Wrist (RITA) Flashcards
What is the name of fx that occurs 1.5” proximal to distal end of radius?
“colles fx”
distal radius fx
CRPS is also known as
RSD
reflex sympathetic dystrophy
Post colles fx, what complication is most common?
malignment/malunion of fragments resulting in joint incongruity
With a smith fx, what type of complication is most common?
median nerve injury
What factors influence fx management?
mechanism of injury anatomical location relationship of fragments stable fx - cast immobilization pintrack infection
Goals with colles fx?
maximize pain-free ROM
strength
UE fxn
With colles fx, if radius is dorsally angulated, what motions are limited and why?
limited flex/ext because of impaired glide of proximal row of carpals on radius
The radius should be slightly _____ tilted.
volarly tilted
If the radius is tilted _____, it impairs ROM.
dorsally
What is normal and functional wrist flex/ext ROM?
normal 70/80
functional 40/40
What is normal and functional wrist RD/UD ROM?
normal 15/30
functional 15/15
What is normal and functional wrist Sup/Pron ROM?
normal 80/70
functional 50/50
What signifies that fx is stable enough to withstand AROm and case can be removed.
Callus formation
What percept of all carpal fxs are scaphoid fxs?
60-70%
What percent of scaphoid fxs occur in the middle of the bone?
70%
Fx to which pole of the scaphoid heals faster?
proximal pole heals slower than distal
What are common clinical findings with scaphoid fractures?
radiologic evidence not always common early on
hx of high force hyperextension injury
pain in snuff box region
decreased pinch grip strength
Healing of scaphoid depends on
coaptation of fragments
adequate blood supply
early dx and adequate rx (immobilization from injury until union)
For fx at proximal pole of scaphoid, what is healing time?
up to 30 weeks
For fx at middle 1/3 of scaphoid, what is healing time?
6-12 weeks
For fx at distal 1/3 of scaphoid, what is healing time?
4-8 weeks
What intrinsic complications can contribute to non-union of scaphoid fxs?
displacement of fx >1mm
instability b/w prox and distal carpal rows
What extrinsic complications can contribute to non-union of scaphoid fxs?
delayed diagnosis
inadequate mobilization
Management considerations for scaphoid fxs?
beware of extremes of ROM
beware of excessive loading during ADL/sports
Lunate fxs mostly affect ____ pole of the bone.
volar
Common complication of lunate fx?
kienbock’s disease
What does kienbock’s disease result in?
AVN of the lunate
collapse
What are predisposing factors to kienbocks?
pattern of intrinsic blood supply
negative ulnar variance
radial slope
Age incidence of lunate fxs?
20-40
Gender incidence of lunate fxs?
2:1
Male:Female
Lunate avascular necrosis is treated with:
surgery
What are some surgical interventions for lunate avascular necrosis?
external fixator revasculation with pronator flap silocone arthroplasty carpal fusion procedures salvage procedures
Describe salvage procedures:
proximal row carpectomy/wrist arthrodesis
