50 Questions
What is another name for Smith's fracture?
Reverse Colles' fracture
Which mechanism of injury is associated with a Smith's fracture?
Falling on the dorsal (posterior) side of an outstretched hand
In Smith's fracture, the distal radial segment displaces in which direction?
Palmar
Smith's fracture occurs due to which type of fall?
Fall on the dorsal (posterior) side of an outstretched hand
How does Smith's fracture differ from a Colles' fracture?
Smith's fracture displaces palmarly, while Colles' fracture displaces dorsally
What is the most common fracture of the distal radius?
Colles' fracture
What mechanism of injury typically causes a Colles' fracture?
Fall on the palm of an outstretched arm/hand
In which direction is the distal segment displaced in a Colles' fracture?
Dorsally
Which clinical sign is associated with Colles' fracture?
Dinner fork deformity
What is the common treatment required for a Colles' fracture?
Reduction
What type of wrist deviation is typically involved in a minor fall on an outstretched palm?
Radial deviation
Pain and swelling in which area is commonly associated with a scaphoid injury?
Anatomic snuff box
What is a common consequence of misdiagnosing a scaphoid fracture as a sprain?
Delayed diagnosis and treatment
Which symptom is NOT typically expected with a scaphoid injury?
Increased grip strength
What typically triggers further evaluation in a suspected scaphoid injury?
Persistent pain and swelling
What specific area of the wrist is associated with pain in this clinical presentation?
Anatomical snuff box
Which activity is most likely to exacerbate pain according to the impairments listed?
Wrist extension
Which functional limitation is highlighted in the clinical presentation?
Reduced hand use for functional activities
What type of motion, in addition to wrist extension, potentially increases pain in this clinical scenario?
Gripping
What aspect of hand function is directly affected, leading to decreased use for functional activities?
Pain
Distal ulnar fractures typically occur in conjunction with which other type of fracture?
Distal radius fractures
Persistent pain with rotation in a patient with a distal ulnar fracture might suggest damage to which structure?
Triangular fibrocartilage complex
What secondary condition should be suspected if pain persists with weight bearing following a distal ulnar fracture?
Soft tissue tear
Which symptom might indicate a complication in a patient with a distal ulnar fracture?
Pain with rotation
What is a possible complication in distal ulnar fractures if the patient continues to experience rotational pain?
Tear to the triangular fibrocartilage complex
Which of the following diagnostic imaging methods may reasonably follow an X-ray to assess fracture and potential ligamentous damage?
MRI and CT
Which part of the scaphoid bone significantly affects its healing time due to its blood supply when fractured?
Proximal segment
What is the typical immobilization period for fractures in the distal part of the scaphoid bone?
5-6 weeks
Which type of fracture is commonly caused by punching a hard object?
Boxer's fracture
What type of splint is used to immobilize fractures that are not displaced or can be easily reduced?
Thumb spica splint
If a patient has a fracture at the palmar base of the proximal first metacarpal, what is the most likely diagnosis?
Bennett fracture
Which of the following is not a typical cause of metacarpal fractures laid out in the content?
Repetitive stress
What is the recommended treatment for non-reducible fractures of the scaphoid?
Internal fixation
A fracture involving which metacarpal is least likely to be diagnosed as a Boxer's fracture?
1st metacarpal
Which of the following descriptions best fits a Bennett fracture?
Fracture of the palmar base of the proximal first metacarpal
What is the recommended duration for immobilizing a Boxer's fracture if the fracture is unstable?
Longer than 6 weeks
Which motion is the focus of AROM exercises following a Boxer's fracture?
Extensor digitorum communis motion
When is PROM and strengthening typically initiated in the treatment of a Boxer's fracture?
At approximately 6 weeks
Which of the following is suggested for edema management in a Boxer's fracture?
Isotoner gloves
What is the purpose of interossei strengthening in the rehabilitation of a Boxer's fracture?
To achieve full extension
Which activity is recommended to increase tendon gliding after immobilization?
Wrist exercises
What type of splint will a patient initially have after immobilization?
Spica splint
Which of the following principles is emphasized during the immobilization phase?
Decrease swelling
Which method may be used if a patient has difficulty regaining full ROM?
Joint mobilization
Which is not a strengthening exercise recommended post immobilization?
Finger splint exercises
Which of the following is essential before beginning active motion in the management of a Bennett fracture?
Confirming union at the fracture site via X-ray
Which guideline should therapy for a Bennett fracture follow?
Boxer's fracture
What is emphasized during rehabilitation to regain function in a Bennett fracture?
Regaining web space of the thumb and composite flexion and extension movements
Which exercise progression is recommended for a Bennett fracture?
Progressive weight bearing with the thumb abducted and grip and pinch exercises
Why is it crucial to confirm union at the fracture site with an X-ray before starting active motion in Bennett fracture?
To prevent further injury and ensure proper healing
Study Notes
Fractures of the Distal Radius
- Most common fracture of the distal radius is Colles' fracture
- Mechanism of injury: fall on the palm of an outstretched arm/hand
- Distal segment is displaced dorsally, resulting in "dinner fork deformity"
- Usually requires reduction
Smith's Fracture
- Also known as reverse Colles' fracture
- Mechanism of injury: fall on the dorsal (posterior) side of an outstretched hand
- Distal radial segment displaces in the palmar direction
Distal Ulnar Fractures
- Usually occur with distal radius fractures
- May be associated with a tear to the soft tissue (triangular fibrocartilage complex)
Pathophysiology/Pathomechanics/MO
- Minor fall on an outstretched palm can cause fracture
- Wrist extended and radially deviated at time of injury
- Often dismissed as a sprain, leading to delayed diagnosis and treatment
- Patient may experience continued pain and swelling in the "anatomic snuff box"
Clinical Presentation
- Pain on the radial side of the wrist at the "anatomical snuff box"
- Pain with wrist extension and gripping
- Decreased grip strength
Impairments
- Pain on the radial side of the wrist
- Pain with wrist extension and gripping
Activity Limitations and Participation Restrictions
- Decreased use of the hand for functional activities
Medical Management
- Diagnostic imaging: X-ray, possible MRI and CT follow-up
- Pharmacological interventions: pain management as needed
- Surgical procedures: determined by location of the fracture
Conservative Management
- Rehab begins during immobilization
- Focus on decreasing swelling, ROM of uninvolved joints, and wrist exercises
- After immobilization, patient will have spica splint initially
- Further treatment includes strengthening, stretching, and ROM exercises
Metacarpal Fractures
- Caused by falls, jammed fingers, or direct trauma
- Can fracture the base, shaft, or head of the metacarpal
- Boxer's fracture: fracture of the 4th or 5th metacarpal
- Bennett fracture: fracture of the palmar base of the proximal first metacarpal
Boxer's Fracture
- Immobilized 3-4 weeks, with additional 2 weeks in a sling splint
- Proximal interphalangeal joints (PIP) can flex and extend within 24 hours
- Edema management: isotoner gloves, massage, elevation
- AROM focuses on extensor digitorum communis motion, MCP flexion, and composite flexion
Bennett Fracture
- X-ray must confirm union at the fracture site before active motion begins
- Therapy follows same guidelines as Boxer's fracture
- Emphasizes regaining web space of the thumb, opposition, and composite flexion and extension movements
Learn about the most common fracture of the distal radius, its mechanism of injury, and characteristics. Identify the 'dinner fork deformity' and understand the treatment requirements.
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