Week 6 - E - Regional Adult Trauma (4) -Scaphoid, carpus and hand injuries

Question 1

Label the bones of the hand?

Answer 1

• * 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

Question 2

Which carpal bone articulates with the 1st metacarpal?

Answer 2

This would be the trapezium

Question 3

A fall onto an out-stretched hand usually causes two fractures What are they? What type of people are the fractures more likely in?

Answer 3

Usually causes a scaphoid fracture and a colles fracture

More common in old osteoporotic women

Question 4

What are the usual signs of a scaphoid fracture? What is a colles fracture?

Answer 4

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

Question 5

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?

Answer 5

Need 4 views - one AP, one lateral, 2oblique views

Minimally displaced colles - reduce and splint

Displaced - manipulation under anaesthetic and cast

Commminuted - ORIF + Kwiring

Question 6

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

Answer 6

Wrist is splinted and further clinical assessment +/- xrays 2 weeks later

Question 7

What is the treatment of an undisplaced scaphoid fracture?

Answer 7

Treatment would be to plaster cast for 6-12 weeks

Question 8

What is the treatment of a displaced scaphoid fracture?

Answer 8

Compression screw - sunk into bone to avoid non-union

Question 9

What are two of the complications of scaphoid fractures?

Answer 9

Risk of non union and avascular necrosis of the proximal pole

Question 10

If avascular necrosis of the scaphoid does occur, what may be the only treatment option?

Answer 10

Arthrodesis (fusion)of the wrist

Question 11

Peri-Lunate and Lunate Dislocations are both high energy injuries What are they fractures of?

Answer 11

Peri lunate is dislocation of one of the carpal bones surrounding the lunate

Lunate is dislocation of the lunate bone from the radius

Question 12

What is the treatment of both lunate and peri-lunate fractures as they are high energy and can be unstable?

Answer 12

This would be closed or open reduction plus pinning

Question 13

As the lunate forms part of the carpal tunnel, what nerve may be injured in a lunate fracture?

Answer 13

May get injury to the median nerve - may need to have median nerve decompression

Question 14

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?

Answer 14

This would be a split tea cup sign - indicative of a lunate fracture

Question 15

What is this finger abnormality known as?

Answer 15

This is a mallet finger

Question 16

Describe what a mallet finger is?

Answer 16

It is avulsion of the extensor tendon at the distal phalynx leading to a fixed flexion at the distal phalynx

Question 17

How do patients with mallet finger tend to present?

Answer 17

patinets tend to present with a drooped DIPJ and inability to extend at this joint usually from a ball or sport related injury

Question 18

What is the treatment of a mallet finger to ensure the tendon heals?

Answer 18

Mallet splint at DIPJ for a minimum of 4 weeks

Question 19

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?

Answer 19

Flexor digitorum superficialis - flexes the proximal interphalangeal joints and the metacarpals

Flexor digitorum profundus - flexes the distal interphalangeal joints

Question 20

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

Answer 20

This is where the tendon is pulled away from the PIP joint and causes a bowstringing Usually the A3 pulley is ruptured

Question 21

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?

Answer 21

A1 nodule preventing extension of the finger at the metacarpphalngeal joint

Usually due to rheumatoid arthriits (can be gout)

Question 22

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?

Answer 22

Usually occur during fighting

Question 23

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?

Answer 23

5th metacarpal = Boxer’s fractures

Strap to adjacent digit

If rotation use K wires

Question 24

Phalangeal fractures * Strapping to adjacent finger * Significant displacement = manipulation under anaesthetic / digital nerve block

How are unstable/intraarticular phalngeal fractures treated?

Answer 24

Usually with K-wiring or screws