2.  Vascular Injuries  Ligament Injuries  Dislocations  Fractures

3.  Vessel divisions  Compartment syndrome Following crush injuries and the fractures of the forearm and hand, pressure within the facial compartments rises, Occlude the microcirculation

4.  Carpal instability Damage to the ligaments interconnecting intercalated segment Following outstretched hand Rx- early repair and stabilization with wires  Thumb ulnar collateral ligament Can be torn when thumb is wrenched radially or with chronic over use Rx – relatively stable injury is splinted for 3 weeks Unstable- need repair

5.  Triangular fibro cartilage complex attach ulnar styloid to the ulnar side of the distal radius and stabilize distal radio ulnar joint  Can be torn leading to instability of the distal radio ulnar joint and ulnar sided wrist pain  Rx- repair

6.  Dislocation of the lunate bone Following fall on to the hand Lunate bone lies at the front of the wrist rotated 90 degrees  Rx- early-manipulation under anesthesia Late- open reduction Complications Avascular necrosis Osteoarthritis Median nerve injury

8.  Perilunate dislocation Compress median nerve Painful and swollen wrist Radiograph – usually normal Rx- ligament repair Temporally Kirschner wires

9.  Distal radioulnar joint Can occur in isolation or in association with radial head or shaft fracture Rx- Perfect fixation of the radius and stable reduction of the joint is essential

10. Bennett’s fracture-dislocation Intra-articular fracture of the thumb carpometacarpal joint Rx- Closed reduction and percutaneous wire fixation Inter phalangeal joints Easy to reduce and are stable

12.  Sudden passive flexion of the distal interphalangeal joint may rupture the extensor tendon at the point of its insertion into the base of the distal phalanx  Clinically the distal IP joint rests in moderate flexion and can not be actively extended.  Management : Tendon avulsion without a bone fragment is treated by uninterrupted splintage in the fully straight position for 6 weeks.

14.  Flexor tendon division  Extensor tendon division - Cut over proximal interphalangeal joint buttonhole deformity - Cut over MCP joints from opponents' tooth can leads to septic arthritis

16.  Many heal when left alone  If > 1cm2 is lost, may need skin graft  If bone is exposed,shortning should be considered in manual workers  Replantation of digits may lead to stiffness