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Hand and Upper Extremity Conditions > Wrist Fractures > Flashcards

Wrist Fractures Flashcards

1
Q

Colles’ fracture

A

complete fracture of the distal radius with dorsal displacement of the distal fragment and radius shortening (from hyperextension of the wrist)

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2
Q

Smith’s fracture

A

complete fracture of the distal radius with volar displacement of the distal fragment (from hyperflexion of the wrist))

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3
Q

Barton’s fracture

A

fracture-dislocation of rim of radius along the carpus caused by shearing forces from the proximal carpus translating across the radius

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4
Q

Chauffeur’s fracture

A

fracture of distal radial styloid

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5
Q

Salter-Harris fracture

A

fracture of the growth (epiphyseal) plate of children and teens

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6
Q

Galeazzi’s fracture

A

unstable fracture of radial shaft and DRUJ disruption (usually the result of a FOOSH and most common in males)

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7
Q

Monteggia’s fracture

A

unstable fracture of ulnar shaft and radial head dislocation (usually the result of a FOOSH or blunt trauma)

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8
Q

Greenstick fracture

A

incomplete fracture common in children

concave side of bone may be intact or buckled with convex side fractured

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9
Q

Torus (buckle) fracture

A

incomplete fracture common in children

concave side of bone compresses (buckles) with convex side intact

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10
Q

Primary healing

A

when the bone fragments are secured using plates and/or screws where there is essentially no movement and good vascularity of the fracture site
*will bypass the three typical phases of bone healing

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11
Q

Secondary healing

A

process of bone tissue repair and reorganization

consists of the inflammatory phase, repair phase, remodeling phase

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12
Q

Triangular Fibrocartilage Complex (TFCC)

A

hammock-like structure composed of cartilage and ligaments, suspends the ulnar carpus and acts as both a force distributor between the ulna head and triquetrum, and a primary stabilizer for the DRUJ

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13
Q

Central portion of TFCC

A

consists of articular disc which provides smooth gliding surface for the ulnar carpus
has no blood supply so will not heal if torn

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14
Q

Peripheral portions of TFCC

A

ligamentus and capable of bearing tensile loads generated during gripping or weight bearing on the wrist

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15
Q

% of load traveling through the carpal bones and transferred to the radius by TFCC

A

80%

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16
Q

% of load traveling through the carpal bones and transferred to the ulna by TFCC

A

20%

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17
Q

FOOSH

A

fall on out-stretched hand
44% of UE fractures
15% of all adult fractures in US

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18
Q

Most common distal forearm fracture

A

Colles’ fracture

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19
Q

2nd most common distal forearm fracture

A

Smith’s fracture

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20
Q

Categories of forearm fractures (3)

A
  1. extra-articular fracture
  2. intra-articular fracture
  3. comminuted
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21
Q

Extra-articular fracture

A

fracture did not cross into the joint space

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22
Q

Intra-articular fracture

A

fracture did cross into the joint space

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23
Q

Comminuted fracture

A

bone breaking into multiple segments

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24
Q

Types of fixation for distal radius fracture (4)

A
  1. cast
  2. external fixation
  3. dorsal plating
  4. volar fixed angle plating
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25
Q

How do you control edema in a patient who has a cast?

A

use positioning (elevation of extremity), retrograde massage, and AROM of uninvolved joints

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26
Q

How long does a cast typically stay on?

A

4-6 weeks

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27
Q

What happens after the cast is removed?

A

client wears orthosis for comfort and support for the next 2-4 weeks

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28
Q

How do you address joint contracture/muscle -tendon tightness following the removal of a cast?

A

static progressive splinting after 6 weeks

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29
Q

What do you need to make sure to address that is unique to an external fixation?

A

pin site care

30
Q

What ROM do you initially need to address with an external fixation?

A

immediate AROM of uninvolved joints

31
Q

What AROM is limited with external fixation?

A

limited/difficult forearm rotation

AROM of wrist not possible

32
Q

How do you address irritated RSN with an external fixation?

A

desensitization program

33
Q

What do you address following the removal of external fixation hardware?

A

A/PROM to wrist and forearm

34
Q

What ROMs should you focus on following the removal of external fixation hardware? (4)

A
  1. digital flexion
  2. wrist extension
  3. ulnar deviation
  4. supination
35
Q

What type of orthosis can be introduced to regain ROM following an external fixation?

A

static progressive orthosis as needed

36
Q

At what rate do you advance activity and ADLs following the removal of an external fixation?

A

as tolerated

37
Q

What needs to be addressed early on following dorsal plating?

A

edema control and scar management

38
Q

What type of orthosis is used with dorsal plating?

A

resting static wrist orthosis between exercise sessions for 4-6 weeks

39
Q

What ROM is addressed with dorsal plating?

A

immediate AROM of all joints

40
Q

What may be necessary if EDC integrity is compromised by dorsal plating?

A

guarded early active wrist motion (place and hold for wrist extension) for 4-6 weeks

41
Q

What type of orthosis is used to regain wrist motion once the fracture is adequately healed with dorsal plating?

A

static progressive wrist orthosis

42
Q

When can you advance activities and ADLs following dorsal plating?

A

after 6 weeks

43
Q

What needs to be addressed early following volar fixed angle plating?

A

edema control and scar management

44
Q

What ROM is addressed with volar fixed angle plating?

A

immediate AROM of wrist and uninvolved joints allowed

45
Q

When can you address ADLs with volar fixed angle plating?

A

initially light ADLs to tolerance out of orthosis

advance activities and ADLs after 6 weeks

46
Q

What orthosis is initially used following volar fixed angle plating?

A

wrist extension immobilization orthosis is slight extension for 4-6 weeks for comfort and protection

47
Q

What type of orthosis is used to regain wrist and forearm motion after the fracture has adequately healed with volar fixed angle plating?

A

static progressive wrist orthosis

48
Q

Treatment concepts for distal radius fractures (7)

A
  1. monitor shoulder movement, strength, and function
  2. some casting positions are with moderate wrist flexion - monitor for CTS
  3. encourage finger movement
  4. edema control
  5. watch for extensor and intrinsic tightness
  6. educate on signs of infection
  7. modalities as appropriate
49
Q

Complications following distal forearm fractures(8)

A
  1. Complex Regional Pain Syndrome (CRPS)
  2. Negative Ulnar Variance
  3. Positive Ulnar Variance
  4. Ulnocarpal abutment syndrome (ulnar impaction syndrome)
  5. malunion
  6. non-union
  7. teninopathy and tendon rupture
  8. DRSN compression or irritation
50
Q

Watson’s test

A

scaphoid shift test
tests for SL ligament injury
forearm supinated with slight wrist extension
place pressure on volar distal pole of scaphoid
move wrist from ulnar to
radial deviation
+ when painful “clunk” with radial deviation

51
Q

Non-operative management of non-displaced scaphoid fracture

A

6 weeks or more of immobilization

52
Q

Healing time - scaphoid distal pole fracture

A

8-10 weeks

53
Q

Healing time - scaphoid waist fracture

54
Q

Healing time - scaphoid proximal pole fracture

A

12-24 weeks

55
Q

Non-operative management of scaphoid waist or proximal pole fracture

A

6 weeks in long arm thumb spica followed by 6 weeks in a short arm thumb spica
(some in thumb spica orthosis for 2 weeks after a cast)

56
Q

Operative management of scaphoid fracture

A
  • needed if fracture is displaced, comminuted, or associated with soft tissue injures
  • may need graft
  • pinning
  • screwing
57
Q

Trapezium fracture

A

3-5% of carpal fractures
tender at base of thumb
pain with resisted wrist flexion
CTS may be present

58
Q

Trapezoid fracture

59
Q

Capitate fracture

A

1-2% of carpal fractures
largest carpal bone
AVN can occur

60
Q

Hamate fracture

A

2-4% of carpal fractures
one of the larger carpal bones
hook is most common fracture site

61
Q

Pisiform fracture

A

1-3% of carpal fractures
sesamoid bone
attachment of FCU and origin of ADM

62
Q

Triquetrum

A

2nd most common carpal fracture

small irregular shape

63
Q

Lunate fracture

A

moon shape
fracture more likely from repeated compression
AVN (Keinbock’s disease)

64
Q

Non-operative management of carpal bone fractures

A

non-displaced and good blood flow
cast for 6-8 weeks
when fully healed - PROM, static and dynamic orthosis

65
Q

Operative management of carpal bone fractures

A 
displaced fractures or blood supply issues
pins or ORIF
partial fusion
proximal row carpectomy
pisiform excision
66
Q

Rehabilitation guidelines for wrist fractures

A
  1. AROM - all joints
  2. don’t let digital extensors initiate wrist extention
  3. opposition exercises to protect the EPL
  4. monitor pain
  5. normal vs. functional ROM
  6. edema control
  7. scar management
  8. dynamic/static progressive orthoses
  9. stretching
  10. strengthening
67
Q

Edema control for wrist fractures

A
  • cold packs during first 48 hrs
  • avoid slings if possible
  • compressive dressings or wraps
  • active muscle pumping
68
Q

When is UE elevation not appropriate?

A

if there is arterial compromise

69
Q

Scaphoid fractures

A

70-90% of carpal fractures

70
Q

Complications following wrist fractures (8)

A
  1. non-union
  2. malunion
  3. AVN (Keinbock’s disease)
  4. OA
  5. carpal instability
  6. nerve compression
  7. late tendon ruptures
  8. SNAC wrist (scaphoid non-union advanced collapse)

Hand and Upper Extremity Conditions (27 decks)

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