The Forearm, Wrist, Hand dislocation and fractures Flashcards
What are the three types of Unstable Forearm fractures
- Both bone forearm fracture
- Galiazzi fracture
- Monteggia
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What is a Colle’s Fracture of the Distal radius
What is the MOI
MOST COMMON
Distal radius fracture fragment is tilted dorsally
Falling on outstretched hand
What is a Smith’s fracture of the distal radius
What is the MOI
Distal radius fracture fragment is tilted ventrally
Falling on wrist while flexed
Which view on x-ray is best used to diagnose a Collie’s or Smith’s fracture?
Lateral view- shows angulation of the radius if it is titled dorsally (Collie’s) or Ventrally (Smith’s)
What is a Barton’s fracture
Intra-articular fracture associated with dislocation of the carpus
How is a Colle’s Fracture reduced
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Who is a Radial Torus “Buckle” Fracture MC in?
How is it caused and what part of the bone is involved
MC in children less than 10
Buckling of cortex due to compression failure
Children have more stable bones that wont break on a FOOSH
What is a Greenstick fracture
How does it appear on x-ray
Complete fracture of the tension side of the cortex with buckling of the compression side.
On x-ray complete disruption on one side with buckle on opposite side
How is a Radial Torus “Buckle” Fracture treated?
Immobilization x 4-6 weeks
MC fractured carpal bone
Scaphoid bone
What is the MOI for Scaphoid Fracture?
FOOSH
What are the clinical findings of a Scaphoid Fracture
Snuffbox pain and tenderness to palpation
ROM limitation
Limited blood supply during a scaphoid fracture can cause what complications
Limited blood supply leads to high incidence of nonunion (of the bones again) and osteonecrosis
What is a initial treatment for scaphoid fractures?
What if clinical exam is indicative of fracture but x-rays are negative?
Long-arm thumb spica cast x 6-12 weeks
If x-rays are neg. , cast and repeat x-rays in 10-14 days
If a follow up x-ray for a scaphoid fracture is still negative after 10-14 days what should be done?
Still treat the patient as if it is a scaphoid fracture
ORDER MRI
How are displaced transverse and oblique fractures charactised?
The tend to angulate
What tendency do spiral fractures have?
The tend to rotate
MC fracture of the hand?
Boxer’s fracture
What is the MOI of a Boxer’s fracture and which bone does it involve?
Results from closed fist striking an object
Distal metaphysis of 5th metacarpal
When would you manage a boxer’s fracture with just an Ulnar gutter?
tranvserve/oblique fracture at the base or head and is less than 15 degrees
When would you refer to surgery of a Boxer’s fracture?
Intra-articular
> 15 degrees angulation
Comminuted
Spiral
What is a DeQervain’s tenosynovitis?
Inflammation of the sheath that surrounds the abductor pollicus longus and extensor pollicus brevis tendons
How do patients with DeQervain’s tenosynovitis present?
They will have pain and tenderness in the first dorsal extensor compartment (anatomic snuffbox)
Aggravated by attempts to move thumb or make a fist
What test can be used to diagnose DeQervain’s tenosynovitis?
What would a positive test show?
Finklestein Test
Positive if pain with passive stretching of the tendons
How is DeQervain’s tenosynovitis managed?
NSAIDs
Thumb spica splint
Avoid offending activity
Steroid injection
What is a Ulnar Collateral Ligament Sprain also known as?
Where is the sprain located?
Skiier’s thumb or Gamekeeper’s thumb
UCL injury at 1st MCP joint
How do you test stability of a UCL sprain?
Pain but no laxity indicates mild sprain
Pain and partial laxity indicates moderate sprain
Pain and significant laxity indicates complete tear
How is a UCL sprain managed?
When is surgery needed?
Brace: mild to moderate sprain
Surgical consult: complete tear or avulsion fracture involving >25% of the articular surface
MOI of a Mallet Finger?
MC due to traumatic injury to the tip of a fully extended finger
How does a Mallet finger present?
Pain and inability to extend at the DIP
How is a Mallet finger treated? What is imperative for full recovery?
Continuous splinting for 6-8 weeks
If extension is lost at any point, healing is disrupted and the clock starts again
When is surgery needed to treat Mallet finger?
Failure with conservative care
Complete tendon laceration
Fracture involving >30% of the articular surface
what are the two flexor tendons that supply the fingers?
FDP – Flexor digitorum profundus
FDS – Flexor digitorum superficialis
What is the MOI of a Flexor Tendon injury “Jersey Finger”
Spontaneous (RA) or Traumatic (forced extension of actively flexed finger)
Which tendon and finger is MC involved in a Flexor Tendon injury?
MC flexor digitorum profundus
4th (ring) finger affected most commonly 75%
Symptoms of a Flexor Tendon Injury?
Pain and swelling at palmar aspect of DIP
Proximal fullness if tendon retracted
Affected finger more extended at DIP when hand at rest
Inability to flex at affected DIP joint
What imaging is needed for a Jersey Finger?
What is the best management?
Splint finger in presenting position
Hand surgeon referral
Best recovery if repaired within 7-10 days of injury
What is a Trigger Finger injury?
Where is it most common at?
Nodular thickening of the flexor tendon
MC at the MP join
How is Trigger finger injury treated?
Steroid injections x2
What is Dupuytren’s Contracture also called and why?
“Viking disease”
Due to being most common in Men > 50, northern European descent
What is the Dupuytren’s Contracture involve?
Which finger is mostly involved?
Nodular thickening and contraction of palmar fascia
Flexion of finger at MCP then PIP
MC ring finger
How do treat Dupuytren’s Contracture
Xiaflex injection
- Breaks down collagen adhesion
- Injected into contracted cord
- Manipulation the following day
What are synonyms of Ganglia of Wrist and Hand
Synovial Cyst
Mucous cyst
How are synovial cysts or ganglia presented?
Cystic swelling overlying a joint or tendon sheath
What are common locations of cysts in the wrist or hand
Dorsum of the wrist
Volar radial aspect of wrist
If typical i presentation how do you treat ganglia of the wrist or hand?
What are other treatments for severe or reoccuring cysts?
reassurance
Needle aspiration
Sugery
Which joints are involved in Osteoarthritis of the hands?
How does this present
DIP and PIP joints are most often involved
Stiffness and loss of motion in the fingers
Herbendens vs Bouchards nodes
Heberden nodes = nodules at the DIPs
Bouchard nodes = bony nodules at the PIPs
What is the MOI for a Subungual Hematoma
Hammering nail into the finger
Dropping weight on foot
Treatment for a Sunungual Hematoma
If traumatic –> Get an X-ray
Followed by decompression