HAND

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HAND WRIST INJURIES
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Distal Radius Fractures

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

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Distal Radius FracturesDeformities

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

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Distal Radius FracturesReduction

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

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Distal Radius FracturesWhen to Refer?

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

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Distal Radius FracturesComplications

• malunion
• compartment syndrome
• nerve entrapment
• tendon rupture
• loss of motion

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Distal Radius Fractures

• osteotomy to correct malunion
• DRUJ reconstruction
• tendon reconstruction

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Scaphoid Fractures

• most commonly fractured carpal bone
• 5-12 nonunion rate
• when in doubtcast
• may take 12 weeks to heal

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Wrist Dislocations

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

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Metacarpal Fractures

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

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Boxers Fractures

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

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Bennetts Fracture

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

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Skiers 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

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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

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Phalanx fractures

• intraarticular trouble
• oblique condyle fracture often displaceseven
  after couple of weeks
• PCP or ORIF

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Phalanx fractures

• chip fractures
• FDP avulsion
• Volar plate injuries(PIP joint dislocation)
• FDP gt 10 days not salvageable

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Phalanx fractures

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