Chapter 11 Fracture of the Wrist and Hand

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Questions and Answers

Stable fracture is a fracture that does not have a tendency to after it has been .

displace, reduced

The sensation of the hand for Ulnar nerve is at the tip of the _____ finger.

small

The sensation of the hand for Median nerve is at the tip of the _______ finger.

index

The sensation of the hand for Radial nerve is at the ______ of the first web space.

dorsum Signup and view all the answers

What test is used to evaluate the efficiency of blood flow from the radial or ulnar artery to the hand?

Allen Test Signup and view all the answers

Malunion is associated with which kind of deformity?

Both A and B Signup and view all the answers

What is the protected safe positioning of the hand when falling?

Wrist extension, MCP 90 degree flexion, PIP extension (0) Signup and view all the answers

A Colles fracture is an extra-articular, transverse, ______ angulated fracture of the distal radius.

dorsally Signup and view all the answers

How would we describe an intraarticular, displaced, dorsally angulated fracture of the radius?

Comminuted Signup and view all the answers

What is the opposite of the Colle's fracture?

Smith's fracture Signup and view all the answers

What kind of fracture is Chauffer's fracture?

Non-displaced radial styloid fracture Signup and view all the answers

Chauffer's fracture injury is often caused by compression of the _ bone against the _ process of the distal radius.

scaphoid, styloid Signup and view all the answers

What kind of fracture is Barton's fracture?

Intra-articular fracture Signup and view all the answers

What does the image on the right and the left show regarding Barton's fracture?

Dorsally displaced fracture Signup and view all the answers

What kind of fracture is associated with the Essex-Lopresti lesion?

Comminuted radial head fracture Signup and view all the answers

What does a double density in the orthopedic world mean?

Normal alignment or dislocated/malformed structures Signup and view all the answers

Why do you feel tingling when you press on the hook of hamate on your palm?

The ulnar nerve passes between the pisiform and the hook of hamate. Signup and view all the answers

How do you treat a hook of hamate fracture?

Excision of the hook of hamate Signup and view all the answers

A scaphoid fracture most commonly occurs with ________.

FOOSH Signup and view all the answers

Tenderness and swelling in the _ _ is indicative of a scaphoid fracture.

anatomical snuff box Signup and view all the answers

What is the next step if a patient has pain in the snuff box and the X-ray comes back negative?

Come back in 7-10 days to repeat the exam and the X-ray. Signup and view all the answers

MRI's in a scaphoid fracture are important to see if there is _______ of the bone.

edema Signup and view all the answers

CT scan of a scaphoid fracture will show if the bone is ________.

displaced Signup and view all the answers

Where is the blood supply better on the scaphoid bone?

Distally Signup and view all the answers

Avascular necrosis of the scaphoid is known as?

Preiser's Disease Signup and view all the answers

Avascular necrosis of the lunate is known as?

Keinbock's Disease Signup and view all the answers

Scapholunate ligament tear is indicated by the ____ sign.

Terry Thomas Signup and view all the answers

Normal SL interval should be less than _____ mm.

4 Signup and view all the answers

What dislocation is noted for requiring urgent reduction?

Perilunate redislocation Signup and view all the answers

How would you describe the fracture of the 4th and 5th digits in a Boxer's fracture?

Angulated, displaced, transverse fracture Signup and view all the answers

What kind of fracture is described as an apex of bone dorsally angulated oblique fracture of the 5th metacarpal shaft?

Boxer's fracture Signup and view all the answers

Study Notes

Fracture Types and Definitions

Stable Fracture: A fracture that remains in place after being reduced and immobilized without displacing.
Malunion: Results in functional and/or cosmetic deformity.
Nonunion: An uncommon occurrence where the fracture fails to heal.
Infection: May require delayed closure in some cases.
Loss of Motion: Can be due to tendon adherence or intra-articular issues.
Posttraumatic Arthritis: Arises from failure to restore articular congruity.

Hand Sensation

Ulnar Nerve: Provides sensation to the tip of the small finger.
Median Nerve: Supplies sensation to the tip of the index finger.
Radial Nerve: Covers sensation on the dorsum of the first web space.

Fracture Tests and Diagnosis

Allen Test: Assesses blood flow efficiency from the radial or ulnar artery to the hand.
Scaphoid Fracture: Most commonly fractured bone in the wrist, often occurs with a fall on an outstretched hand (FOOSH). Diagnosis typically requires X-ray, and CT scan can confirm displacement if initial films are negative.

Specific Fractures

Colles Fracture: An extra-articular, transverse, dorsally angulated fracture of the distal radius associated with an ulnar styloid fracture.
Smith's Fracture: Opposite of Colles; involves a volarly displaced fracture of the distal radius.
Chauffeur's Fracture: A non-displaced fracture of the radial styloid, often caused by compression against the distal radius.
Barton’s Fracture: A fracture where the distal radius is fractured with dorsal displacement; can be volarly displaced.
Essex-Lopresti Lesion: Highlights a comminuted radial head fracture with disruption of forearm interosseous ligament.

Imaging and Treatment Considerations

Double Density: Indicates either expected normal alignment or dislocation, angulation, or malreduction causing overlap of bony cortices.
Blood Supply: Better preserved in distal scaphoid fractures, increasing healing chances compared to proximal fractures.
MRI and CT Scans: Used to assess possible edema and displacement in scaphoid fractures.

Interventions and Aftercare

Treatment for Hook of Hamate Fracture: Requires excision due to potential injury to the ulnar artery and nerve.
Scapholunate Ligament Tear: Diagnosed with the Terry Thomas sign; normal scapholunate interval should be less than 4mm.
Perilunate Redislocation: Requires urgent reduction as splinting alone is insufficient.

Fracture Management

Metacarpal Boxer's Fracture: Characterized by an angulated, displaced, transverse fracture of the 4th and 5th metacarpals.
Safe Positioning of Hand: Recommended during falls is wrist extension, MCP flexed at 90 degrees, and PIP extension at 0 degrees.

Avascular Necrosis

Preiser's Disease: Refers to avascular necrosis of the scaphoid bone.
Kienbock's Disease: Describes avascular necrosis of the lunate bone.

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Test your knowledge with flashcards on fractures of the wrist and hand. This quiz covers definitions and sensations associated with different types of fractures and their implications. Perfect for students studying orthopedics or related fields.