Week 6 - E - Regional Adult Trauma (4) -Scaphoid, carpus and hand injuries Flashcards
Label the bones of the hand?

- * 1. - proximal phalanges
- * 2. middle phalanges
- * 3. distal phalnges
- * 4. trapezoid
- * 5. Trapezium
- * 6. scaphoid
- * 7.Radius
- * 8 . metacarpals
- * 9. hamate
- * 10. pisiofrm
- * 11. capitate
- * 12. triquetrum
- * 13. lunate
- * 14. ulna

Which carpal bone articulates with the 1st metacarpal?
This would be the trapezium
A fall onto an out-stretched hand usually causes two fractures What are they? What type of people are the fractures more likely in?
Usually causes a scaphoid fracture and a colles fracture
More common in old osteoporotic women
What are the usual signs of a scaphoid fracture? What is a colles fracture?
Scaphoid fracture is seen when their is pain in the anatomical snuffboux and pain when compressing/telescoping the first metacarpal
Colles fracture is an extra-articular fracture of the distal radius within 1inch of the articular surface with dorsal angulation or displacement
What are the four views taken off the scaphoid as it is a difficult fracture to view?
What is colles fracture treatmnet? If minimally displaced? Displaced? Comminuted?
Need 4 views - one AP, one lateral, 2oblique views
Minimally displaced colles - reduce and splint
Displaced - manipulation under anaesthetic and cast
Commminuted - ORIF + Kwiring
If a scaphoid fracture is suspected but the xray fails to demonstrate a fracture what is carried out? This is known as a clinical scaphoid practure
Wrist is splinted and further clinical assessment +/- xrays 2 weeks later
What is the treatment of an undisplaced scaphoid fracture?
Treatment would be to plaster cast for 6-12 weeks
What is the treatment of a displaced scaphoid fracture?
Compression screw - sunk into bone to avoid non-union
What are two of the complications of scaphoid fractures?
Risk of non union and avascular necrosis of the proximal pole
If avascular necrosis of the scaphoid does occur, what may be the only treatment option?
Arthrodesis (fusion)of the wrist
Peri-Lunate and Lunate Dislocations are both high energy injuries What are they fractures of?
Peri lunate is dislocation of one of the carpal bones surrounding the lunate
Lunate is dislocation of the lunate bone from the radius
What is the treatment of both lunate and peri-lunate fractures as they are high energy and can be unstable?
This would be closed or open reduction plus pinning
As the lunate forms part of the carpal tunnel, what nerve may be injured in a lunate fracture?
May get injury to the median nerve - may need to have median nerve decompression
The classic radiographic sign is the ______ sign of the lunate which is usually tilted volarly and empty like a ______ What is this sign on the xray known as?

This would be a split tea cup sign - indicative of a lunate fracture
What is this finger abnormality known as?

This is a mallet finger
Describe what a mallet finger is?
It is avulsion of the extensor tendon at the distal phalynx leading to a fixed flexion at the distal phalynx
How do patients with mallet finger tend to present?
patinets tend to present with a drooped DIPJ and inability to extend at this joint usually from a ball or sport related injury
What is the treatment of a mallet finger to ensure the tendon heals?
Mallet splint at DIPJ for a minimum of 4 weeks
Flexor tendon injuries in the fingers pose a particular problem as the tendons need to run smoothly within the tendon sheath and under the pulleys (thickenings of the tendon sheath which serve to hold the tendon into the finger) What are the flexers of the fingers at the interphalangeal joint?
Flexor digitorum superficialis - flexes the proximal interphalangeal joints and the metacarpals
Flexor digitorum profundus - flexes the distal interphalangeal joints
The tendon sheath requires careful repair with preservation of the pulleys to avoid “bowstringing” of the tendon. What is the bowstringing of the tendon? it is often seen as a complication of trigger finger
This is where the tendon is pulled away from the PIP joint and causes a bowstringing Usually the A3 pulley is ruptured

Annular and cruciate pulleys are present in the hand to keep the tendons from bowstringing and help with movement of the finger In trigger finger, the nodule is under which pulley? What is the cause of trigger finger?

A1 nodule preventing extension of the finger at the metacarpphalngeal joint
Usually due to rheumatoid arthriits (can be gout)
Fractures of the 3rd, 4th and 5th metacarpals are usually treated conservatively. The 3rd and 4th metacarpals have strong intermetacarpal ligaments proximally and distally giving stability to these fractures and usually minimal displacement. How do fractures of the 5th metacarpal usually occur?
Usually occur during fighting
Due to 5th metacarpal fractures occuring in fighters, what is it often known as? What is the treatment? What is the treatment if there is rotational alignement?
5th metacarpal = Boxer’s fractures
Strap to adjacent digit
If rotation use K wires
Phalangeal fractures * Strapping to adjacent finger * Significant displacement = manipulation under anaesthetic / digital nerve block
How are unstable/intraarticular phalngeal fractures treated?
Usually with K-wiring or screws