colles fracture) bartons fractures
What is the treatment of colles fractures ?
Depends on the degree of displacement or angulation:
- Minimally displaced - splintage
- Fracture may be treated with plaster cast alone but if dorsal communion or particularly unstable - then percutaneous wires or ORIF with plate or screws
What is the treatment for all smith fractures and why ?
ORIF using plate and screws - as they are highly unstable fractures
What is the treatment of bartons fractures ?
ORIF (as with most intra-articular fractures)
For Comminuted intra‐articular distal radius fracture what can be done to treat it ?
An external fixator and supplementary wires may be used for larger fragments
What is the typical presentation of a scaphoid fracture ?
Usually occur after a FOOSH. Clinical signs include tenderness in the anatomic snuff box and pain on compressing the thumb metacarpal
How are scaphoid fractures diagnosed ?
X-ray but 4 views done when suspected as it is hard to see (AP, lateral and 2 oblique views)
What is the treatment of scaphoid fractures ?
- Undisplaced - plaster cast
- Displaced - special compression screw
What are some of the common complications of scaphoid fractures ?
- Non-union
- AVN
Penetrating injuries to the hand are common - what structures are at risk of damage due to these type of injuries ?
- Volar injuries risk damage to the flexor tendons, digital nerves and digital arteries.
- Dorsal injuries risk damage to the extensor tendons.
Describe what mallet finger is and what it looks like
- An injury due to avulsion of the extensor tendon from its insertion into the terminal phalanx caused by forced flexion of the DIPJ of the extended DIPJ, often from a ball at sport
- Presents as a drooped DIDJ of affected finger and inability to extend at the DIPJ
