Hand & Wrist Fractures Flashcards
Types of bone fracture
- Transverse (right angle fracture)
- Oblique (at an angle)
- Spiral (corkscrew around bone)
- Segmental (2 or more large fragments)
- Comminuted (breaking into multiple fragments 3 or >)
Define compound fracture
is when the skin is broken and the broken bone is exposed to the air. The broken bone can puncture through the skin.
Define a pathological fracture
refers to when a bone breaks due to an abnormality within the bone
what is a stable fracture
refers to when the sections of bone remain in alignment at the fracture
whar are the soft tissues that can be effected by fracture
- ligaments
- tendons
- blood vessels
- nerve
- skin
- muscles
why is it important to assess soft tissue damage in bone fracture
it impacts healing, treatment, and complications
soft tissue blood supply factor complications
- poor healing
- delayed union
- non-union
soft tissue infection risk factor
- open fracture
- infection risk: e.g. osteomyelitis
soft tissue compartment syndrome complication
soft tissue injury –> internal haemorrhage / oedema –> increase Pa restrict blood flow –> ischaemia
soft tissue neovascular complications
damage to nerves / vessels –> loss of sensation, function, ischaemia (e.g. scaphoid, humerus)
Bone fracture complications
- Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung)
- Haemorrhage leading to shock and potentially death
- Compartment syndrome
- Fat embolism
- VTEs (DVTs and PEs) due to immobility
- AVN
- Infection (osteomyelitis)
- chronic pain
Define Colles’ fracture
A transverse/extra-articular fracture of the distal radius near the wrist, causing the distal portion to displace posteriorly (upwards), causing a “dinner fork deformity”.
what is the common cause of a Colles’ fracture
FOOSH forward
what bone fracture does FOOSH commonly cause
- Colles’
- Scaphoid
Scaphoid fracture complication
- AVN - due to retrograde blood supply from radial artery
- non-union due to poor blood supply
Scaphoid fracture signs
- tenderness in the snuff box
- pain on telescoping the thumb
- pain on palpating the scaphoid tubercle
Scaphoid fracture Ix
- X-ray series (AP, Lat., obliique)
when to repeat x-rays for scaphoid
10-14D post -ve initial X-rays and clinical suspicion
Scaphoid fracture Mx
- Undisplaced: strict immobilisation in a plaster with a thumb spica splint.
- Displaced/non-proximal pole: surgical Tx
Colles’ fracture clinical presentations
- usually post a fall
- severe pain
- swelling to the wrist
how to examine for neovascular compromise in a fracture
limb perfusion (CR, Pulses) nerve function (sensation/motor)
Wrist fracture neuro exam locations for radial, median and Ulnar
Radial: 1st web, ext. of thumb
Median: 2nd digit, abductn of thumb
Ulnar: 5th digit, adductn of thumb
Colles’fracture X-ray features
- Transverse fracture
- post. displacement
Colles’ Mx
- Analgesia / local anaesthetics
- remove jewllery
- manipulation + closed reduction
- hold: restricted mobilisation (plaster cast)
- repeat X-ray for displacement
- rehab (physio)
Colles’ complications
- Malunion: poor re-alignment (shorted radius)
- Median nerve compression
- OA
which nerve injury is common with Colles’ fracture
Median nerve
