wrist and hand fracture and disloc

Question 1

what is barton’s fracture

Answer 1

fracture of the distal end of the radius involving the intra articular joint of the radius and its adjoining carpal bones

Question 2

what is boxer’s fracture

Answer 2

fracture at the neck of the 5th metacarpal bone

Question 3

what is chauffeur’s fracture

Answer 3

avulsion fracture of the distal end of the radial styloid process

Question 4

what is colle’s fracture

Answer 4

fracture of the distal end of the radius resulting to dinner fork deformity

Question 5

what is smith’s fracture

Answer 5

fracture of the distal end of the radius accompanied by fracture of the ulnar styloid process

Question 6

intervention scenario in rehab for distal fractures

Answer 6

1. restore - rehab
2. compensate - to function indep
3. preventive - tightness, contractures and LOM

Question 7

goals in protection phase in distal fractures

Answer 7

0-6 wks

control swelling

limit stiffness

promote functional use of hand and other jts

Question 8

interventions to control swelling

Answer 8

elevation of hand above heart level - pillow

encourage active mob - fingers should move

compressive stocking and tapes

Question 9

interventions to limit stiffness

Answer 9

aggressive AROM and PROm of digits

scar massage or cross fiber

Question 10

interventions to promote functional use of hand and other jts

Answer 10

light activities - < 5 lbs of force

AROM to shoulder, elbow; jts above and below

Question 11

goals in controlled motion phase of distal fractures

Answer 11

6-8 wks

maximize mob

• fixations are removed
• active-assisted FA and wrist mob; esp supination
• may use dynamic splint

Question 12

goals in return to function phase of distal fractures

Answer 12

8-12 wks

improve mob, strength and function

• continue active assisted mob
• strengthening: theraputty and small weights

Question 13

discuss immob phase for wrist arthroplasty

Answer 13

neutral pos for several days to 2 wks

then 10-15° ext for 1-4 wks
; functional wrist pos allows function

Question 14

discuss maximum and mod protection phase for wrist arthroplasty

Answer 14

~4 wks post op

maintain mob of unoperated jts - AROM of digits, elbow and shoulder

restore control and mob of wrist
- active wrist ext > flexion kc better grip
- tendon gliding c wrist in neutral
- postpone radial and ulnar dev bcs might displace wrist
- muscle sets, isoms, manual, light resistance

Question 15

discuss minimum protection phase for wrist arthroplasty

Answer 15

8-10 wks post op

regain functional strength - wrist extensors > flexors

simulate gripping activities

regain functional ROM - at least 15° wrist extension

Question 16

discuss immob phase in MCP arthroplasty

Answer 16

wrist in neutral

MCP ext or neutral or slight radial dev

IPs in slight flexion

avoid or slight lateral dev only

Question 17

discuss maximum phase in MCP arthroplasty

Answer 17

first 3 wks

active hand exercises in dynamic splint - AROM and GPS of MP, PIP and DIP

avoid lateral pressure of thumb on digits

Question 18

discuss moderate and minimum phase in MCP arthroplasty

Answer 18

~3 wks if stable na

full active ROM
- MCP ext
- 45-60° flexion of index and middle
- 70° flexion of ring and little; for grip

active radial dev of fingers - to faci locking of grip

Question 19

discuss management of PIP/DIP arthroplasty

Answer 19

start ROM
- central slip sparring: 1-3 days post op
- central slip splitting: 3-5 days post op

pos of immob and exercises depends if swan neck or boutonniere’s

goal is 70° PIP flexion and full ext

avoid lateral stresses to jt

Question 20

post op guidelines for boutonniere deformity

Answer 20

maintain PIP ext - in extension orthosis for 3-6 wks

early DIP flexion ex c PIP stab in ext

AROM or AAROM PIP flexion and ext 10-14 days post op or sooner

Question 21

precautions for post op boutonniere deformity

Answer 21

avoid hyperextension of DIP

for central slip splitting - avoid resisted ex and stretching of extensors of PIP for 6-8 wks as long as 12 wks

Question 22

post op guidelines for swan neck deformity

Answer 22

maintain PIP in 20-30° flexion and DIP in ext - static digital orthosis

AROM of PIP and DIP several days post op

DIP ext ex c PIP jt in slight flexion

stab DIP in neutral during PIP ROM

PIP flexion and DIP ext

Question 23

precautions for post op swan neck deformity

Answer 23

limit PIP ext to 10° flexion during ex to avoid excessive stretch to volar aspect

avoid extreme flexion of DIP

Question 24

post op guidelines for 1st CMC arthroplasty

Answer 24

initially avoid opposing thumb to little finger - lateral movements to thumb should be avoided

in stretching - apply force on 1st metacarpal not on phalanx