Fractures of the hand and wrist Flashcards
What is Bennet’s fracture?
This is a fracture of the 1st metacarpal base
What is the most common cause of Bennet’s fracture?
Forced hyper-abduction of the thumb, usually caused by an axial force applied to the thumb in flexion
What are some possible complications of Bennet’s fracture?
The fracture can extend into the 1st carpometacarpal joint leading to instability and subluxation of the joint, which needs surgical repair
What are some risks associated with missing a Bennet’s fracture?
If missed, the articular cartilage of the CMC joint can degenerate, leading to defomrity, dysfunction and arthritis
How will patients with a Bennet’s fracture usually present?
- Acute pain in thumb base
- Swelling
- Ecchymosis
- Tenderness to palpation
- Pain on motion
What is shown on this X-ray?
Bennet’s fracture
Why will most Bennet’s fractures require surgery?
Following the fracture, there tends to be a small bony fragment attached to the volar beak ligament (a ligament of the CMC joint), which requires surgery
What surgical options are used in fragmentation of the bone in Bennet’s fracture?
Surgical reduction
Fixation with K-wires
What is a Boxer’s fracture?
This is a fracture of the neck of the 5th metacarpal
What is the most common cause of Boxer’s fracture?
A clenched fist hitting a hard object (e.g. person, wall)
How will Boxer’s fractures usually present?
- Dorsal hand pain
- Swelling
- Possible deformity
What is shown in this X-ray?
Boxer’s fracture
How is Boxer’s fracture managed?
Management of Boxers fracture requires a buddy strap, in which the pinky and ring finger are strapped together, with early mobilisation required
What is the most commonly fractured carpal bone?
Scaphoid bone
What is the most common cause of scaphoid fracture?
FOOSH (Fall onto out-stretched hand)
What is a possible complication of scaphoid fracture?
Radial artery rupture leading to:
- Non-union
- Avascular necrosis
- Early wrist osteoarthritis
How will scaphoid fractures usually present?
Pain and tenderness in anatomical snuff box
What 4 x-ray views are required in scaphoid fracture?
- AP
- Lateral
- 2x oblique
How are scaphoid fractures managed?
Management can either be conservative, requiring a cast, or operative using ORIF
What is the most common cause of distal radius fracture?
FOOSH (Fall onto out-stretched hand)
What are some fracture patterns in distal radial fracture?
Colles fracture
Smith’s fracture
Barton’s fracture
How are fracture patterns to the hand and wrist described?
When describing fracture patterns, its important to describe the movement of the most distal fragment of the fracture
What are Colles fractures?
Colles fracture are volarly displaced, extra-articular radius fractures, meaning that the articular surface doesn’t move, but the metaphyseal region of the radius moves anteriorly (Volar)
What are Smith’s fractures?
Smith’s fracture are intra-articular, dorsally displaced distal radius fractures
What are Barton’s fractures?
Barton’s fractures are intra-articular volarly displaced distal radius fracture
What is shown in this X-ray?
Colle’s fracture
What is shown in this X-ray?
Barton’s fracture
What is shown in this X-ray?
Smith’s fracture
How are un-displaced or minimally displaced distal radial fractures managed?
Conservatively managed using a splint
How are Colles fractures, especially in elderly patients mostly managed?
Casting
What are some surgical managements used in distal radial fracture?
K-wires
ORIF
External fixators (Comminuted fractures)
What are K-wires?
K-wires are temporary wires forming a cross, with one wire through the radial styloid
