MSK Hand Teaching Flashcards
what is a Colles #
distal fragment of the radius is displaced dorsally
extra articular #
low energy injury
tends to be from FOOSH
what is a smiths #
volar displacment of the distal fragment of the radius
exta-articular #
fall onto flexed hand or direct blow to posterior hand
low energy injury
what is a bartons fracture
fracture-dislocation of radiocarpal joint
intra-articular fracture
The hand and the fragment of distal radius undergo a proximal and volar displacement.
what is a die punch fracture
intra-articular #
depressed fracture of the lunate fossa of the distal radius
also known as a bennets fracture
occurs due to vertical load through the lunate
what do you need to assess for wrist injuries
mechanism of injury
reason for fall
examine neurovascular status
soft tissue damage
when are CT and MRI suitable in wrist injuries
CT:
evaluate intra-articular involvement and for surgical planning
MRI:
soft tissue injury, ligamentous injury, nerve entrapment
what analgesic options are available for wrist #
biers block
haematoma block - LA introduced to haematoma
inhaled - pentorex, gas and air
what is a biers block
tourniquet and IV local anaesthetic
is prefered to haematoma block
how are stable displaced fractures of the wrist managed
manipulation: exaggerate deformity, realign bone, splint fracture and XR post reduction
what is measured to assess if a wrist fracture is stable
radial inclination
radial shortening
volar tilt
what is radial inclincation
around 23 degress
what is radial height
around 12 mm
what is volar tilt
between 2 -20 degrees
what are the operative timings for intra/extra-articular fractures
intra-articular - 72 hours
extra-articular - 1 week
when is conservative management appropriate for wrist fractures
radiologically stable, extra-articular
first line for over 65
involved closed reduction and immbolisation
what are operative options for wrist #
closed reduction and percutaneous pinning can be used for colles
DRAFTF trails show no difference between K wires and plates and are quicker and less expensive
when would you use ORIF for a wrist fracture
severe angulation
intra-articular #
insability
when can they restore function post wrist operation
light use within 2 week
more vigorous activity 6 weeks
which nerve is affected in cubital tunnel syndrome and what are its nerve roots
ulnar nerve
C8 and T1
what is the route of the ulnar nerve
ulnar nerve descends in a plane between the axillary artery (lateral) and the axillary vein (medial).
It proceeds down the medial aspect of the arm with the brachial artery located lateral.
At the mid-point of the arm it enters the posterior compartment of the arm.
through the ulnar tunnel (small space between the medial epicondyle and olecranon).
In the forearm, the ulnar nerve pierces the two heads of the flexor carpi ulnaris, and travels deep to the muscle, alongside the ulna
what does the muscular branch of the ulnar nerve supply
flexor capri ulnaris
flexor digitorum profundus (ulnar part)
what does the superficial branch of the ulnar nerve supply
palmaris brevis
what does the deep branch of the ulnar nerve supply
hypothenar muscles
adductor pollicis
interossei muscles
what can cause cubital tunnel syndrome
compression of the ulnar nerve at the medial malleolus by:
normal motions
fractures
arthritis
