Fracture Types - Hand And Wrist

Question 1

Complete fracture

Answer 1

fracture in which bone fragments separate completely

Question 2

Incomplete fracture

Answer 2

fracture in which bone fragments are still partially joined

Question 3

Transverse

Answer 3

Fracture at eight angle to bone long axis (straight line)

Mechanism = direct force e.g kick or blow from bat

Question 4

Oblique

Answer 4

Fracture that is diagonal to bones long axis

Mechanism = shearing or twisting

Question 5

Spiral

Answer 5

Fracture where at least one part of bone has been twisted (spiral look)

Question 6

Comminuted

Answer 6

Fracture that has two or more fragments

Question 7

Impacted

Answer 7

Fracture caused when bone fragments are driven into each other (top aspects, looks squashed)

Question 8

Intra- articular

Answer 8

Fracture that has involvement with articular surface

Question 9

Avulsion fracture

Answer 9

• bone fracture which occurres when fragment of bone tears away from main mass of bone
• result of physical trauma
• can occur at ligament due to application forces external to body (e.g fall or pull)
• or at tendon due to muscular contraction that is stronger than forces holding bone together

Question 10

Mallet finger

Answer 10

Anatomy =avulsion fracture/ extensor digitoxin tendon tear

Mechanism = forced flexibility if extended digit

Treatment = splint x 4 weeks/ORIF

Question 11

ORIF

Answer 11

Open reduction internal fixation

Question 12

Gamekeepers/skiers

Answer 12

• due to chronic stretching of ulnar collateral ligament
• most cases = ligament torn and standard radiographs appear normal
• occasionally = avulsion fracture of base of proximal phalanx at insertion of ligament
• more common amongst skiers = due to fall on outstretched hand with abducted thumb caught in pole strap
• also seen in rheumatoid arthritis

Question 13

UCL

Answer 13

Ulnar collateral ligament

Short ligament that originated from metacarpal head and inserts into medical aspect and base of proximal phalanx of thumb

Question 14

Bennett’s fracture

Answer 14

dislocation of base of first metacarpal

(Bottom of metacarpal)

Mechanism = trauma force going down the length of the first metacarpal bone, semi bent CMC joint (I.e punching movement)

Injury can occur from punching, sport e.g football goalkeeper

Question 15

Distal interphalangeal joint DIP

Answer 15

Mechanism = forced hyperextension

IP joint = hinge joint allows only flexion and extension and consists of several ligamentous complexes

Volar plate = provides stability against dislocation, often associated with avulsion fracture at base of phalanx
Very thick ligament & prevents hyperextension from occurring

Question 16

Boxers/fighters fracture

Answer 16

Mechanism = punch injury

Fighters fracture = When the blow is struck with the wrist flexed and commonly results in fracture of 4th and 5th Mc

Boxers fracture = fight with wrist in Neutral position and results in fracture of 2nd and 3rd Mc

Question 17

Distal radial fracture

Answer 17

result from fall on outstretched hand

FOOSH mechanism

Question 18

FOOSH

Answer 18

Fall on outstretched hand

Question 19

Colles fracture

Answer 19

Associated with avulsion fracture of ulna styloid process

Occurred in older people 45-60 years

Fracture fragment = displaced dorsally,
(Dinner fork deformity on lateral view)

Question 20

Smiths fracture

Answer 20

Following impaction of supinated forearm against a dorsi-flexed wrist

Less common than colles fracture

Fragment has Palmer displacement

Question 21

Undisplaced fracture

Answer 21

Fracture fragment had been impacted

Loss of radial height common sign

Question 22

Scaphoid fracture

Answer 22

Most common fractured carpal bone

Mechanism = FOOSH or direct force

Question 23

Vascularity of scaphoid

Answer 23

• supplied by branches of radial artery at distal end
• middle & distal pole of scaphoid = direct blood supply
• proximal pole = no direct blood supply
• blood supply to proximal pole enters at the waist = supply can be cut off by a fracture at waist
• proximal pole is at risk from delayed union/ avascular necrosis = where proximal fragment collapses and becomes radiographically denser