Hand fractures Flashcards
1
Q
Causes of scaphoid fracture?
A
- FOOSH with radial deviation at wrist
- Contact sports
- RTA with patient holding steering wheel
2
Q
Epidemiology of scaphoid fracture?
A
- Male:female - 7:1
- Average age is 22 (range from 9 to 35)
- 12.4 per 100,000
- Peak incidence in autumn (children returning to school sports)
3
Q
Presentation of scaphoid fracture?
A
- Pain on radial aspect of wrist and base of thumb
- Loss of grip and pinch strength
4
Q
What signs are 100% sensitive and 74% specific for scaphoid fracture?
A
- Pain and tenderness of anatomical snuffbox
- Telescoping pain
- Tender scaphoid tubercle
5
Q
Investigation for scaphoid fracture?
A
- AP and lateral X-ray immediately
- AP and lateral X-ray in 2 weeks if scaphoid fracture confirmed or highly suggestive clinical signs present (X-ray may initially be normal)
- CT scan if planning operation or checking fracture union
- MRI definitive to confirm or exclude (usually used as second line imaging)
6
Q
What is the management of scaphoid fracture?
A
- Undsiplaced: wrist immobilised in neutral position in POP cast until radiological evidence of union (6 weeks to several months)
- Displaced, proximal scaphoid pole or symptomatic non-union: surgical fixation with bone graft and screw insertion
7
Q
What is a Bennet’s fracture, what causes it, and what does radiology show?
A
- Intra-articular fracture at the base of the thumb’s (1st) metacarpal)
- Caused by forced hyperabduction of the thumb
- X-ray shows triangular fragment at base of first metacarpal
8
Q
What is a Boxer’s fracture, what causes it, and what does radiology show?
A
- Intra-articular fracture at the distal end of the little finger’s (5th) metacarpal bone
- Caused by impact on a flexed MCP joint/clenched fist (fist fights, punching wall)
- X-ray shows fragmentation of distal portion of 5th metacarpal
9
Q
What nerve damage is associated with lunate fracture?
A
Median nerve damage
10
Q
What carpal fracture is associated with median nerve damage?
A
Lunate fracture
11
Q
Metacarpal fractures?
A
- Common
- Important they don’t unite poorly or with malrotation as this will affect finger flexion
- Normally heal with simple strapping
12
Q
Why is the lunate less likely to dislocate?
A
- The lunate is firmly attached to the distal radius by ligaments and is known as the keystone of the carpals
- Therefore dislocation is severe
13
Q
Lunate dislocation?
A
- Lunate dislocates dorsally but rest of carpals stay aligned
- Less common but more severe
14
Q
Perilunate dislocation?
A
- Lunate remains in place but one of the other carpals dislocates
- More common but less severe
15
Q
What are the clinical signs of carpal fracture?
A
- Wrist pain following trauma
- Palmar wrist often swollen and can cause acute carpal tunnel
- Pain on extension of fingers so fingers stay flexed
16
Q
A
