MUN Orthopedics

HAND &WRIST INJURIES

MUN Orthopedics

MUN Orthopedics

Distal Radius Fractures

elderly vs. young intra vs. extra-articular “acceptable reduction” follow-up

MUN Orthopedics

Distal Radius FracturesDeformities

Radial Shortening Loss of Radial Tilt (A/P view) “Dorsal Angulation” (lateral view)

MUN Orthopedics

Distal Radius FracturesReduction

Traction/Correction of Deformity radius = ulna radial styloid 1 cm distal articular surface at least neutral

angulation

MUN Orthopedics

Distal Radius FracturesWhen to Refer?

unable to acheive reduction unable to maintain reduction in cast intra-articular fractures acute carpal tunnel syndrome open fractures

MUN Orthopedics

Distal Radius FracturesComplications

malunion compartment syndrome nerve entrapment tendon rupture loss of motion

MUN Orthopedics

Distal Radius Fractures

osteotomy to correct malunion DRUJ reconstruction tendon reconstruction

MUN Orthopedics

Scaphoid Fractures

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

MUN Orthopedics

Wrist Dislocations

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

MUN Orthopedics

Metacarpal Fractures

shaft = rotational deformity neck = angulation deformity base = usually intraarticular

MUN Orthopedics

Boxer’s Fractures

neck of 5th controversy re acceptable reduction palmar prominence loss of knuckle cast position

MUN Orthopedics

Bennett’s Fracture

base of thumb metacarpal APL pulls on larger fragment unstable & frequently require pinning

MUN Orthopedics

Skier’s Thumb

ulnar collateral ligament avulsion with or without bone fragment ?? stability compare to other side less pain often more unstable stable 6 weeks cast immobilisation

MUN Orthopedics

Phalanx fractures

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

MUN Orthopedics

Phalanx fractures

intraarticular = trouble oblique condyle fracture often

displaces;even after couple of weeks PCP or ORIF

MUN Orthopedics

Phalanx fractures

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

MUN Orthopedics

Phalanx fractures

PIP joint sprains may swell > 1year extension block splint buddy-tape rare comminuted fractures require

surgery isolated digit lateral view