Fractures: Wrist and Hand

Question 1

What is a Colles’ fracture?

Answer 1

• Transverse # of radius along metaphysis
• Dorsal displacement and angulation
• 1 inch proximal to radiocarpal joint

NO ARTICULAR INVOVLEMENT

Question 2

When do Colles’ fracture classically present?

Answer 2

FOOSH

Question 3

What type of deformity is a/w Colles’ fractures?

Answer 3

Dinner fork type deformity

Question 4

What is a Bennett #?

Answer 4

Intra-articular # at the base of the thumb metacarpal

Due to forced abduction of first metacarpal (e.g. in fist fights)

Question 5

What is seen on x-ray in a Bennet #?

Answer 5

Triangular fragment at base of thumb metacarpal

Question 6

What is a Dupuytren #?

Answer 6

Medial malleolus avulsion fracture
Posterior malleolus fracture
Tibiofibular ligament rupture

Question 7

What is a Galeazzi #?

Answer 7

fracture of the radial shaft

dislocation of the ulna from its articulation with the radius at the distal radio-ulnar joint

Question 8

When do Galeazzi # typically occur?

Answer 8

Fall on hand with rotational force

Question 9

In whom do Galeazzi #s present?

Answer 9

Children

Question 10

What is a Smith #?

Answer 10

Distal radius # a/w volar angulation and displacement (‘Garden spade deformity’)

Question 11

How are Smith # commonly caused?

Answer 11

Falling onto the POSTERIOR aspect of the outstretched hand

(E.g. by falling backwards or falling with flexed wrists)

Question 12

Another term for Smith #?

Answer 12

Reverse Colles’ #

Question 13

When do Galeazzi # typically occur?

Answer 13

Fall on hand with rotational force

Question 14

What is seen on x-ray in Galeazzi #?

Answer 14

Displaced radial fracture
Prominent ulnar head due to dislocation of inferior radioulnar joint

Question 15

What is seen on examination in Galeazzi #?

Answer 15

Bruising, swelling, tenderness over lower forearm

Question 16

What is a Barton’s #?

Answer 16

Distal radius fracture + radiocarpal dislocation

Question 17

How may Barton’s # occur?

Answer 17

Fall onto extended and pronated wrist

Question 18

What is the most common type of carpal fracture?

Answer 18

Scaphoid

Question 19

What does the scaphoid form in the anatomical snuffbox?

Answer 19

Floor

Question 20

A FOOSH can cause what types of scaphoid fractures?

Answer 20

Tubercle
Waist
Proximal 1/3

Question 21

Main signs of scaphoid fractures?

Answer 21

Tenderness and swelling in anatomical snuffbox - MAIN
Pain on wrist movement
Pain on longitudinal thumb compression (telescoping)

Question 22

Ix for suspected scaphoid fracture?

Answer 22

Ulnar deviation AP

Question 23

How may scaphoid fractures occur?

Answer 23

Direct hard blow to palm
FOOSH

Question 24

define a monteggia fracture?

Answer 24

proximal third of ulnar shaft
anterior dislocation of radial head at capitellum

Question 25

mx of unstable fractures?

Answer 25

open repair in adults manipulation under anaesthesia and cast for children

Question 26

what is seen in a monteggia fracture on xray?

Answer 26

radiocapitellar line does not pass through middle of capitellum of humerus

Question 27

what is seen in a galeazzi fracture on xray aside from the fracture?

Answer 27

widened distal radioulnar joint (ap) ulna displaced dorsally (lat)

Question 28

what is a chaffeur's fracture?

Answer 28

intraarticular fracture of radial styloid due to direct trauma or forced dorsiflexion and abduction of wrist

Question 29

what is a boxer fracture?

Answer 29

transverse # through MT5 punching hard surface

Question 30

comps of colles' fractures?

Answer 30

mal/nonunion sudek's atrophy extensor pollicis longus rupture median n. injury carpal tunnel syndrome frozen shoulder (due to fall causing shoulder injury as well rather than due to fracture itself)

Question 31

mx of scaphoid fracture?

Answer 31

place wrist in beer glass position and cast it start treatment even if no initial radiographical evidence of fracture

Question 32

how does scaphoid AVN present?

Answer 32

pain and stiffness at the wrist

Question 33

indications for surgery in a boxer's fracture?

Answer 33

Significant rotation or angulation of the affected fingers. Articular involvement of the fracture Multiple metacarpal fractures Open fractures

Question 34

most common carpal bone fracture?

Answer 34

scaphoid then triquetrum