44. Wrist and forearn

Question 1

2 major groups of ligaments

Answer 1

o	intrinsic
	connect individual carpal bones
o	extrinsic
	carpals to radius, ulna, metacarpals
	volar and dorsal groups

Question 2

5 specific aspects to assess on wrist xray

Answer 2

1. Radial length
2. Ulnar slant
3. 3 carpal arcs
4. Volar tilt
5. Pronator quadratus fat pad

Question 3

What is normal radial length

Answer 3

radial styloid should extend 9-12mm beyond ulnar articular surface

Question 4

What is normal ulnar slant

Answer 4

Ulnar slant of distal radius should be 15-25 degrees

Question 5

What is normal volar tilt

Answer 5

10-25 deg in lateral

Question 6

3 PHx to test for scaphoid #

Answer 6

1. snuffbox
2. axial compression
3. Wrist pinch

Question 7

MGMT of scaphoid

Answer 7

CT

spica with ortho FU

Question 8

Signs of lunate #

Answer 8

Pain in depression distal to listers tubercle

Question 9

MGMT of lunate #

Answer 9

• Non displaced are immobilized and displaced are ORIF

Question 10

Complication of lunate #

Answer 10

Keinbock disease

- AVN of lunate

Question 11

MGMT of triquetral #

Answer 11

immobilize in short arm splint or ulnar gutter and ortho FU

Question 12

Complication from pisiform #

Answer 12

ulnar nerve parathesia

Question 13

MGMT of pisiform #

Answer 13

Short arm cast x 3 weeks

- If neuropraxia, then urgent ortho

Question 14

PHx for hamate #

Answer 14

• Isolated pain over hypothenar eminence

Question 15

MGMT of hamate #

Answer 15

• Hook #s should be immobilized with ulnar outrigger and thumb spica
• If distal ischemia, urgent ortho

Question 16

MGMT of trapezium

Answer 16

spica with ortho follow-up

Question 17

MGMT of capitate #

Answer 17

• non-displaced in spica and ortho

- urgent if displaced and dislocation

Question 18

Mayfield classification of carpal instability

Answer 18

All proceed around the lunate
o	1. Scapholunate
	widening of joint
	David Letterman sign (wide teeth)
o	2. Perilunate
	lateral view
	capitate dorsally dislocated
o	3. Triquatral dislocation
	appears as stage 2
o	4. Lunate dislocation
	triangular appearance of lunate on PA

Question 19

Definition of colles

Answer 19

• transverse # of radial metaphysis, dorsally displaced and angulated
• classic dinner fork deformity
• common to have ulnar styloid # with it

Question 20

MGMT of colles

Answer 20

reduction and casting

Question 21

3 things that need to be reduced in colles

Answer 21

1. radial length
2. Dorsal angulation
3. Volar tilt

Question 22

5 Indications for emergency reduction of colles

Answer 22

o	neurovasc compromise
o	big deformity
o	tenting skin
o	loss of volar tilt
o	dorsal angle > 20%

Question 23

Define smiths #

Answer 23

Transverse # of the metaphysis of the distal radius
o *volar displacement and angulation
o may extend into joint
- garden spade deformity – opposite of colles

Question 24

Complication of smiths #

Answer 24

median nerve compromise

Question 25

Define Barton’s #

Answer 25

-oblique intraarticular # of the rim of radius, displacement and dislocation of the carpus

Question 26

MGMT of Barton’s

Answer 26

Emeregent ORIF

Question 27

Define Hutchison’s #

Answer 27

intraarticular # of radial styloid

Question 28

MGMT of Hutchison’s #

Answer 28

non-displaced
o	sugar tong
o	then short arm cast
displaced –common
o	ORIF

Question 29

3 tests for carpal tunnel

Answer 29

1. Phalen test
o	Wrist flexion against each other for 60 seconds
2. Tinel’s test
o	Tap on median nerve
3. Durkans
o	Direct pressure on carpal tunnel
o	May be best sens and spec

Question 30

MGMT of “both bone” radius and ulna #

Answer 30

• need to assess NVS closely
• consider compartment syndrome
• if grossly displaced, sugar tong while waiting for ortho
• will need OR

Question 31

3 signs of unstable ulnar shaft #

Answer 31

1. > 50% displaced
2. 8 deg angled
3. involve proximal 1/3

Question 32

MGMT of ulnar shaft (nightstick)

Answer 32

Unstable:
- should refer to ortho for ORIF
Stable:
-can be managed with 6 weeks in short arm below elbow

Question 33

Define Monteggias

Answer 33

ulna # with radial head dislocation

Question 34

MGMT of Monteggias

Answer 34

o Peds can Tx conservatively

o Adults need ORIF

Question 35

Define Galeazzi

Answer 35

• middle to distal 1/3 of radius with DRUJ injury

Question 36

MGMT of Galeazzi

Answer 36

OR

Question 37

Xray finding of Galeazzi

Answer 37

o Widened space
o Radius appear shortened
o Possible # at base of ulnar styloid

Question 38

Def Essex-Lopresti

Answer 38

• longitudinal radioulnar disassociation

- unstable forearm

Question 39

Triad of disruption in Essex-Loresti

Answer 39

o radial head injury
o DRUJ violation
o IO disruption

Question 40

MGMT of Essex-Lorpresti

Answer 40

ortho