Presentation on theme: "Wrist and Scaphoid Index case term 1. Anatomy Can you name all these bones?"— Presentation transcript:
Wrist and Scaphoid Index case term 1
Anatomy Can you name all these bones?
Clinical Case 1 85 year old woman Falls over and lands on outstretched arm Pain in wrist Tender over base of thumb and wrist What are possible injuries?
X-ray of wrist
Distal Radial Fracture Colles Fracture
Colles fracture of wrist How is this injury treated? What long term complications may the patient experience? What can be offered to help reduce these complications?
Post manipulation x-ray
Wrist fractures 3 types Depends on what position the hand is forced into by the fall Depends on displacement of distal radius and whether the wrist joint is involved
Clinical case 2 8 year old child Falls onto outstretched arm whilst skateboarding Not using arm Tender over wrist on examination What is most likely injury?
Greenstick fracture of distal radius
Clinical case 3 25 year old man Falls over handlebars whilst mountain biking Attends A and E Tender over base of thumb and wrist
Scaphoid views on x-ray
Scaphoid fracture Fall on outstretched hand Tender in anatomical snuffbox Usually fractures through the waist of Scaphoid Complications???
Blood supply to Scaphoid
Avascular necrosis of scaphoid Affects proximal pole of scaphoid Bone may fragment Causes secondary degenerative pain
What if X-ray normal? If clinically suspect scaphoid fracture Treat as fracture and repeat x-ray in fourteen days time when fracture maybe more apparent Image wrist with MRI as will show subtle fractures, bone oedema, and ligamentous injury
MRI of Scaphoid fracture T1 weighted T2 weighted fat sat showing oedema in distal scaphoid
Wrist and hand In Summary, we have looked at Anatomy Common injuries Complications of injury