Common wrist injuries ( fractures + OA )

MOI + presentation of distal radial #

MOI	Younger : high energy injury  Older: FOOSH
Presentation	Swelling + pain  Restricted RoM  Point tenderness

Classification of distal radial #

AO classification: Extra-articular  Partical articular  Completely articular  Frykman/ Melone/ AO/ Eponym Displacement Structure involved  Articular involvement  Colles  Dorsal  Distal Radius Extra Smith Volar  Extra Barton Fracture dislocation  Volar/ dorsal  Intra  Die-punch  Depressed # lunate fossa  Chauffer  Radial styloid

Complications of distal radial #

1. Median nerve damage → acute carpal tunnel 

2. Tendon rupture from dorsal fragment / plate → extensor pollicis longus 

3. Re-displacement → collapse of #

4. DRUJ dislocation 

5. Ulnar sided wrist pain

Imaging for distal radial #

Xray/ CT/ MRI

Operation for distal radius # + considerations

Non-op	Op
Percutaneous pinning/ ORIF	Closed reduction + immobilisation  Markers of good reduction  Articular congruity  Radial shortening/ ulnar variance  Dorsal angulation  Radial inclination

Considerations for non-op vs op 

• LaFontaine predictors of instability

Post op therapy ( distal radial # )

	Components
Adivce + education	Healing timeframes  Return to ADL
Wound + scar Mx	Universal precautions  Appropriate dressing  Silicone products
Splinting	TP resting splint
Oedema Mx	Elevation  Compression  Gentle AROM  Effleurage

Post op therapy ( distal radial # ) 2

Therapeutic ex	Dependent on # healing  Assisted AROM/ AROM/ PROM  Hand/ elbow/ shoulder PROM  Wrist: extension/ supination ROM  Strengthening once healed
Manual therapy	Effleurage  Passive Accessory mobilisation dependent on # type + healing stage
Functional integration	Dependent on # healing stage

Conservative therapy ( distal radial # )

	Components
Adivce + education	# healing timeframe  Functional use
Immobilisation	Plaster TP splint  Which position ?  Time frame: 6 weeks
Oedema Mx	Elevation  Compression when cast removed

Conservative therapy ( distal radial # ) 2

Therapeutic ex	Hand/ elbow/ shoulder RoM ( within limits of cast )  Post cast removal + confirmation of # healing  RoM  Strengthening  RTW/ sport
Manual therapy	Effleurage  Soft tissue massage  Radiocarpal + DRU joint mobilisation
Functional integration	Dependent on # healing stage

Feature of scaphoid

→ largest + important carpal bone → link proximal + distal carpal rows 

→ blood supply from distal to proximal pole

MOI + clinical tests ( scaphoid fractures )

	Details
MOI	FOOSH  Slight pronation + ulnar deviation
Clinical tests	Variable pain + swelling  Reduction in RoM  Tender in anatomic snuff box  Tender over scaphoid tubercle  Scaphoid compression test → axial load through MC

Classification ( scaphoid fractures )

Imaging: 

1. X ray: high clinical suspicion → repeated 2 weeks later

2. Bone scan: occult # in acute settings 

3. MRI: occult # 

4. CT: for # location/ angle/ displacement 

Location of fracture: ( in order of prevalence ) 

1. Waist 

2. Proximal third 

3. Distal third 

→ mayo + herbert classification

Considerations for op vs non-op ( scaphoid # )

Op	Non-op	Complications
Unstable  → displaced # > 1 mm  → proximal pole # ( less blood supply )	Non-displaced #	Non-union Avascular necrosis  Scaphoid non-union advanced collapse in wrist

Non-op immobilisation considerations ( scaphoid # )

Timeframe	Type of cast	When to take cast off
Early immobilisation: < 3 weeks  Duration: 6-8 weeks	Wrist immobilisation → crucial  Thumb X  Situation where thumb cast needed: articular cartilage damaged in #	Confirmed healing w/ X rays

Thumb CMC OA presentation

	Details
Presentation	Location of pain: radial dorsal aspect of wrist  Deformity:  Thumb adducted  Loss of webspace  MCP hyper E  Palpation:  tender over CMC joint line  Aggravating movements: Pinch + grasp  Test: provocative grind test

Associated impairments ( thumb CMC OA)

Attenuation of CMC supporting ligaments 

→ instability 

→ subluxation 

→ arthritis of CMC joint

Classification ( thumb CMC OA)

Eaton + Littler 

Stage	Joint space	Osteophyte
I ( pre-arthritis )	Slight narrowing	/
II	Slight narrowing  Sclerosis	Y  < 2mm
III	Marked narrowing	Y > 2mm
IV	Pantrapezial arthritis  ( STT involved )

Joint protection principles ( thumb CMC OA)

Plan activity  Pace  Respect pain  Balance activity + rest  Muscle strength + RoM maintenance  Use larger + stronger joints  Avoid staying in one position for long periods of time  Maintain good movement patterns  Wear splints → offload  Change the way of moving objs

Thumb CMC OA stability ex( thumb CMC OA)

1. First dorsal interossei 

2. Thumb abduction 

3. Thumb opposition 

4. Thumb circumduction

Splints ( thumb CMC OA)

Push brace