Lecture 2 - Flashcards
(40 cards)
Injuries to fingers, hand and wrist most commonly occur due to:
Sporting injuries Work related Work around home Falls Fights
Name the fractures of the hand
Volar plate avulsion
Mallet finger
Jersey fracture
Boutonnière deformity
Explain the volar plate avulsion
Volar plate is a thick band of fibrous ligament on Palmer side of IP joint. It stabilises joint and prevents hyperextension
The avulsion I’d flexor digitorium superficialis due to hyper3xtension cussing force pulling at attachment point and removing fragment of bone with tendon
What are the symptoms of volar plate avulsion
Pain, limited rom
Tenderness of volar surface of PIP, and swelling
Can see change in density (due to extra fluid tissue), slight malalignment of distal phalanges to proximal phalanges
Exaplin a mallet finger fracture
Occurs due to forced flexsion at DIP joint
There are 2 forms:
Soft tissue mallet - extensor tendon ruptured
Bony mallet - avulsion of extensor tendon removing bone fragment
What are symptoms of mallet fracture?
Inability to straighten finger
Red, swollen and tender
Explain what a jersey fracture is
Caused by forceful extension against actively flexed finger at DIP (75% common for 4th digit)
Avulsion of FD Profundus
Symptoms: inability to flex DIP, pain, tenderness over volar distal portion
Explain what is Boutonnières deformity
Normal structural orientation of ligament and tendons of the phalanx but it’s abnormal because of an over stretch of the central slip (a bone fragment) at dorsal side of PIP ie. avulsion of central slip of extensor tendon
Leads to flexsion contract I’ve of PIP and extension at DIP
Name the carpals
Scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capiatate, hamate
There are 3 carpal arcs, and if there is no carpal disorganisation, the arcs are parallel and uninterrupted
On lateral scan:
Pisiform, trapezium, scaphoid, hamate hook = volar
Triquetral, hamate,capitate = dorsal
Lunate looks like half moon on bottom
Explain the joints of the carpal and metacarpal
Between each carpal bone = intercarpal joint
Between each metacarpal = carpometacarpal joint (forms perfect zigzag when aligned and normal)
Joints are 1-2 mm wide
Cortical margins should be parallel
Explain the anatomy of carpal bones and ligaments
Each carpal bone is connected to its neighbour by 1 or more interosseous ligament
There are 2 collateral ligaments
- ulnar collateral (ulnar styloid to triquetral/pisiform)
- radial collateral (radial styloid to scaphoid)
What is meant by the ulnar variance ?
Refers to the level of the distal articular surface of the ulna relative to the distal articular surface of radius
Negative variance = ulnar below radius
Neutral variance = in line with radius
Positive variance = ulnar above radius
Explain different carpal bone fractures and their frequencies
Scaphoid = 50-80% freq, at waist, FOOSH Lunate = 3.9%, axial force Triquetral = 18%, blow to dorsum hand, or extreme hyperextension Pisiform= 1.3%, FOOSH Trapezium = 3-5%, blow to dorsum of wrist Capitate = 1.9%, axial blow to 3rd MCP joint with dorsiflexed wrist and slight radial deviation Hamate = 1.7%, blow to volar hand, or axial blow to 4/5th MCP joint with closed fist
Why are weightlifters subject to wrist injuries?
A clenched fist creates more pressure on the carpal ligaments and can be used to test for ligamentous damage, and weightlifters often tear ligaments between lunate and scaphoid when there is axial force brought on by the barbell
Where is the scaphoid fat pad?
It’s in the space between the extensor pollicus brevis and longus
Lateral to the scaphoid
Where is the fat pad in the lateral wrist?
Fractures of the wrist and suspected from the elevation of the pronator quadratus fat pad, which is on the lateral wrist at the lower end of the radius and ulna
Ie. think line anterior to pronator quadratus muscle
What’s an impact injury?
FOOSH
If hand extended can cause:
- fracture ulnar styloid process (absorbs 20% of force)
- injury to triangular fibrocartilage complex
- rupture radiocarpal ligamnets
- die punch fracture (lunar fossa depression of radius)
If hand is flexed:
- fracture distal radius (absorbs 80% of force)
- fracture scaphoid
- rupture of scapholunate or lunotriqetral ligaments
- avulsion of dorsal capsule from distal radius
Name the fracture of the wrist/forearm
Barton Reverse Barton Chauffeur Colles’ Smith Galeazzi Monteggia Reverse Monteggia Die punch Night stick fracture
Explain what is a Barton fracture and the bones involved and reverse Barton
Distal radius interarticular fracture of posterior margin
Dorsal displacement
Falling on pronated hand for Barton and FOOSH for reverse Barton
Explain what a colles fracture is
Extension of wrist, FOOSH
Causes radial head fracture accompanied by ulnar dislocation
With distal fragment dorsal displacement, and proximal fragment volar displacement
Explain a smiths fracture
Opposite of colles
So flexsion of wrist , or blow to posterior distal radius
Explain what a galleazzis fracture is
Uncommon, FOOSH with elbow flexed
Distal 3rd radial shaft fracture + dislocation of ulna (vollalry) (if not already fractured)
Can lead to colles if forearm is extended, malunion, nonunion, limited pronation/supination, anterior interosseous nerve palsy
Explain what is a Monteggia fracture
Common fracture of forearm, FOOSH, forearm in excessive pronation
Fracture of proximal 3rd ulna shaft (anterior displacement) + proximal radius dislocation
Can cause non union, limited movement at elbow
What’s a night shift fracture?
An isolated fracture of proximal 3rd of ulna
Very similar to Monteggia fracture but this doesn’t have a dislocated radial head
