Fractures of the hand and wrist

Question 1

What is Bennet’s fracture?

Answer 1

This is a fracture of the 1st metacarpal base

Question 2

What is the most common cause of Bennet’s fracture?

Answer 2

Forced hyper-abduction of the thumb, usually caused by an axial force applied to the thumb in flexion

Question 3

What are some possible complications of Bennet’s fracture?

Answer 3

The fracture can extend into the 1st carpometacarpal joint leading to instability and subluxation of the joint, which needs surgical repair

Question 4

What are some risks associated with missing a Bennet’s fracture?

Answer 4

If missed, the articular cartilage of the CMC joint can degenerate, leading to defomrity, dysfunction and arthritis

Question 5

How will patients with a Bennet’s fracture usually present?

Answer 5

• Acute pain in thumb base
• Swelling
• Ecchymosis
• Tenderness to palpation
• Pain on motion

Question 6

What is shown on this X-ray?

Answer 6

Bennet’s fracture

Question 7

Why will most Bennet’s fractures require surgery?

Answer 7

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

Question 8

What surgical options are used in fragmentation of the bone in Bennet’s fracture?

Answer 8

Surgical reduction
Fixation with K-wires

Question 9

What is a Boxer’s fracture?

Answer 9

This is a fracture of the neck of the 5th metacarpal

Question 10

What is the most common cause of Boxer’s fracture?

Answer 10

A clenched fist hitting a hard object (e.g. person, wall)

Question 11

How will Boxer’s fractures usually present?

Answer 11

• Dorsal hand pain
• Swelling
• Possible deformity

Question 12

What is shown in this X-ray?

Answer 12

Boxer’s fracture

Question 13

How is Boxer’s fracture managed?

Answer 13

Management of Boxers fracture requires a buddy strap, in which the pinky and ring finger are strapped together, with early mobilisation required

Question 14

What is the most commonly fractured carpal bone?

Answer 14

Scaphoid bone

Question 15

What is the most common cause of scaphoid fracture?

Answer 15

FOOSH (Fall onto out-stretched hand)

Question 16

What is a possible complication of scaphoid fracture?

Answer 16

Radial artery rupture leading to:
- Non-union
- Avascular necrosis
- Early wrist osteoarthritis

Question 17

How will scaphoid fractures usually present?

Answer 17

Pain and tenderness in anatomical snuff box

Question 18

What 4 x-ray views are required in scaphoid fracture?

Answer 18

• AP
• Lateral
• 2x oblique

Question 19

How are scaphoid fractures managed?

Answer 19

Management can either be conservative, requiring a cast, or operative using ORIF

Question 20

What is the most common cause of distal radius fracture?

Answer 20

FOOSH (Fall onto out-stretched hand)

Question 21

What are some fracture patterns in distal radial fracture?

Answer 21

Colles fracture
Smith’s fracture
Barton’s fracture

Question 22

How are fracture patterns to the hand and wrist described?

Answer 22

When describing fracture patterns, its important to describe the movement of the most distal fragment of the fracture

Question 23

What are Colles fractures?

Answer 23

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)

Question 24

What are Smith’s fractures?

Answer 24

Smith’s fracture are intra-articular, dorsally displaced distal radius fractures

Question 25

What are Barton’s fractures?

Answer 25

Barton’s fractures are intra-articular volarly displaced distal radius fracture

Question 26

What is shown in this X-ray?

Answer 26

Colle’s fracture

Question 27

What is shown in this X-ray?

Answer 27

Barton’s fracture

Question 28

What is shown in this X-ray?

Answer 28

Smith’s fracture

Question 29

How are un-displaced or minimally displaced distal radial fractures managed?

Answer 29

Conservatively managed using a splint

Question 30

How are Colles fractures, especially in elderly patients mostly managed?

Answer 30

Casting

Question 31

What are some surgical managements used in distal radial fracture?

Answer 31

K-wires
ORIF
External fixators (Comminuted fractures)

Question 32

What are K-wires?

Answer 32

K-wires are temporary wires forming a cross, with one wire through the radial styloid