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?