orthopaedic Mx of wrist and hand

DRF managemetn 3steps

• obtain good reduciton

• maintain good reduciton

• early motion as fracture stability allows

what is good reduction on orthopaetic DRF

1. Articular congruity 2. Radial shortening/Ulnar variance 3. Dorsal angulation 4. Radial inclinationhan

hand surgery pre-op Ax

• allergies (antibiotics+anasthetic)

• bleedign disorders

• illness

• poort healing Hx

hand surgery pre-op common complicaitons

infection  scar formation  Nerve injury/altered sensation, CTS  Malunion, Stiffness,  CRPS

hand surgery pot op aims

wound and odema Mx

splintage (promote healing)

movement (exercise MT)

scar management

sensory re-education

funcitonal integration

inflamation healing phase

0 - 48 hours Vascular response, Phagocytosis Negligible wound strength Mx: Rest, Elevation, Oedema control

proliferation helaing phase

12hr-10days

Migrate & Bridge wound edges Mx: Rest, Elevation, Oedema, Light exercise

healing phase fibroplasia

Day 4 - 28 days

Collagen deposition

Mx: Exercise, oedema control, function

healing phse remodelling

1-2mths - scar maturation

Mx: Exercise, manual techniques, function

wound Mx

use appropriate dressing (min bulk, moist, specific to wound)

prevent + control infection

minimise (odema, tension, necrotic tissue)

odema Mx

limit odema (limit stiffness, improve blood flow)

prevention: elevation, early AROM + tendon gliding, cold pack, compression

compression for hand

coban bandag, handy gauze, tubigrip, gloves

scar Mx

massage, taping, silicone

desensitisaiton: can be hypersensitive - want to gradually increase Pt tolerance to tactile stimulation (map area and prgressively increase introducing stimuli)

desensitisaiton program

Identify stimuli that provokes a response: - textures/textiles - immersion particles - maintained pressure - temperature changes Apply stimuli 5 - 10 minutes, 3 - 4 x times a day

sensory re education

avoid heat, cold, sharp

avoid excessive force,

observe skin for sign of stress

DRF complications

Significant Malunion - stiffness, OA, pain 2. Carpal Tunnel Syndrome 3. TFCC tears 4. EPL rupture 5. Complex Regional Pain Syndrome Type 1