Fracture Types - Hand And Wrist Flashcards
Complete fracture
fracture in which bone fragments separate completely
Incomplete fracture
fracture in which bone fragments are still partially joined
Transverse
Fracture at eight angle to bone long axis (straight line)
Mechanism = direct force e.g kick or blow from bat
Oblique
Fracture that is diagonal to bones long axis
Mechanism = shearing or twisting
Spiral
Fracture where at least one part of bone has been twisted (spiral look)
Comminuted
Fracture that has two or more fragments
Impacted
Fracture caused when bone fragments are driven into each other (top aspects, looks squashed)
Intra- articular
Fracture that has involvement with articular surface
Avulsion fracture
- 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
Mallet finger
Anatomy =avulsion fracture/ extensor digitoxin tendon tear
Mechanism = forced flexibility if extended digit
Treatment = splint x 4 weeks/ORIF
ORIF
Open reduction internal fixation
Gamekeepers/skiers
- 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
UCL
Ulnar collateral ligament
Short ligament that originated from metacarpal head and inserts into medical aspect and base of proximal phalanx of thumb
Bennett’s fracture
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
Distal interphalangeal joint DIP
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
Boxers/fighters fracture
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
Distal radial fracture
result from fall on outstretched hand
FOOSH mechanism
FOOSH
Fall on outstretched hand
Colles fracture
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)
Smiths fracture
Following impaction of supinated forearm against a dorsi-flexed wrist
Less common than colles fracture
Fragment has Palmer displacement
Undisplaced fracture
Fracture fragment had been impacted
Loss of radial height common sign
Scaphoid fracture
Most common fractured carpal bone
Mechanism = FOOSH or direct force
Vascularity of scaphoid
- 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
