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HAND &WRIST INJURIES

HAND &WRIST INJURIES. Distal Radius Fractures. elderly vs. young intra vs. extra-articular “acceptable reduction” follow-up. Distal Radius Fractures Deformities. Radial Shortening Loss of Radial Tilt (A/P view) “Dorsal Angulation” (lateral view). Distal Radius Fractures Reduction.

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HAND &WRIST INJURIES

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  1. HAND &WRIST INJURIES

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

  3. Distal Radius FracturesDeformities • Radial Shortening • Loss of Radial Tilt (A/P view) • “Dorsal Angulation” (lateral view)

  4. Distal Radius FracturesReduction • Traction/Correction of Deformity • radius = ulna • radial styloid 1 cm distal • articular surface at least neutral angulation

  5. Distal Radius FracturesWhen to Refer? • unable to acheive reduction • unable to maintain reduction in cast • intra-articular fractures • acute carpal tunnel syndrome • open fractures

  6. Distal Radius FracturesComplications • malunion • compartment syndrome • nerve entrapment • tendon rupture • loss of motion

  7. Distal Radius Fractures • osteotomy to correct malunion • DRUJ reconstruction • tendon reconstruction

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

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

  10. Metacarpal Fractures • shaft = rotational deformity • neck = angulation deformity • base = usually intraarticular

  11. Boxer’s Fractures • neck of 5th • controversy re acceptable reduction • palmar prominence • loss of knuckle • cast position

  12. Bennett’s Fracture • base of thumb metacarpal • APL pulls on larger fragment • unstable & frequently require pinning

  13. 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

  14. 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

  15. Phalanx fractures • intraarticular = trouble • oblique condyle fracture often displaces;even after couple of weeks • PCP or ORIF

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

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

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