Wrist (RITA)

Question 1

What is the name of fx that occurs 1.5” proximal to distal end of radius?

Answer 1

“colles fx”

distal radius fx

Question 2

CRPS is also known as

Answer 2

RSD

reflex sympathetic dystrophy

Question 3

Post colles fx, what complication is most common?

Answer 3

malignment/malunion of fragments resulting in joint incongruity

Question 4

With a smith fx, what type of complication is most common?

Answer 4

median nerve injury

Question 5

What factors influence fx management?

Answer 5

mechanism of injury
anatomical location
relationship of fragments
stable fx - cast immobilization
pintrack infection

Question 6

Goals with colles fx?

Answer 6

maximize pain-free ROM
strength
UE fxn

Question 7

With colles fx, if radius is dorsally angulated, what motions are limited and why?

Answer 7

limited flex/ext because of impaired glide of proximal row of carpals on radius

Question 8

The radius should be slightly _____ tilted.

Answer 8

volarly tilted

Question 9

If the radius is tilted _____, it impairs ROM.

Answer 9

dorsally

Question 10

What is normal and functional wrist flex/ext ROM?

Answer 10

normal 70/80

functional 40/40

Question 11

What is normal and functional wrist RD/UD ROM?

Answer 11

normal 15/30

functional 15/15

Question 12

What is normal and functional wrist Sup/Pron ROM?

Answer 12

normal 80/70

functional 50/50

Question 13

What signifies that fx is stable enough to withstand AROm and case can be removed.

Answer 13

Callus formation

Question 14

What percept of all carpal fxs are scaphoid fxs?

Answer 14

60-70%

Question 15

What percent of scaphoid fxs occur in the middle of the bone?

Answer 15

70%

Question 16

Fx to which pole of the scaphoid heals faster?

Answer 16

proximal pole heals slower than distal

Question 17

What are common clinical findings with scaphoid fractures?

Answer 17

radiologic evidence not always common early on
hx of high force hyperextension injury
pain in snuff box region
decreased pinch grip strength

Question 18

Healing of scaphoid depends on

Answer 18

coaptation of fragments
adequate blood supply
early dx and adequate rx (immobilization from injury until union)

Question 19

For fx at proximal pole of scaphoid, what is healing time?

Answer 19

up to 30 weeks

Question 20

For fx at middle 1/3 of scaphoid, what is healing time?

Answer 20

6-12 weeks

Question 21

For fx at distal 1/3 of scaphoid, what is healing time?

Answer 21

4-8 weeks

Question 22

What intrinsic complications can contribute to non-union of scaphoid fxs?

Answer 22

displacement of fx >1mm

instability b/w prox and distal carpal rows

Question 23

What extrinsic complications can contribute to non-union of scaphoid fxs?

Answer 23

delayed diagnosis

inadequate mobilization

Question 24

Management considerations for scaphoid fxs?

Answer 24

beware of extremes of ROM

beware of excessive loading during ADL/sports

Question 25

Lunate fxs mostly affect ____ pole of the bone.

Answer 25

volar

Question 26

Common complication of lunate fx?

Answer 26

kienbock’s disease

Question 27

What does kienbock’s disease result in?

Answer 27

AVN of the lunate

collapse

Question 28

What are predisposing factors to kienbocks?

Answer 28

pattern of intrinsic blood supply
negative ulnar variance
radial slope

Question 29

Age incidence of lunate fxs?

Answer 29

20-40

Question 30

Gender incidence of lunate fxs?

Answer 30

2:1
Male:Female

Question 31

Lunate avascular necrosis is treated with:

Answer 31

surgery

Question 32

What are some surgical interventions for lunate avascular necrosis?

Answer 32

external fixator
revasculation with pronator flap
silocone arthroplasty
carpal fusion procedures
salvage procedures

Question 33

Describe salvage procedures:

Answer 33

proximal row carpectomy/wrist arthrodesis