Hand Fractures Flashcards
hand fractures
Scaphoid Fracture
Carpal Dislocations
Metacarpal Fractures
Phalangeal Fractures
cause of scaphoid fracture
Fall on outstretched hand
violent hyperextension
location of scaphoid fractures
Distal & proximal pole
Waist / tubercle
Most common site of fracture is the waist (80% )
most common site of scaphoid fracture
With waist and proximal 1/3 fractures the blood supply of the scaphoid is disrupted.
Increased risk of tendency of non- union and AVN (5-15%)
types of scaphoid fractures
stable/undisplaced
unstable/displaced
most of blood supply for scaphoid
form branch of radial artery
clinical signs of scaphoid fracture
tenderness and swelling of snuff box
pain w/ pinch grip
may not be present
methods of diagnosing scaphoid fracture
Bone scan
CT
MRI
Re-xray
management of scaphoid non or minimally displaced fracture
Thumb spica cast
Wrist in neutral position
+ Sling
management of displaced scaphoid fracture
ORIF Herbert compression screw Kirschner (K) wires Non-union may require bone grafting Thumb Spica Cast 2 - 3 months
complications of scaphoid fracture
AVN Non-union Advanced OA Carpal Instability Post-op damage sensory Branch Radial Nerve
cause of carpal dislocations
Fall outstretched hand
High energy injuries
Relatively uncommon
different types of carpal dislocations
Perilunate dislocation
Scapholunate dislocation
+ More
how is perilunate dislocation
Easily missed - need lateral X-Ray
management and complications of perilunate dislocation
Accurate reduction MUA POP x 4/52 If unstable – ORIF (K-wire) Complication – Median Nerve palsy AVN OA
most common type of carpal instability
scapho-lunate dislocation
cause of scapholunate dislocation
similar to scaphoid fracture, except hand may be in ulnar deviation
+/- fracture radial styloid
signs and symptoms of scapholunate dislocation
Pain/swelling on dorsal/radial side of wrist
“Clicking” sensation with wrist movement
3 types of metacarpal fracture
Neck
Oblique: rotation deformity
Transverse comminuted
- stable/unstable
management of stable metacarpal fracture
Buddy Strapping
management of unstable metacarpal fracture
ORIF (wire/plate)
management of metacarpal or phalangeal fracture
Strapping ‘buddy tape’ Splint / POP Functional position of MCP 70-900 flexion PIP + DIP’s extended Thumb abducted Difficult reduction - ORIF
boxer’s fracture cause
Fracture to Neck of Metacarpal (4th and 5th most common)
Usually caused by direct blow to immovable object
management of non-displaced boxers fracture
If small amount of angulation
Immobilise (Ulnar Gutter Cast)
