KIN 428 Final Flashcards
Where does elbow bursitis usually occur?
Primarily in the olecranon bursa
What are the causes of elbow bursitis?
Trauma, accumulation of small trauma, sustained pressure on the elbow, contusion fills with fluid
What are symptoms of elbow bursitis?
large swelling, tenderness, fever (if due to infection), pain at elbow tip, minor decreases in elbow ROW
Conservative treatment for elbow bursitis?
Elbow pads for protection (especially for machinists), inflammation treatment (antibiotics, cortisone shot)
Surgical treatment for elbow bursitis?
fluid draining (remove pressure), bursa removal (same general idea to remove pressure)
What is Panner’s Disease?
Disruption of the capitellum growth plate
What causes Panner’s disease?
Several theories: hereditary, repeated trauma (Little League Arm or compromised vascularization)
Symptoms of Panner’s Disease?
Elbow tenderness (exacerbated by activity) and inability to achieve full extension (bony damage)
Diagnosis of Panner’s disease?
radiographs to find bony abnormalities
Nonsurgical treatment of Panner’s disease?
Reduction of sports activities (pitch count in Little League) and anti-inflammatories.
Surgical treatment of Panner’s disease?
Very rare because kids heal well and it usually self resolves
WHat is osteoarthritis of the elbow?
damage to cartilage/joint articulating surface
What causes osteoarthritis at the elbow?
subsequent to injury (altered mechanics = different wear), age-related degeneration, strenuous manual labour, untreated instability such as ligament damage and laxity (also alters mechanics)
Symptoms of osteoarthritis of the elbow?
pain, loss of ROM< locking sensation, joint swelling, finger numbness, visible osteophyte formation
Non-surgical treatment of osteoarthritis at the elbow?
anti-inflammatory drugs, physical therapy, activity modification, steroidal injections
What is the main point of treatments for osteoarthritis at the elbow?
To reduce pain because it is pretty much impossible to “fix” osteoarthritis
Surgical treatments for osteoarthritis at the elbow?
elbow fusion (rare), interposition athroscpoy, arthroscopic loose body removal, joint replacement
What is interposition arthroplasty?
Arthritic joint surfaces areremoved and fascia is placed between the bones. Healing creates scar tissue as a false joint surface. “surrogate cartilage”
Why is the elbow a trochoginglymus joint?
3 articulations in same articular capsule
Locations of fractures at the elbow?
olecranon, radial head, supracondylar
Risk factors for elbow fractures?
advancing age, decreased muscle mass, osteoporosis, participations in contact sports
Elbow fractures are caused by trauma in the form of…
FOOSH, direct fall on elbow, direct blow to elbow, hypermotion (outside normal ROM, mostly from hyperextension because more bones are in contacnt so more likely to fracture)
Symptoms of an elbow fracture?
severe pain, tenderness, bruising around the elbow, swelling, numbness in fingers, hand or forearm. Decreased ROM. A lump or visible deformity over the fracture site.
Classification of elbow fractures focuses on?
fracture displacements, fracture line direction, articular comminution, articular involvement, % of joint involved in fracture (comorbidities)
2 types of olecranon fractures?
Comminuted (direct blow, 2+ parts). transverse (traction lesion from triceps, 1 part)
Causes of olecranon fractures?
direct blow to elbow, fall on flexed blow
Symptoms of olecranon fractures?
sudden intense pain, bruising, numbness in fingers, pain with joint movement
Classification/treatment for Type I olecranon fracture?
little displacement, conservative splint/sling
Classification/treatment for Type II olecranon fractures?
Most common, relatively stable, usually surgical ORIF and immediate PT after
Classification/treatment for Type III olecranon fractures?
> 50% articulating surface (the more proximal on the humerus the humerus the more unstable it is), always ORIF
General treatment of olecranon fractures?
If no displacement of the bone: alignment in a proper position with use of a splint (no elbow flex/ext because it uses the triceps and you don’t want any triceps activation). If displacement of the bone exists: surgery/
Secondary pathologies of olecranon fractures?
Nonunion (due to traction by triceps), and loss of motion may result
Occurrence/causes of radial head fractures?
20% of traumatic elbow injuries, women»_space; men, 30-40, approx. 10% of dislocations
Symptoms of radial head fractures?
pain on outside of elbow, swelling, decreased ROM in pronation and supinationC
Classification/treatment of Type I radial head fracture?
usualyl cracks, undisplaced. Conservative treatment with slings and early motion
Type II radial head fracture classification/treatment?
larger displacement, but repairable, Surgically remove small fragments, ORIF if possible, radial head removal (elderly)
Type III radial head fracture classification/treatment?
More than 3 bone fragments, Usually other joint damage (fracture/dislocation), surgery required.
As the type number of radial head fractures increases, what happens to the enery needed for hte fracture?
It increases
Secondary pathologies of radial head fractures?
a loss of elbow extension and rotation (pro.supination) of forearm
What is a supracondylar fracture?
fracture through the lower end of the humeral shaft
Two types of suparcondylar fractures, and which is most common?
flexion and extension (most common)
Type I supracondylar fracture?
non-displace
Type II supracondylar fracture?
displaces with intact posterior cortex
Type III supracondylar fracture?
displaced with no cortical contact
Supracondylar fracture treatment?
If no displacement: immobilize arm by use of a splint. If displacementL bones need to be reduced and a pin will be used to hold the bones in place
Secondary pathologies of a supracondylar fracture?
transcondylar fracture, intercondylar fracture, condylar fractures
What is a transcondylar fracture?
loss of motion can result from callus formation in the olecranon or coronoid fossae
What is an intercondylar fracture?
a loss of joint function may result
What is a condylar fracture?
Non-union, arthritis, cubitus carus or valgus deformity, and lateral transposition of the forearm may occur. If coronoid process fractures are untreated, they may lead to instability of the joint.
Why are there so many possibilities for different injury patterns at the elbow?
Because there is so much allowed movement
What is the “arc of injury” at the elbow?
different angles of the elbow joint yield different fractures under the same direction of force.
What does the radial head articulate with?
the capitellum
Pronation =
maximal contact of radial head with capitellum + minimal rension of interosseous membrane
FOOSH for a radial head fracture?
forearm pronated + the elbow partially flexed. Radial head will absorb the indirect force of the fall and impacts on the capitellum (severity based on contact)
In what range do radial implications usually occur?
0-80 degrees of flexion
What does the olecranon articulate with?
the trochlea
In what range do most olecranon fractures occur?
60-110 degrees flexion…“mid range”
How does the olecranon fracture during hyperextension?
Acts as a fulcrum and fractures due to bending load
How does the olecranon fracture during full flexion?
load passes through point of elbow (tip of olecranon has to support humerus)
In what range of flexion do the humeral condyles usually fracture?
115-145, direct, humeral condyles are exposed
In what range of extension do the humeral condyles usually fracture?
40-60 degrees, indirect, 45 degrees incline
2 cumulative mechanisms for humeral condylar fractures?
hyperextension and overhead throwing
How does overhead throwing lead to condylar fractures at the elbow?
Throwing = high valgus stress on medial aspect of joint. Forces > tensile strength of the ligament and produces tears/avulsions. Continued throwing can lead to alteration of rupture of the ligament. Olcranon stress fracture and loose bodies because if you lose ligaments, you lose stability, the bones grind, and then you get a stress fracture.
Radial head ORIF general technique?
Lateral incision from lateral epicondyle to distal radial neck. Internal between anconeous and ECU. Incision along parallel fibers of LCL. Fracture exposed. Temporarily reassembled with K-wires. Herbert Screws and mini plates fix radial head to shaft.
What is the point of olecranon tension band wiring?
Put in a figure 8 configuration to stop the triceps from pulling the joint apart.
What is nursemaid’s elbow?
s a dislocation of the elbow joint caused by a sudden pull on the extended pronated arm, such as by an adult tugging on an uncooperative child or by swinging the child by the arms during play. The technical term for the injury is radial head subluxation
How are elbow dislocations defined?
defined as radial and/or ulnar deviation with respect to the humerus
Types of elbow dislocations?
anterior, posterior, lateral, medial, divergent
2nd most common dislocation joint within adults?
Elbow
Most elbow fractures happen between what ages?
5-25
Do men or women get more elbow fractures?
Men
Why are elbow dislocations happen less in children, and what types of injuries do they more commonly have?
There ligaments are more elastic, so there is greater movement allowed. Tend to have supracondylar fractures and radial head subluxations (nurse’s maid)
What type of dislocations make up >90% of elbow dislocations?
posterior dislocations
Symptoms of elbow dislocation?
intense pain, clear deformity, hand numbness, changes in hand color (blood supply interrupted)
Acute elbow dislocations are caused by?
Traumatic forces (FOOSH, car accident)
Chronic elbow dislocation is caused by?
Laxity of the elbow joint (LCL). Diseased joint: arthritis (very advanced stages), osteoporotic bones, and degeneration of articular cartilage
Optimal conditions for posterior elbow dislocation?
Pathological External Forearm Rotation. 1) Axial loading along forearm (FOOSH) 2) Varus stress 3) 30 degrees flexoim 4) External rotation (PEFR)
Simple dislocation classification at the elbow?
Damage to ligaments and soft tissue only. No major bones injury…may have resulting muscle avulsion and neurovascular damage
Complex dislocation classification at the elbow?
Ligament damage, soft tissue damage, bone damage (may be severe)…may have resulting muscle avulsion and neurovascular damage
Secondary pathologies of elbow dislocation?
Brachial artery disruption, median nerve entrapment, ulnar nerve entrapment, Monetggia fracture, coronoid/olecranon/radial head fracture, avulsion of triceps (anterio dislocations), entrapment of bone fragments, joint stiffness
Pathology of brachial artery disruption?
Rare, 5-13%, hand will be cool on palpitation and have a white or purple hue
Pathology of median nerve entrapment?
complications often occur in skeletally immature people, patient will experience weakness and paraesthia
Why do brachial artery disruption and median nerve entrapment happen together?
anatomic position within the cubital fossa predisposed concomitant median nerve injury with the brachial artery
What is the terrible triad?
Posterior dislocation with radial head and coronoid fracture. High force causes the fracture.Callled the “terrible triad” because of the propensity for complications related to instability, arthrosis and stiffness
What is a Monteggia Fracture?
fracture of the foreaem with dislocation of the proximal RADIOULNAR joint
How are elbow dislocations diagnosed?
Straightforward assessment for elbow dislocation, normally found on examination. With a posterior radiograph a dislocated elbow, a straight line appear when normally a triangle is seen
Treatment for nonsurgical dislocated elbows
reduce the dislocation (put it back in the way it came out), early motion, and strengthening
Surgical treatment for elbow dislocations
Ligament damage+fracture = external hinge fixation
What was the problem with the original external fixation devices for the elbow?
Didn’t have a carrying angle, so there was joint disruption due to improper moving of the joint
What is the surgical goal in an elbow dislocation surgery?
Convert complex fracture-dislocation patterns into simple dislocation patterns through fracture fixation. Every complex fracture-dislocation is case specific, and algorithms are used to simplify the decision
Criteria to get an external fixation of the elbow?
- persistent gross elbow instability following repair or reconstruction of all injured structures 2. the need to protect the repaired structures in the post-operative course 3. there has been a delay in treatment of the elbow fracture-dislocation from the time of injury 4. there is a need for prolonged immobilzation/mobilization of the joint
What is epicondylitis?
Inflammation of the muscles and soft tissue around the epicondyle
Progression of chronic epicondylitis?
Not an inflammatory process (like acute injury), rather a wear and tear of tendon leads to tissue degradation. Produces fibroblasts, causing weak collagen fibers which breaks down and forms scar tissue in tendon as a result
Nirschl’s progressive stages of epicondylitis?
Stage 1 = inflammation (may reverse with rest) Stage 2 = permanent pathologic tissue alterations due to “angiofibroblastic hyperplasia” Stage 3 = structural failure Stage 4 = secondary changes including fibrosis or calcification
What is a more common cause of epicondylitis, chronic or acute?
Chronic…acute is caused by an avulsion, usually
What is tennis elbow?
Lateral epicondylitis
Occurrence/causes of lateral epicondylitis?
most common, actually occurs in extensor carpi radialis brevis aponeurosis, tissue degeneration. From overuse (repeated forceful exertions, traumatic overload)
Risk factors for lateral epicondylitis?
Age 30-50 (70% of cases between 4-50 years). Sport. Smoking. Obesity.
Symptoms of tennis elbow?
burning pain radiating down arm (as far as ring finger), diminished grip strength, pain in gripping in pronated forearm position. Tenderness over insertion.
Tests for lateral epicondylitis?
Resisted wrist extension and radial deviation. Passive forearm pronation, wrist flexion, elbow extension. resisted extension of the 3rd digit/
Relevance to anatomical mechanics in tennis elbow?
10-15% reduction in ROM. Peak torque in wrist extension decreased by about 17%. More common than medial epicondylitis with ratios ranging from 4:1 to 7:1
Whta % of tennis players will develop tennis elbow?
50%
Causal factors in tennis?
Mechanics on one handed backstroke and over head serve related to lateral epicondylitis. Overhead serve–>greatest ROM at the elbow seen in serving moving from 20 to 116 degrees of elbow flexion. High force production in the elbow extensors of pronators (988 d/s and 350 d/s). One handed backstroke requires large force production from wrist extensors and pronator teres to counteract force of ball hitting racket.
treatment options for tennis elbow
rest from usual activities. ice massage (reduced swelling and helps with mobilization of scar tissue), anti-inflammatory drugs, exercise program, forearm strap, surgery (rare <5%, usually removal of granulated tissue)
How does an elbow strap work for tennis elbow?
Acts by reducing tension of the muscles as they atttach to the lateral epicondyle (especaiily ECRB)
Lateral epiondylitis strengthening/rehab program?
1) Isomertric wrist/finger extensor exercises 2) Weight liftings (military press and curls) 3) Flexibility exercises at shoulder/elbow 4. Strengtheninh of wrist extensors (until 90 degrees palmar flexion achieved)
What are some residual problems of lateral epicondylitis?
40% have prolonged discomfort, and 226% have recurring symptoms following treatment (within 5 years…don’t change joint mecahnics, you still get the same response)
Occurrence/causes of medial epicondlyitis/Golfer’s elbow?
Very similar to lateral. Inside of elboww. Flexor overuse from golf, hammering, pitching
Risk factors for medial epicondylitis?
Sex (male to female ratio of 2:1). Age 20-50 years. Sport. Smoking. Obesity.
Causal factors of medial epicondylitis in golf?
Contributing factors include: overuse, poor swing mechanics, lack of conditioning, inadequate warm-up, improper equipment, age, and preexisting pathological mechanisms. Making contact with the ground, especially in cases where a divot is made. The coutneracting forces need to be large in order to control the club face.
Test for medial epicondylitis?
Passive forearm supination, elbow, and wrist extensions.
Symptoms of golfer’s elbow?
Very similar to LE, but in a different location. Pain at medial epicondyle (spreading down forerarm). Wrist bend increases pain, particularly in supination. Grip strength decreases.
Relevance to anaomtical mechanics from medial epicondylitis
13% decrease in peak torque produced during wrist flexion. Assoicated injuries that occur with inflammation and degeneration of tendons include ulnar entrapment and medial collateral ligament damage (due to large valgus force production)
Treatments for medial epicondylitis?
same as for lateral…exercises geared towards flexors
Flexibility and stretching for golfer’s elbow?
wrist flexion, extension, and rotation stretching done regularly to increase ROM in wrist. Extend elbow to increase amount of stretch. Avoid vigorous stetching–no pain
Strengthening for medial epicondylitis?
wrist extension/flexion, forearm pronation/supination, finger extension, ball squeeze. When symptoms are resolved and full range of motion and strength is regained, gradually increase level of playing activity (typically 4-6 months)
Neural entrapment syndromes at the elbow?
cubital tunnel syndrome, radial tunnel syndrome, pronator syndrome
What is ulnar nerve entrapment also known as?
cubital tunnel syndrome
Causes/occurrence of ulnar nerve entrapment?
Ganglionic cysts, repetitive elbow flexion, leaning on elbow, sublux of ulnar nerve, bone spurs, direct blow to tunnel. A distant second to carpal tunnel syndrome.
Symptoms of ulnar nerve entrapment?
numbness on inside of hand, ring and little fingers. Tinel’s sign = tapping nerve sends electrical shock to little finger. Grip weakness, especially with flexed elbow. Loss of manual dexterity.
Special tests for cubital tunnel syndrome?
Tinel’s test. Sustained elbow flexion
Grade I ulnar nerve entrapment
mild lesions, no muscle wasting, “clumsiness” (feel like you don’t have any control)
Grade II ulnar nerve entrapment
intermediate lesions, weak interossei, muscle wasting
Grade III ulnar nerve entrapment
several lesions, paralysis of interossei, marked hand weakness
Non-surgical treatments for ulnar nerve entrapment
splinting, activity reduction, anti-inflammatory drugs
Surgical management of cubital tunnel syndrome?
Nerve transposition (moved ulnar nerve from cubital tunnel and move it elsewhere to stop compression of it). Medial epicondyle shaving (increase the cubital tunnel space by shaving some of the epicondyle off)
What is radial tunnel syndrome? What causes it?
Compression of radial nerve (mostly by muscles) Caused by a narrow tunnel, repetitive and forceful pulling and pushing, or a direct blow
Symptoms of radial tunnel syndrome
tenderness and pain on outside of elbow, dull pain in forearm muscles, muscle weakness and wrist drop, no loss of sensation
Non-surgical treatment for radial tunnel syndrome?
avoid trigger activities, arm splinting
Surgical treatment for radial tunnel syndrome?
remove abnormal pressure, muscle splitting
What is pronator syndrome? What causes it?
median nerve compression. Caused by compression between heads of pronator teres, can be confused with CTS, and from prolonges, reptitive activity
Symptoms of pronator syndrome?
Numbness and tingling in thumb, index, and middle fingers. Pain is localized in proximal forearm. Hypersensitivity to percussion.
Non-surgical treatment for pronator syndrome?
rest, modification of activities, anti-inflammatory drugs (NSAIDs)
Surgical treatment for pronator syndrome?
release of compressing muscular structures, usually the arch of the FDS
2 main functions of the wrist
1) final positioning of fingers and hand once the shoulder and elbow are fixed 2) Force transfer from the shoulder/large muscles to hand and forces from the hand to the body
Bones at the wrist
distal radius and ulna, carpals (scaphoid, lunate, triquetrium, pisiform, trapezium/greater multiangular, capitate, hamate), metacarpals
Joints at the wrist
Distal radioulnar (radius/ulna), radiocarpal (radius and scaphoi, lunate, triquetrium), midcarpal, carpometacarpal, pisotriquetral
Are there muscles in the wrist?
NO. only ligaments and tendons of msucles
Nerves at the wrist
ulnar, median, superficial radial
Muscles for wrist flexion
flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digtial superficialis, flexor digital profundus
Muscles for wrist extension
extensor carpii radialis brevis, extensor carpi radialis longus, entensor carpi ulnaris
Muscles for wrist radial deviation
abductor pollicis longus, extensor carpi radialis longus, extensor carpi radialis brevis, flexor carpi radialis
muscles for wrist ulnar deviation
extensor carpi ulnaris
Structures in the carpal tunnel?
Flexor tendonds and the median nerve
Range of motion for radial/ulnar deviation?
20 degrees radially, 35 degrees ulnarly
Range of of motion for wrist flexion/extension?
Flexion = 70 degrees. Extension = 75 degrees.
What is unique about wrist mechanics?
Unique in that no direct motor control present for each joint/articulation. No active muscle or control, it just responds.
What do wrist mechanics rely on?
Ligamentous engagement (they only act when stretch, and act mostly as checkreins by keeping bones from moving too far. If the movement goes uncheckes, there is altered kinematics and arthritis) . Carpal contact surfaces (joint contact surfaces change….contures and shapes of the carpals drive movement along with what ligaments are resisting. Force on each bone will change based on posture)
2 main classes of ligaments at the wrist
- Crossing carpal rows 2. Within carpal rows (proximal and distal)
What is the ligament crossing the carpal rows? What is its function?
Radiocapitate. Keeps the distal row connected to the radius and acts as a sling for the proximal row.
What is the ligament within the proximal carpal row? What is its purpose?
Interosseous (scapholunate and lunate-triquetral). Limit carpal rotation.
What is the ligament within the distal carpal row? What is its purpose?
Hamate-capitate. Shock absoprtion…limit relative row movement
What are the three parallel columns in the Weber carpal joint contact theory?
1) Force bearing (the central core…metacarpal —> capitate —> lunate —> radius) 2) Control (ulnar side, enables control of movement) 3) Thumb column (radial, all about thumb placement)
Where does palmar flexion take place?
Mostly at the midcarpal joints
Where does extension/dorsiflexion of the wrist take place?
Radiocarpal joint…“locking” of radiocapitate ligament and stops movement
3 links of the wrist
Radius, proximal row (lunate), distal row (capitate)
What are Nanarro and Taleisnik’s columns?
- Cenral (flex/ext) 2. Lateral (radial, mobilits of thumb) 3. Medial (ulnar, rotation)
What is the perilunate instability progression?
Progressive loading in dorsiflexion, ulnar deviation, and intercarpal supination
What type of injuries occur in the greater force arc at the wrist?
Primarily made up of bone, so fractures from direct force
What type of injury usually occurs in the less force arc at the wrist?
Ligamentous injuries caused by ligaments
What is Lichtman’s Ring Concept?
Proximal and distal rows are considered rigid posts stabilized by interosseous ligaments. Mobility controls at the triquetrohamate and scapulotrapezoid. Damage to either link results in DISO/VISI
In a flexed wrist, what are the tendons on the palmar side supported by?
Retinacular and carpal ligaments
In an extended wrist, the extrinisc finger flexor tendons are supported on the dorsal side by?
The carpal bones
At the wrist, what is worse flex or ext, and big or small?
Extension worse than flexion and small wrists are worse than large
3 primary degeneration in the wrist?
1) SLAC wrist (55%…Scapho Lunate Advanced Collapse) 2) Triscaphe arthritis (20%) 3) Combiation (10%)
What is SLAC wrist?
ScaphoLunate Advanced Collapse
What is the progression of the SLAC wrist?
1) Distal radioscaphoid joint 2) Proximal radioscaphoid joint 3) Capitolunate joint (radiolunate joint unaffected)
What is the geometry of the radioscaphoid joint?
2 spoons…even slight rotations can create edge contact
What is the radiolunate joint geometry?
Shaped like a ball and cup, even with abnormal motion there is very little edge contact
At the wrist, what joint will always be conserved?
Radiolunate because of its role in force transmission
What is the treatment of the SLAC wrist based on?
Based on resistance of radiolunate’s propensity for resistance to degenerations (spherical)
Treatment for SLAC wrist?
Fusion of capitate and lunate (trasnfer force transmission, removes rubbing between them). Silastic scaphoid implant (done to avoid carpal collapse, scpahoid removed because it is painful)
What is triscaphe arthritis due to?
usually due to osteoarthritis
What are the symptoms of triscaphe arthritis?
Aching at thumb base, weakness, may be precipitated by dorsiflexion injury, swelling over dorsal joint aspect
Treatment of triscaphe arthritis?
Fusion of triquetral, scaphoid, and trapezium…combination treated as SLAC if possible
What is a crush injury of the carpus, and how is usually treated?
Disruption of carpal arch, capitohamate distally, and pisotriquetral prximally. Comes from flattening of carpal arch. Generally ORIF
Distal radius fractures account for what % of bony wrist injuries?
75%
Scaphoid fractures account for what % of carpal fractures?
70%
Triquetral fractures account for what % of carpal fractures?
14%
Most fractured bone in the body?
Distal radius. Very common and usually traumatic.
Smith’s fracture?
flexion fracture of the radius
Colles’ fracture?
extension fracture of the radius
Barton’s fracture?
intr-articular fracture of the distal radius with dislocation of the radiocarpal joint
Risk factors for distal radial fractures?
Children (bones aren’t completely ossified so buck fractures/greenstick fractures on one side). Elderly (brittleness of cones = decreased bone density). Active pre-senior, especially women (more active than bones can handle)
Causes of Colles’ fracture?
forced extenion and FOOSH
Causes of Smith’s fracture?
Forced flexion, FOOSH
Distal radius fracture classifications are usually based on?
Articular inclusion, comminuted or displaced…all increase in severity with type besides Thomas classification
Principles for managing an unstable fracture?
Accurate reduction (radial length restoration, normal is 9-14 mm and anything less than 6 mm compromises wrist function). Stable reduction. Medial complex must be restored to prevent degenerative distal radial articulation events.
Open reduciton techniques for distal radius fracture?
Generally for more comminuted fractures. Assisted by buttress plate fixation.
Non-surgical treatments for distal radius fracture?
closed manipulation and casting
Surgical treatments for distal radius fractures?
Internal fixation (Kirschner wires and Volar Fixed Angle Plate). External fixation.
Colles’ fracture treatment seequence
3 point cast, short forearm cast, removable wrist brace
How are K-wires places in a Colles’ fracture?
Pins are places at a forty-five degree angle to form a sort of basket which prevents recurrent dorsal tilting
Wht is the fixed angle plate placed volarly not dorsally when repairing a Colles’ fracture?
Because of anatomy…more space for the plate and flexor tendons, less disturbance of blood supply, etc.
Concomitant injuries that come along with a distal radius fracture?
Nerve, soft tissue, other fracture (ulnar head, scaphoid), scapholunate dissociation
Rehab for DR fractures?
Shoulder, elbow and digital motion immediately following reduction. After fracture healing, splinting and gradual exercise intensity increases. Should continue to improve for approx. 8 months
Classifications commonly used for scahpoid fractures?
Mayo, Russe, and Herbert
Risk factors for scaphoid fractures
sports activities (football and skating), MVA, young men (20-30)
Waist scaphoid fracture cause?
Forced dorsiflexion or FOOSH
Proximal pole scaphoid fracture?
Hyperextension and ulnar deviation, dorsal subluxation
Most susceptible bone to fracture amongst carpals?
Scaphoid
Classifcation of scaphoid fractures?
Anatomical (distal, waist, proximal), and directional (horizontal, vertical, transverse)
Treatment for distal and/or medial scaphoid fracture>
Short arm spica cast (SATSC) used for intact fractures. Strict immobilization with cast for 3 weeks. 90-100% proper union within 8-10 weeks.
Surgical treatments for scaphoid fractures?
Percutaneous and arthroscopic guided fixation (with arc wrist traction tower) and placement of a headless cannulated screw. Attempted by volar apporach–preserves dorsal blood supply of scaphoid
Symptoms of a scapholunate dissociation?
“sprained wrist”…low swelling, tenderness over scapholunate joint, pain over dorsoradial wrist accentuated by dorsiflexion
Treatment for scapholunate dissociation?
Ligament repair (interosseus scapholunate, can also damage radioscaphoid)
Symptoms of perilunate dislocation?
Considerable swelling, visible deformities as a result of lunate movement
Treatment for perilunate dislocations?
Cllosed reduction and finger trap traction (avoids carpal collapse by spreading them out), open reduction/fixation. Both allow for ligament healing.
Stage 1 of perilunate dislocation?
Scapholunate dislocation…proximal pull of scaphoid more dorsally, 61% subsequent to scaphoid fracture
Stage II perilunate dislocation?
Capitolunate dislocation…Dorsal dislocation of capitate b/c radiocapitate ligmanet damage
Stage III perilunate dislocation?
Triquetrolunate dislcation…Interosseus lunotriquetral ligaments…capitate is generating large moments on the lunate (spoons)
Stage IV perilunate dislocation?
Radiolunate dislocation…radiotriquetral ligaments, no lunate ligamentous support, “floating” lunate
Diagnostic tests for perilunate dislocations.
Scapholuante ballottement, lunotriquetral ballotement test (Reagan’s), the Watson or Scahoid Shift Test (tests scapholunate instability). The Shuck test (for perilunate instability, looking for a bulge on back of wrist)
Other diagnostic procedures for perilunate dislocations?
Fluoroscopy (flex/ext) to see mobile characterization and MRI to see ligament specific characterization
Treatment for perilunate dislocations
Closed reduction and a finger trap. Open fixation/reduction (high displacement, “floating” lunate)
