2. Hand is divided in to three regions:
• Proximal region of the hand is the carpus(wrist)
• The middle region the metacarpus(palm)
• The distal region the phalanges (fingers)
3. WRIST INJURIES
• COLLE’S FRACTURES:
> fracture of distal radius proximal to radio carpal joint
with dorsal displacement of fracture.
> It can be associated with ulnar styloid avulsion.
4. SMITH’S FRActure:
>it is reverse colle’s
> fracture of distal radius
proximal to radiocarpal joint with
palmar/volar displacement of fracture
7. Barton's fracture:
>displaced fracture of volar lip of the
Distal radius (without involvement of the dorsa
lip)
Reverse barton’s fracture:
>displaced fracture of dorsal lip of the
distal radius
8. Carpal bone fractures
• SCAPHOID FRACTURE:
• Most commonly fractured carpal bone
• Most common etiology is hyperextension
• The scaphoid blood supply is via artery entering the bone at its
waist – non union of fracture fragments interrupts the blood
supply to the proximal fragment
• Leading to osteonecrosis
9.
10. Triquetal fracture:
•2nd most common carpal bone fracture
•There is usually small avulsion fragment on the dorsal
surface of the bone at the dorsal radiocarpal ligament
attachment—best seen on lateral XR
11. HAMATE FRACTURE:
•May involve hook or may involve the dorsal surface
•TRAPEZIUM FRACTURE:
•Occurs secondary to the abduction and hyperextension of the
thumb
•Manifests as vertical fracture within lateral aspect of the bone
12. DISLOCATIONS OF CARPAL
BONES
• Hyperextension is mechanism of injury leads to two
dislocations perilunate dilocation vs lunate dislocation
• Presents with either palmar or dorsal wrist/palm
swelling,visible/palpable deformity ,neurological symptoms.
13. PERILUNATE DISLOCATION:
•There is palmar/volar displacement of proximal row of carpal
bones on lunate so that lunate is dorsal to other bones
•Rupture of volar radiocarpal ligaments and proximal row of
carpals stripped away from lunate
•LUNATE DISLOCATION:
•Palmar / volar displacement of lunate relative to carpals
•Furthur hyperextension forces ruptures dorsal radiocarpal
ligaments and the carpals are subsequently displaced
14.
15. SCAPHOLUNATE DISLOCATION
•most common
•Rotatory subluxation of scaphoid and disruption of the
scapholunate ligament
•TERRY THOMAS or MADONNA SIGN-widened scapholunate
space seen on APXR >4cms (normal-2cms)
18. • BOXER’S FRACTURE:
• It is transversal metacarpal fracture of neck and most
common in the 5th metacarpal
• The classical mechanism is a fist blow against a person or
hard surface (e.g. a wall)
• The axial force in the flexed hand causes a boxer’s fracture
,frequently with dislocation of the distal part(the head) to
palmar
22. •BENNETT’S FRACTURE
•Intra articular fracture of the ulnar side of the base of MC-I
•Mechanism is axial force where thumb is in flexion as in a
blow with the fist
•Adductor pollicis/long abductor pollicis muscles contribute
to the associated dislocation
23.
24. Rolando’s fracture:
•Similar to bennette’s but there is comminution at the base of
1st MC
•Less prone to displacement of the distal fragment
25.
26. Skier’s thumb/ gamekeeper’s thumb
•There is ligament damage of ulnar collateral ligament of
MCP I joint which results from forced abduction of the thumb
eventually causing instability
•Rupture may be associated with avulsion fragment. with
sufficient force avulsion fragment may penetrate the adductor
aponeurosis
•Adductor aponeurosis is then located between the avulsion
fragment and the insertion site forming STENER LESION.
27.
28. TUFT FRACTURE
• It is a comminuted fracture of the distal phalanx and
usually results from crush injury for example:finger
caught between is the door
• These fractures are associated with subungual
hematomas
29.
30. >VOLAR AVULSION FRACTURE
•It develops as a result of forced hyperextension at either PIP
or DIP
•+/- dislocation
•Loose fragment is visible on the lateral image only.
31.
32. Extensor tendon injuries
• Mallet finger:
• This involves avulsion of the extensor tendon on the distal
phalanx causing DIP hyperflexion
• This may be purely ligamentous avulsion or may/may not be
combined with an ossal avulsion
33.
34. BOUTONNIERE DEFORMITY:
•also termed as buttonhole deformity
•Characterized by flexion of PIP joint and hyperextension of DIP
joint due to disruption of central band of extensor tendon
•Due to fracture or volar luxation, others include osteoarthritis
and rheumatoid arthritis
35.
36. osteoarthritis
• It is wear and tear on the cartilage
• Patients may complain about progressive load dependent pain
and/or reduced function
• May be PRIMARY or SECONDARY
• PRIMARY OA develops particularly in the interphalangeal
joints (PIP’S $DIP’S), CMC-I joint and scaphoid –trapezium-
trapezoid joint(STT)
