MUN Orthopedics HAND &WRIST INJURIES

MUN Orthopedics

Distal Radius Fractures l elderly vs. young l intra vs. extra-articular l “acceptable reduction” l follow-up

MUN Orthopedics Distal Radius Fractures Deformities l Radial Shortening l Loss of Radial Tilt (A/P view) l “Dorsal Angulation” (lateral view)

MUN Orthopedics Distal Radius Fractures Reduction l Traction/Correction of Deformity l radius = ulna l radial styloid 1 cm distal l articular surface at least neutral angulation

MUN Orthopedics Distal Radius Fractures When to Refer? l unable to acheive reduction l unable to maintain reduction in cast l intra-articular fractures l acute carpal tunnel syndrome l open fractures

MUN Orthopedics Distal Radius Fractures Complications l malunion l compartment syndrome l nerve entrapment l tendon rupture l loss of motion

MUN Orthopedics Distal Radius Fractures l osteotomy to correct malunion l DRUJ reconstruction l tendon reconstruction

MUN Orthopedics Scaphoid Fractures l most commonly fractured carpal bone l 5-12 % nonunion rate l when in doubt;cast l may take 12 weeks to heal

MUN Orthopedics Wrist Dislocations l perilunate fracture - dislocations l beware the displaced scaphoid fracture l require surgical treatment l best seen on lateral view l rarely possible to reduce without GA

MUN Orthopedics Metacarpal Fractures l shaft = rotational deformity l neck = angulation deformity l base = usually intraarticular

MUN Orthopedics Boxer’s Fractures l neck of 5th l controversy re acceptable reduction l palmar prominence l loss of knuckle l cast position

MUN Orthopedics Bennett’s Fracture l base of thumb metacarpal l APL pulls on larger fragment l unstable & frequently require pinning

MUN Orthopedics Skier’s Thumb l ulnar collateral ligament avulsion l with or without bone fragment l ?? stability l compare to other side l less pain often more unstable l stable 6 weeks cast immobilisation

MUN Orthopedics Phalanx fractures l shaft = rotation l base of fifth often hard to see on Xray l clinical examination critical l check nail bed orientation l Xray healing later than clinical

MUN Orthopedics Phalanx fractures l intraarticular = trouble l oblique condyle fracture often displaces;even after couple of weeks l PCP or ORIF

MUN Orthopedics Phalanx fractures l “chip” fractures l FDP avulsion l Volar plate injuries(PIP joint dislocation) l FDP > 10 days not salvageable

MUN Orthopedics Phalanx fractures l PIP joint sprains may swell > 1year l extension block splint l buddy-tape l rare comminuted fractures require surgery l isolated digit lateral view