forearm, wrist and hand fractures Flashcards
what is a monteggia fracture?
-fracture on the proximal ulna in association with a radial head dislocation
what is the MOI of a monteggia fracture?
fal on outstretched fully pronated arm
how is a monteggia fracture managed?
-ORIF
-cast above elbow in 90 degrees flexion to below wrist and in supination x4-6 weeks
-physio post cast
what is a galeazzi fracture?
-fracture of distal 1/3 of radius
what is a galeazzi fracture associated with?
a distal radioulnar joint injury
what complications are associated with a galeazzi fracture?
-malunion
-unstable distal fragment
how is a galeazzi fracture managed?
-ORIF - plate and screws
-cast as for monteggia
what is the MOI for a radial and ulna fracture?
-twisting injury / rotational deformity
what are the complications for a radius and ulna fracture?
-mal union
-non union
-compartment syndrome
what is the conservative management of a radius and ulna?
-not usually successful due to unopposed supination due to rotational deformity and slippage
how is a radial and ulna fracture treated surgically?
-ORIF - treatment of choice for this fracture
-cast above elbow
what is acute compartment syndrome?
-can happen after fracture - due to pressure increase - leading to ischaemia
-affects flexor muscles in forearm
can also affect median nerve, brachial artery etc
what condition can a patient have if their acute compartment syndrome is not treated?
-volkmann’s ischaemic contracture
what pressure in compartment syndrome requires fasciotomy?
30mmhg
list symptoms of compartment syndrome
-pain
-swelling
-numbness
-pins and needles
-painful ROM
what is a colles fracture?
fracture of distal radius but the broken end of radius is bent backwards (dorsally displaced)
what age pop is coleus fracture common in?
-common in middle aged and elderly women
-NB osteoporosis
what is the MOI for a colles fracture?
fall on outstretched hand
what is a smiths fracture?
fracture of distal radius w/ volar displacement
what is Bartons fracture?
fracture of distal radius - compression fracture - intraarticular
what deformity is seen with colles fracture?
classical dinner fork deformity
what are complications of colles fracture?
-complex regional pain syndrome (sympathetic NS dysfunction)
-carpal tunnel syndrome
-rupture EPL tendon
-malunion / deformity
how is a colles fracture managed?
-manipulation under anaesthetic
-POP short arm cast - 4-6 weeks
-ORIF - K wires (removed when fracture healed), POP for 6 weeks
what is the MOI of smiths fracture?
patient lands w/ wrist flexion
what is important to note about osteoporosis & wrist fractures?
-high degree of suspicion if coleus fracture presents with low force
-wrist fracture is most common fragility fracture in perimenopausal and young post menopausal women
-DEXA scan needed
how is a smiths fracture managed?
-reduction of fracture
-long arm plaster - above elbow in supination, wrist ext and elbow flex
-remove POP 6 weeks and refer to physio
what is the MOI for Bartons fracture?
fall on extended and rotated wrist
what can Bartons fracture also be associated?
dislocation of wrist
how is Bartons fracture managed?
-ORIF to ensure stabilisation
-need to restore radoiocarpal joint integrity
-below elbow cast
what are the most common fractured carpal bones?
-scaphoid
-triquetrum
-trapeuzium
how can smiths and coleus fracture be differentiated from Bartons fracture?
bartons fracture is intraarticular and also involves carpal displacement / dislocation
Describe a scaphoid fracture - MOI, what pops is it common in?
-MOI - fall on outstretched hand w/ wrist extension and radial deviation
-rare in younger children
what would a patient w/ a scaphoid fracture present with?
-radial sided pain
-swelling
-limited range of wrist motion
-tenderness in the anatomical snuff box
-pain with axial loading along thumb
how is a scaphoid fracture managed conservatively?
-cast immobilisation for minimum 6-8 weeks
-can often need longer or transfer to a thumb spica splint after 6 weeks
-can take up to 3 months to heal
how can a scaphoid fracture be managed surgically?
-ORIF
-immobilised in thumb spica for 4-6 weeks post op
what is the MOI for a triquetrum?
-direct blow to the dorsum of the hand or a fall resulting in extreme dorsiflexion of the wrist
how is a trapezium fracture managed ?
- if non displaced immobilised in thumb spica
-surgery if displaced - OORIF
what is a Bennetts fracture?
-a radial intraarticular fracture at the base of the 1st metacarpal phalangeal joint
what is a MOI for a trapezium fracture?
-direct blow to the dorsum of the hand or a fall onto a radially deviated closed fist
what is the MOI for a Bennetts fracture?
-FOOSH - fall on outstretched hand
what are the symptoms of Bennetts fracture?
- pain
-swelling at the base of the thumb
-limited ROM
-pain and weak pinch grip
-reduction and painful grip strength
what is a Rolando fracture?
- a comminuted intra-articular fracture at the base of the 1st MCP
what is an MOI for a Rolando fracture?
-punch or FOOSH with thumb in partial flexion
what is the most common upper limb fracture?
finger fractures
what are common site of finger fractures?
- base of 5th phalanx
-distal phalanx of 4th
what is a boxers fracture & MOI?
-fracture to neck of 5th MCP
-MOI - punching @ speed
what are the symptoms of a boxers fracture?
-reduced ROM of 5th digit
-swelling and pain in hand
-may or may not have malalignment
how is boxers fracture managed?
-casting
-may to may not need closed reduction w/ physio if non displaced
-surgery if displaced and immobilisation and physio
what is important physiotherapy treatment for forearm, wrist and finger fractures?
-POLICE
-strengthening & ROM exercises - wrist fingers, thumb, elbow
-manual therapy once fracture well healed
-hand function - gross grip and fine grip
