describing anatomy of the wrist and hand .. what is fracture mechanism of injury of all the fracture classification of fracture clinical features radiologicals exminations management of the fracture

1. By kajal

8. Involves the distal end of radius at cortico-
cancellous junction(about 2cm from the distal
articular surface.)
Deformity : normally , the distal articular
surface of the radius faces ventrally and
medially.The tip of the radial styliod is about
1cm distal to tip of the ulnar styloid.

9.  Fall on an outstretched hand
 Run into wall with wrist hyperextended

11.  As the displacement occurs , some amount of
comminution of dorsal and lateral cortices and
soft cancellous bone of the distal fragements
occurs. some injuries are commonly associated:
 # of the styloid process of the ulna
 Rupture of the ulnar collateral ligament
 Rupture of the traingular cartilage of the ulna
 Rupture of the interosseous radio-ulnar ligament
, producing radio-ulnar subluxation.

12.  Visible deformity
 Swelling
 Pain
 POT - point tender

21.  Tendons may be torn away from attachment
site
 Stiffness of joints (occurs due lack of ex”)
 Mal-union(re-dislocation of colles #)
 Subluxation of the inferior radio-ulnar joint
 Carpal tunnel syndrome(after united)
 Sudeck’s osteodystrophy (after removal of
plaster is removed patient still complains of
plain, stiffness and swelling in the hand)
 Rupture of extensor pollicis longus
tendon(limited B.S)

22.  Reverse of colles #
 Uncommon #
 In old people
 Occurs in same site
 # that the distal fragment ventrally and tilts
ventrally.
 Treatment : closed reduction and
immobilisation for 6 weeks.

34.  Immobilised in a scaphoid cast for 3-4 months
 Scaphoid cast for 2 weeks (cast extending
from below elbow to the metacarpal heads ,
includes the thumb , up the interphalangeal
joint….the wrist is maintain in little
dorsiflexion and radial deviation(glass-
holding position)special compression screw
are applied.)
 Time for healing taken

36.  Avascular necrosis (proximal fragment
becoming avascular)
 Delayed-and non-union (due to imperfect
immobilisation ,the synovial fluid hindering
the formation of fibrinous bridge between
the fragments or impaired B.S )
 Wrist osteoarthritis

37.  Defination: this the a # of the upper-third of
the ulna with disclocation of the head of the
of the radius. It is caused by a fall on the out
stretched hand with the forearm forced into
excessive pronation (hyper-pronation injury).
It may also result from a direct blow of the
upper forearm.

38.  Types: (depending on the angulation)
 Flexion type
 Extension type (commoner type , ulna #
angulates ant” (extends) and the radial head
disclocates ant”)
The flex” type is where the ulna # angulates
post”(flexes) and radial head disclocates
post”

40.  # of the ulna in its upper half
 Dislocation of the head of the radius

43.  Mal – union (re-displacement happening
within the plaster)

44.  # of the lower third of the radius with
disclocation or subluxation of the distal radio-
ulnar joint. Commonly results from a fall on
an out strectehed hand.
 displacement : the radius # is angulated
medially and ant”, the distal radio-ulnar joint
is disrupted ,resulting in dorsal dislocation of
the distal end of the ulna .

45.  Isolated # of the distal half of the radius
 The distal radio-ulnar joint must be
subluxated dislocated.

46.  Prefect reduction
 Conservative methods (except in children)
 Reduction and fixation of the radius with a
plate.

47.  Mal-union (displacement of fragment and
limitation of pronation and supination.)

48.  Defination: # extends from the distal articular
surface of the radius to the either its ant” or
post” cortices.
 The small distal fragments carries with it the
carpals
 Acc” , volar bartons # (ant” marginal type) and
dorsal bartons # (post” marginal type)
 Treatment : closed manipulation and a plaster
cast .
 Open reduction and internal fixation (where
closed reduction fails.)

53.  Triquetral fractures are carpal
bone fractures generally occuring on the dorsal
surface of the triquetrum.Thetriquetral may
be fractured by means of impingement from the
ulnar styloid, shear forces, or avulsion from strong
ligamentous attachments.

56.  The triquetrum is the most
commonly fractured carpal bone. ... Dorsal
cortical fractures may be treated with cast
immobilization for 6 weeks. If un-united
cortical fragments remain symptomatic,
excision may be
necessary. Triquetral body fractures are
usually nondisplaced and heal well with cast
immobilization for 6 weeks

58.  These are rare dislocation of the wrist
 2 types:
 Lunate disclocations (dislocates ant” but the
rest of carpals remain in position)
 Peri-lunate disclocations (lunate remains in
position and rest of carpal dislocate dorsally ,
commoner type)
 Treatment : open reduction
 Complication : avascular necrosis

60.  Bennett fracture is a fracture of the base of
the first metacarpal bone which extends into
the carpometacarpal (CMC) joint.This intra-
articular fracture is the most common type
of fracture of the thumb, and is nearly always
accompanied by some degree of subluxation
or frank dislocation of the carpometacarpal
joint.

62.  Closed manipulation and plaster cast
 Closed reduction and percutaneous flixation
under x-ray using an image intensisfer , is a
good techq”
 Open reduction and internal fixation

64.  O.A
 PAIN
 LOSS OF GRIP

76. The causes are: (i) a fall on the hand,
(ii) a blow on the knuckles (as in boxing)
(iii) crushing of the hand under a heavy object. Fracture of one or more
metacarpals may occur. The fracture may be classified, according to the site, as
follows:
a) Fracture through the base of the metacarpal,usually transverse and undisplaced.
b) Fracture through the shaft – transverse or oblique. These fractures are usually
not much displaced because of the splinting effect of the interossei muscles and
adjacent metacarpals. When more than one metacarpal shafts are fractured, this
“auto-immobilisation” advantage is lost. Such fractures are unstable and
require operative treatment.
c) Fracture through the neck of the metacarpal– It commonly affects the neck of
the fifth metacarpal. The distal fragment is tilted forwards. It is usually
sustained when a closed fist hits against a hard object (Boxer's fracture).

78.  Conservative treatment is sufficient in most
cases.
 immobilisation for 3 weeks.
 reduction ( closed reduction)
 internal fixation with K-wires or mini plates

80.  These are common fractures, generally
sustained
 by fall of a heavy object on the finger or
crushing
 of fingers.The fractures can have various
patterns,
 and may be displaced or undisplaced.

82.  a) Undisplaced fracture:Treatment is
basically for
 the relief of pain.
 A simple method of splintage
 is to strap the injured finger to an adjacent
 finger for 2 weeks After this, finger
 mobilisation is started.

83.  b) Displaced fracture: An attempt should be
made
 to reduce the fracture by manipulation, and
 immobilised in a simple malleable aluminium
 splint.Active exercises must be started not
later
 than 3 weeks after the injury
 open reduction
 and internal fixation using K-wire

84.  Mallet finger (Baseball finger) results from
the
 sudden passive flexion of the distal
interphalangeal
 joint so that the extensor tendon of the distal
interphalangeal
 (DIP) joint is avulsed from its insertion
 at the base of the distal phalanx. Clinically,
distal phalanx
 is in slight flexion.

85.  DISLOCATION OFTHE METACARPO-
PHALANGEAL JOINTS
 These are uncommon injuries, resulting from
 hyperextension of the metacarpo-phalangeal
 (MP) joint, so that the head of the
metacarpalbutton-holes through the volar
capsule.The
 MP joint of the index finger is affected most
 commonly. Open reduction is required in most
 cases.

86. AMPUTATION OF FINGERS:PRINCIPLES OFTREATMENT
1. Every effort should be made to save as much length of the thumb
as possible.
2. Amputations in children are more conservative.
3. Finger tip amputations need reconstruction in such a way that full-
thickness skin covers the tip.
4. In amputations at the level of the distal phalanx, replantation is not
possible.
5. Replantation is not performed in the elderly persons, or sometimes
in labourers who do not need delicate functions of the hand. In
such cases, rather the finger is amputated and the stump closed.
6.Thumb reconstruction is possible using microsurgical technique by:
(i) replantation; (ii) pollicisation of the finger (one of the fingers is
made into a thumb); or (iii) transfer of a toe with its neurovascular
bundle using microsurgery.

87.  Testing of muscles
 FCR
 FRU
 FD
 TESTING OF EXTENSORTENDON

88. a) Primary repair, end-to-end, if it is a clean cut
 injury. In the finger if both flexor tendons are
 cut, only the profundus tendon is repaired.
 b) Delayed repair, reconstruction by tendon graft
 is performed if it is a crushed tendon.The
 palmaris longus is the most commonly used
 tendon for grafting.
 c) Tendon transfer: If a tendon cannot be
 reconstructed, or sometimes as a matter of
 choice, another dispensable tendon can be
 transferred to its position, e.g., in rupture of the
 extensor

89.  Considerations for amputation :
 Age of the patient
 Cause of crushing (h/o is imp”)
 Time since injury
 Severity of crushing
 The part of the hand affected
 Other considerations (e.g : cosmetic finger)

90.  Age of the patient: In children, amputation
 is indicated only when the part is totally
nonviable.
 However, in persons over 50 years of
 age, amputation of one or two digits, except
 the thumb, may be indicated when both
digital
 nerves and both flexor tendons are severed.

91.  The purpose of treatment to restore
functions
 An assessment of the injury by detailed
history
 Treatment priorities
 Individual tissue cinsiderations
 Proper splintage

93. e) Supportive care:The following supportive care
is required:
• Elevation of the hand for first 3-4 days to avoidOedema
• Finger movements to avoid oedema andstiffness
• Antibiotics, prophylaxis against tetanus andgas gangrene
• Suitable analgesics
• Dressings as necessary
f) Rehabilitation: In the initial period, this consistsof
exercises, wax bath and splintage. Later,various
appliances may be designed to help thepatient perform
better. Once maximum benefithas been obtained by
physiotherapy, secondaryoperations may be considered
for furtherimprovement in functions.