Disorders of the hand and wrist Flashcards
What is the most common mechanism of a scaphoid fracture?
They are most common amongst
adolescents and young adults following a fall onto an outstretched hand
(resulting in hyperextension and impaction of the scaphoid against the rim of the radius, or in direct axial (‘end-on’) compression of the scaphoid).
What will a patient with a scaphoid fracture complain of?
Patients with a scaphoid fracture usually complain of pain in the anatomical snuffbox. The pain is exacerbated by moving the wrist. Passive range of motion is reduced, but not dramatically. Swelling around the radial and posterior aspects of the wrist is common.
What part of the scaphoid do fractures occur in?
Fractures most commonly affect the waist of the scaphoid (70-80%) but can also occur in the proximal pole (20%) or the distal pole (10%), which is sometimes called the scaphoid tubercle.
What is a complication of a scaphoid fracture?
The blood supply to the scaphoid is mainly retrograde from the distal to the proximal pole, and since the blood supply to the proximal pole is tenuous, fractures through the waist of the scaphoid can result in avascular necrosis. This means that displaced fractures through the waist of
the scaphoid have high risk of non-union (8-10%), malunion, avascular necrosis and late complications of carpal instability and secondary osteoarthritis. Osteoarthritis is more common if there has been non-union, malunion or avascular necrosis.
What is a Colle’s fracture?
A Colles’ fracture is an extra-articular
fracture of the distal radial metaphysis,
with dorsal angulation and impaction.
Who are Colle’s fractures most common in?
They are particularly common in patients with osteoporosis (reduced bone density), and as such they are most frequently seen in post menopausal women. Younger patients who present with a Colles’ fracture have usually been involved in high impact trauma e.g. skiing.
What is the mechanism of injury of a Colle’s fracture?
The mechanism of injury is usually a fall onto an outstretched hand with a
pronated forearm and wrist in dorsiflexion. The energy is transmitted from the carpus to the distal radius in a dorsal direction and along the long axis of the radius. The fracture is therefore dorsally angulated and impacted.
How will a patient with a Colle’s fracture present?
The patient will present with a
painful, deformed, swollen wrist.
How are Colle’s fractures treated?
Most Colles’ fractures can be treated by reduction and immobilisation in a cast.
What are the complications of a Colle’s fracture?
- malunion, resulting in a ‘dinner-fork’ deformity
- median nerve palsy and post-traumatic carpal tunnel syndrome
- secondary osteoarthritis (more common with intra-articular fractures)
- tear of the extensor pollicis longus tendon (through attrition of the
tendon over a sharp fragment of bone)
What is a Smith fracture?
What is the common mechanism of a scaphoid fracture?
They are most common amongst
adolescents and young adults following a fall onto an outstretched hand
(resulting in hyperextension and impaction of the scaphoid against the rim of the radius, or in direct axial (‘end-on’) compression of the scaphoid).
What do patients with a scaphoid fracture complain of?
Patients with a scaphoid fracture usually complain of pain in the anatomical snuffbox. The pain is exacerbated by moving the wrist. Passive range of motion is
reduced, but not dramatically. Swelling around the radial and posterior aspects of the wrist is common.
What part of the scaphoid do fractures occur in?
Fractures most commonly affect the waist of the scaphoid (70-80%) but can also occur in the proximal pole (20%) or the distal pole (10%), which is sometimes called the scaphoid tubercle.
What are the complications of a scaphoid fracture?
The blood supply to the scaphoid is mainly retrograde from the distal to the proximal pole, and since the blood supply to the proximal pole is tenuous, fractures through the waist of the scaphoid can result in avascular necrosis. This means that displaced fractures through the waist of the scaphoid have high risk of non-union (8-10%), malunion, avascular necrosis
and late complications of carpal instability and secondary osteoarthritis.
Osteoarthritis is more common if there has been non-union, malunion or avascular necrosis.
What is a Colle’s fracture?
A Colles’ fracture is an extra-articular
fracture of the distal radial metaphysis,
with dorsal angulation and impaction.
Who are Colle’s fractures most common in?
They are particularly common in patients with osteoporosis (reduced bone density), and as such they are most frequently seen in post menopausal women. Younger patients who present with a Colles’ fracture have usually been involved in high
impact trauma e.g. skiing.
What is the main mechanism of injury of a Colle’s fracture?
The mechanism of injury is usually a fall onto an outstretched hand with a
pronated forearm and wrist in dorsiflexion. The energy is transmitted from the carpus to the distal radius in a dorsal direction and along the long axis of the radius. The fracture is therefore dorsally angulated and impacted.
How will a patient with a Colle’s fracture present?
The patient will present with a
painful, deformed, swollen wrist.
What are the complications of a Colle’s fractures?
- malunion, resulting in a ‘dinner-fork’ deformity
- median nerve palsy and post-traumatic carpal tunnel syndrome
- secondary osteoarthritis (more common with intra-articular fractures)
- tear of the extensor pollicis longus tendon (through attrition of the
tendon over a sharp fragment of bone)
What is a Smith fracture?
Smith fractures (or Smith’s fractures) are fractures of the distal radius with volar (palmar) angulation of the distal fracture fragment(s)
Who do Smith fractures mainly occur in?
They typically occur in young males (most common) and elderly females.
What is the common mechansim of a Smith fracture?
The typical mechanism is either a fall onto the dorsum of a flexed wrist or a direct blow to the back of the wrist.
What is the main complication of a Smith fracture?
Malunion of a Smith fracture, with residual volar displacement of the distal radius results in a cosmetic deformity referred to as a ‘garden spade’ deformity. It narrows and distorts the carpal tunnel and can result in carpal tunnel syndrome.
What is rheumatoid arthritis?
An autoimmune disease in which autoantibodies, known as rheumatoid factor, attack the synovial membrane. The inflamed synovial cells proliferate to form a pannus, which penetrates through the cartilage and adjacent bone, leading to joint erosion and deformity.
What are the main joints in the hands and feet affected by rheumatoid arthritis?
It particularly affects the metacarpophalangeal joints (MCPJ)
and proximal interphalangeal joints (PIPJ) of the hands and feet
Rheumatoid arthritis is described as a symmetrical polyarthritis, what does this mean?
It means that it affects multiple joints usually in a symmetrical distribution (e.g. right and left wrists at the same time). This symmetrical inflammation can make mild swelling in the hand difficult to diagnose, as there is no ‘normal’ hand with which to make a comparison.
How does a patient with rheumatoid arthritis present?
- pain and swelling of the PIPJs and MCPJs of the fingers
- erythema (redness) overlying the joints (indicating inflammation)
- stiffness, that is worst in the morning or after periods of inactivity
(causing difficulty with tasks such as doing up buttons, using a
smartphone or preparing food) - carpal tunnel syndrome (compression of the median nerve in the carpal
tunnel, in this case due to synovial swelling) - fatigue and flu-like symptoms (due to the systemic nature of
rheumatoid disease)
What are a late feature of rheumatoid arthritis?
Rheumatoid nodules in the fingers and over the elbow
What are the two common deformities associated with rheumatoid arthritis?
Boutonniere deformity and swan neck deformity
What is swan neck deformity?
Swan neck deformity occurs when the PIPJ hyperextends and the MCPJ and DIPJ are flexed.
