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)
management of displaced boxer’s fracture
If significant angulation
Rare
Percutaneous K-wiring
where does the bennett fracture extend to
in 1st metacarpal
Fracture extends into 1st CMCJ
causes of bennett’s fracture
Punching injury
what makes bennett’s fracture unstable
Proximal segment trapezium
Oblique
Muscle pull
treatment of bennett’s fracture
Rx - POP / ORIF (pin/wire)
Thumb spica
Vulnerable to non-union
multiple metacarpals fracture treatment
ORIF
K wiring
+ Cast
mechanism of injury of phalangeal fracture
Twisting force fall on hand
Rotation deformity common
what should be monitored with a phalangeal fracture
bone tendon integrity
management of stable phalangeal fracture
buddy strap / finger splint
management of unstable phalangeal fracture
ORIF
finger exercises to improve joint mobility
isolated exercise stabilising proximal joint and move distal joint hook fist straight fist full fist DIP flexion PIP flexion
