Hand Injuries Flashcards
how to scaphoid fractures present
occur after FOOSH, tenderness in anatomical snuff box and pain on compressing the thumb metacarpal
cant see on xray for 2 weeks
how are scaphoid fractures treated
undisplaced = plaster cast for 6-12 weeks displaced = special compression screw sunk into bone
what are complications of scaphoid fracture
non union (synovial fluid inhibiting fracture healing - treated with screw fixation and bone grafting) and AVN of proximal pole
what is a peri-luntae dislocation
uncommon dislocation of one of carpal bones around lunate, results from dorsiflexion
what would be found in peri-lunate dislocation
xray = loss of alignment of capitate and lunate with concave lunate fossa being empty
may be associated fracture through scaphoid
median nerve injury / acute carpal tunnel may be present
how is peri lunate dislocation treated
emergency = closed reduction and percutaneous pinning or open reduction if closed reduction not possible
what is lunate dislocation
similar high energy injury where lunate dislocates whilst remainder of carpal bones remain enlocated
what is classic radiographic sign of lunate dislocation
split cup sign of lunate which is usually tilted volarly and empty like a split tea cup
what is treatment of lunate dislocation
emergency closed +/- open reduction and pinning
what is a scapho-lunate dissociation and how is it shown on xray
occurs when scapho-lunate ligaments rupture. Shown by increased gap between scaphoid and lunate on AP xray
what happens if scapho-lunate dissociation left untreated
OA
what is treatment of scapho-lunate dissociation
closed reduction and k‐wiring with or without scapholunate ligament repair
chronic cases without OA may be treated with soft tissue tethering to the distal pole of the scaphoid to prevent hyperflexion (dorsal capsulodesis)
Once OA is present partial or total wrist fusion may be required to improve symptoms.
what do penetrating hand injuries risk damage to
volar surface = flexor tendons, digital nerves and digital arteries
dorsal surface = damage to extensor tendons
how are penetrating hand injuries treated
complete or significant partial tendon injuries require surgical repair
what is treatment of extensor tendon injuries
extensor tendon divisions of 50% or more usually require surgical repair with splintage in extension for 6 weeks as any flexion within this period may cause failure of the repair.
what is mallet finger
avulsion of extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of extended DIPJ, often from ball at sport
how does patient with mallet finger present
pain, drooped DIPJ of affected finger and inability to extend at DIPJ
injury may be purely tendinous avulsion or may have bony fragment
how is mallet finger treated
mallet splint holding the DIPJ extended which should be worn continuously for minimum of 4 weeks
fractures of what metacarpals are usually treated conservatively
3rd, 4th and 5th
the 3rd and 4th metacarpals
how does fracture of 5th metacarpal occur
punching injury - boxers fracture
how are boxers fractures treated
neighbour strapping of the affected digit to the adjacent finger and early motion to maintain function
what is a “fight bite” and why is this bad
laceration sustained to fighters hand from poor guys tooth
this could penetrate MCP or disrupt extensor tendon, could also cause septic arthritis
how are most phalangeal fractures treated
neighbour strapping or splintage
significantly displaced or angulated fractures may require manipulation under anaesthetic or digital nerve block (ring block)
unstable fractures may require K‐wiring or fixation with small screws
Intra‐articular fractures may be fixed with k‐wires or small screws.
