Forearm Flashcards
Unstable forearm fractures include
Radial shaft Fx
Ulnar shaft Fx
Galiazzi (radial Fx, carpoulnar dislocation)
Monteggia (ulnar Fx, radial dislocation)
Stable forearm Fx is
Nightstick Fx (distal ulnar shaft Fx)
What is the MC distal radial injury
Colles Fracture 2/2 FOOSH
Distal radius fracture fragment tilts dorsally (distal part goes upwards)
Other distal radial Fx are
Smith’s: oppo of colles, distal radius fracture fragment tilts ventrally (fall on hand inwards)
Barton: Intraarticular Fx w/ carpal dislocation
What XR view is best for diagnosing colles vs smiths
Lateral! because you can see the way the bone is oriented
What is a radial torus buckle fracture
Fx of distal metaphysis causing buckling of cortex 2/2 compression failure
MC in kids <10
Can cause bone to lose structural integrity and predispose to easy fractures in the future
What is a greenstick Fx
complete Fx of tension side of cortex w/ buckling of compression side
AKA bending of the bone! tension side is the outer curve, compression side is the inner curve
How do you treat a Torus buckle fracture
Immobilize 4-6 wks until bone can heal
What are the carpal bones
some lovers try positions that they cant handle; Scaphoid Lunate Triquetral Pisiform Trapezium Trapezoid Capitate Hamate
What is the MC fractured carpal bone
Scaphoid!
MC 2/2 FOOSH in younger population
Limited blood supply leads to high incidence of nonunion and osteonecrosis
Clinical findings of scaphoid Fx are
Snuffbox pain, ttp ROM limitations (limited extension and radial deviation
Why does scaphoid Fx result in limited blood supply
Radial artery passes through and provides blood supply (SF palmar branch), but is often damaged in the injury= no blood flow to the area
How do you manage Scaphoid Fx
Long arm thumb cast x 6-12 weeks
What imaging do you get with suspected scaphoid Fx
1: XR! but it takes 10-14 days for a Fx line to show, so if the 1st XR is negative but you highly suspect Fx, repeat in 10-14 days
2: If 2nd XR is negative for Fx but you still suspect it, get an MRI
What happens to different fractures of phalanges
Displaced transverse and oblique Fx: become angulated
Spiral Fx: tend to rotate (ex. you make a fist and the pinky rotates inwards)
Displaces, spiral, comminuted, intra-articular Fx: refer to specialist
Look at slide 31 and know how to associate Fx with it’s picture!
Do it
What is the MC Fx of the hand
Boxer’s Fx; distal metaphysis of 5th MC
Results from closed fist striking an object
How do you manage Boxer’s fracture
- Ulnar gutter splint if <15 degrees angulated, to cover transverse, oblique, base, and head
- Surg consult if >15 degrees angulated, intra-articular, comminuted, or spiral
What is DeQuervian’s tenosynovitis
Inflammation of the sheath around abductor pollicis longus and extensor pollicis brevis
Sheath thickens and constricts tendon
DeQuervian’s Tenosynovitis will show
pain in 1st dorsal extensor compartment (snuff box) worse w/ moving thumb and making a fist
Swelling
crepitus as pt flexes and extends thumb
What is Finklestein’s test
pain with passive stretching of tendons used to test DeQuervian’s tenosynovitis
Tuck thumb into your fist, and ulnar deviate. this stretches the inflamed tendons over radial styloid causing pain
How do you manage DeQuervian’s tenosynovitis
NSAIDs
Thumb spica splint
avoid offending activity
steroid injections
Difference between DeQuervian’s and a scaphoid fracture
Usually, DeQuervian’s is non-traumatic while Scaphoid is traumatic
What is Gamekeeper’s thumb
Ulnar collateral ligament sprain (1st MCP)
Caused by acute or chronic valgus stress
Will notice pain and swelling localized to ulnar (medial) aspect of thumb
Assessing for stability of 1st MCP UCL tear by applying valgus stress can reveal
Mild sprain: pain but no laxity
Mod: pain and partial laxity
Complete: pain and significant lacity
How do you treat Gamekeeper’s thumb
Mild-Mod: brace
Surgical consult if complete tear, or if avulsion Fx involving >25% of articular surface
What is Mallet finger
Pain and inability to extend at DIP
MC due to trauma to tip of a fully extended finger
Rupture, avulsion, or laceration of extensor tendon at base of distal phalanx
How do you treat mallet finger
(not emergent, can obs first) 6-8 week splint- must be continuous. If extension is lost at any point, must start over w/ the 6-8 weeks
If full extension is not achieved, consider surgical pinning
You need a surgical consult with mallet finger is
Failed conservative care
Complete tendon laceration
Fx involves >30% of articular surface
The surgical Tx for mallet finger is
You basically put a pin through the bone in the finger to keep it firm (Kind of like the penile implant) and then suture a button from the outside of the finger to the inner distal tip
What are the tendons of each finger
FDP: flexor digitorum profundus
FDS: flexor digitorum superficialis
What is Jersey finger
Spontaneous (RA) or traumatic (forced extension of flexed finger), usually 4th finger, causing FDP to snap
Sx of jersey finger are
pain and swelling to palmar DIP
Proximal fullness if tendon retracted
Affected finger is more extended when hand is at rest
Can’t flex affected DIP
What should you never do when evaluating jersey finger
passively force finger into extension! you will pull the two parts further from each other and exacerbate the situation
How do yuo treat jersey finger
get an XR to assess for bony avulsion
NEED surgery, pref in 7-10 days!
Splint finger in presenting position while on their way to hand surgeon
Complications of jersey finger are
fibrosis and scarring of tendon sheath associated with delayed surgery
What is trigger finger
Nodular thickening of flexor tendon, usually idiopathic (or 2/2 RA and DM)
MC at MP joint
They try to make a fist and get resistance from affected finger, until they finally hear a pop
How do you treat trigger finger
Steroid injections (2 max) Surgical release if it persists despite injections
What is Dupuytren’s contracture
Palmar fibromatosis (viking disease bc MC in men >50, northern european)
Nodular thickening and contraction of palmar fascia, usually affecting 4th finger
Does not cause much discomfort
Affects flexion of MCP first, then PIP (travels distally)
How do you treat Dupuytren’s contracture
Xiaflex injection: inject into contracted cord to break down cartilage. follow with manipulation the next day
What are ganglia of wrist and hand (synovial/mucous cysts)
cystic swelling overlying a joint or tendon sheath
herniation of synovial tissue from a joint capsule or tendon sheath
MC in 15-40 y/o
Where do ganglia of wrist and hand usually occur
Dorsum of wrist
Volar radial aspect of wrist
(less commonly over base of finger and DIP)
How do you treat ganglia cyst
Usually reassurance
If acute, severe Sx: immobilize until size decreases and Sx relieve
+/- needle aspiration (usually need to be repeated)
If continued recurrence, surgical excision
How do you treat a mucous cyst
If closed: send to wrist and hand specialist 2/2 risk of infection in the joint being high
If open: can drain in office
MCC of hand arthritis are
OA
secondary DJD
OA of hand commonly involves
DIP and PIP
causes stiffness and loss of motion of fingers
Herbeden and Bouchard nodes
What is a subungal hematoma
traumatic and painful blood collection under the nail
If traumatic, need an XR to make sure there is no fracture
How do you treat a subungal hematoma
If there is an underlying Fx, NO decompression! will cause an open fracture and increase risk of infx
If no Fx: microcautery, 18g needle, or heated paperclip decompression
