Wrist Hand (Carol's Lecture) Flashcards
Disadvantages to internal fixation?
- Infection
- Blood supply compromise
- Nerve injury
- Tendonitis / tendon rupture
What is a Mallet finger?
tear or rupture of terminal tendon
Can lead to avulsion fracture
How are distal phalanx fxs treated?
- Usually treated closed
- May need soft tissue repair & K-wire fixation
- Nail bed repair
- Extensor tendon repair
Distal phalanx bony mallet injury = tuft fx. Describe three different treatment approaches:
- 25% of articular surface-immobilize with splints for 8-12 weeks
- Therapist checks splint and DIP position every 1-2 weeks
- Greater than 1/3 articular surface requires ORIF
What is the least common fx of the hand?
middel phalanx fx
How soon before you can initiate AROM for midshaft middle phalanx fx?
6 weeks
Cortical bone compromised with middle phalanx fractures takes ____ weeks to heal.
12-16 weeks
What is the most common middle phalanx fx?
Volar plate avulsion fractures at the base of the proximal middle phalanx
PIP fx dislocation treatment:
i. Mini-external fixator and K-wire for unstable PIP fx dislocation
ii. Stable: dorsal block splinting
iii. ORIF
iv. Tension band wiring
v. Kirschner wires
What are complications with PIP fx disclocation?
a. Flexor or extensor tendon adhesions
b. Tightness / contractures at DIP and PIP joints
c. Extensor lag
d. Swan neck deformity
What is swan neck deformity?
imbalance in stretching mechanism to volar plate; PIP in hyperextension and DIP in flexion
Boxer’s fx affects which MCs?
4th or 5th
although true boxers usually break 2nd or 3rd
Boxer’s fracture is usually angulated:
dorsally
What presentation with boxers fxs must be repaired surgically in order to avoid functional problems?
rotation malalignment
must be corrected with surgery
What questions are important to ask to understand etiology of wrist injury?
- Single incident or over time?
- Increased physical demands from work?
- Increased productivity demands?
- New sport or exercise routine?
Which bones make up the Central column?
lunate, capitate, hamate (main flexion/ext unit)
*capitate is center of rotation
The distal carpal row moves with the _____.
Capitate
Which bones make up the radial column?
scaphoid and thumb axis
Which bones make up the ulnar column?
triquetrum and lateral border, TFCC
With the wrist in neutral, about ___% of the force is distributed across the radiocarpal joint
80%
About ___% of the force is distributed across the ulnocarpal joint space
20%
Approximately ___% of the midcarpal load is transmitted through the capitate
50%
vi. Total wrist motion is the combination of small arcs of motion at each ______:
carpal articular surface
What is De Quervain’s Tenosynovitis?
Inflammation of first Dorsal Compartment
AKA “washerwoman’s sprain” (new mothers)
What are 3 differentials for De Quervain’s Tenosynovitis?
- CMC arthritis
- Wartenberg’s syndrome
- Intersection syndrome
What is basal joint arthritis?
OA of base of first MC
What are key Sx of basal joint arthritis?
Pain with pinch, torque activities (i.e. opening a jar, turning a key)
what is intersection syndrome?
tendinitis of 2nd dorsal compartment
Scaphoid fxs comprise about ___% of all carpal fxs.
60%
The TFCC receives about ____% of wrist axial load to the forearm
20%
What is primary function of TFCC?
main stabilizer of ulnar side of wrist and the DRUJ (distal radio ulnar joint)
What are symptoms of TFCC injuries?
i. Ulnar Wrist Pain
ii. Tender on Ulnar side of wrist
iii. Pain with forearm rotation
iv. Pain with maximum gripping
With positive ulnar variance, the load increases to ___%
With negative ulnar variance, the load decreases to ___%
42%
4.3%
Ulnar variance changes with forearm rotation. Pronation _____ ulnar variance. Supination _____ ulnar variance.
pro: increase
sup: decrease
Power grip _____ ulnar variance.
increases
