UQ - Wrist and Hand

MOI of Colles Fracture

FOOSH with wrist extension

What is a colles fracture

fracture of the distal radius with dorsal displacement

what is Colle's fracture also known as?

dinner fork deformity

MOI of Smith's fracture

FOOSH with wrist flexion

What is a Smith's fracture?

fracture of the distal radius with volar displacement

What is a Smith's fracture also known as?

garden spade deformity

What is a Barton's fracture?

fracture and displacement of radius

75% of all radial fractures are treated using

closed reduction (ORIF)

How long does immobilization last in wrist fractures

6 weeks

MOI of boxers fracture

punch with a clenched fist

Where does the fracture occur in boxers fracture

4/5 metacarpal neck

Clinical presentation of a boxer's fracture

ulnar sided pain, swelling and bruising, decreased grip strength

treatment of boxers fracture

IP movement, edema management, joint blocking

What is the most fractured carpal

scaphoid

MOI of scaphoid fracture

FOOSH on extended wrist

clinical presentation of scaphoid fracture

pain in snuff box, axial compression of thumb, not much swelling

How are non displaced scaphoid fx treated

closed reduction

How are displaced scaphoid fx treated

ORIF

Displaced scaphoid fractures have a high incidence of

avascular necrosis

SNAC wrist

scaphoid nonunion advanced collapse

SNAC wrist is common in

older farmers/manual laborers

SNAC wrist surgery requires

fusion of mid carpals and removal of scaphoid

Mobility regained after SNAC wrist fusion

60%

MOI of hamate fracture

repetitive gripping causing impact at hypothenar eminence (bat, racket)

Clinical presentation of hamate fracture

ulnar sided pain, pain with gripping and resistance of 4th/5th digits

How are non-displaced hamate fractures treated

closed reduction

how are displaced hamate fractures treated

ORIF

Complications of hamate fractures

avascular necrosis, ulnar nerve issues, FDP issues

Role of TFCC

shock absorber for ulnar carpus

TFCC transfers __% of loading between hand and forearm

20

TFCC stabilizes

DRUJ and ulnar wrist

Primary stabilizers of TFCC

dorsal and volar radioulnar ligaments

the dorsal and volar radioulnar ligaments provide stability for what movements at the TFCC

pronation and supination

The ligaments that arise on the __ and insert onto (4) __ serve as stabilizers for the ulnar carpus

ulna, lunate, triquetrum, hamate, 5th MC

MOI of TFCC injury

FOOSH with pronation; axial loading and UD

special tests for TFCC Injury

TFCC load/compression, pisiform boost/ulnomeniscaltriquetral dorsal glide, piano key sign, piano key test

Clinical Presentation of TFCC Injury

ulnar sided pain, clicking/catching

TFCC injuries have pain with

pronation/supination, grip strength

TFCC injuries can lead to what if it goes undiagnosed

DRUJ instability

Type I TFCC Injury

traumatic

Type II TFCC injury

degenerative

TFCC treatment guidelines

conservative unless the tear is central

Splint for TFCC injury

ulnar gutter

MOI of Lunotriquetral Ligament Injury

FOOSH with wrist extension and RD

Special tests for lunotriquetral injury

lunotriquetral shear, lunotriquetral ballottement

Clinical presentation of lunotriquetral ligament injury

ulnar sided pain, clicking

Lunotriquetral ligament injury mimics what other condition

TFCC injury

Lunotriquetral ligament injury can lead to

VISI (volar intercalated segmental instability)

What occurs in a VISI

lunate tilts volarly (flexes)

Treatment for a lunotriquetral injury

surgery

How long is rehab for lunotriquetral injuries

slow to progress

How long is immobilization for lunotriquetral ligament injuries

12 weeks

What are the AROM limits of lunotriquetral ligament injuries

30 deg flexion, 50 deg extension

When can you return to activity after a lunotriquetral ligament injury

6-9 months

MOI of scapholunate dislocation

FOOSH with wrist extended and UD

Special tests for scapholunate dislocation/injury

scaphoid shift, scapholunate ballottement

What ligament is torn in scapholunate injury

scapholunate ligament

Clinical presentation of scapholunate dislocation

dorsal wrist pain, clicking, LOM at radioscaphoid joint, grip weakness

Treatment for scapholunate dislocation

surgery

How long is rehab for scapholunate dislocations?

slow to progress

How long is immobilization for scapholunate dislocation

12 weeks

What are the AROM limitations for scapholunate dislocations

30 deg flexion and 50 deg extension

When can you return to normal activities after a scapholunate dislocation

6-9 months

a DISI can lead to a

SLAC wrist (scapholunate ligament advanced collapse)

Continuing hyperextension after DISI can lead to

failure of lunate-triquitrium ligament

DISI

dorsal intercalated segment instability

DISI occurs

scapholunate tear that results in dorsal instability

Clinical presentation of DISI

chronic pain, stiffness, decreased grip strength

Treatment of DISI early vs late

early: splinting and activity mods

late: proximal row capectomy or 4 corner fusion

SLAC wrist

progressive arthritis pattern after untreated scapholunate injury

Clinical presentation of SLAC wrist

chronic pain, stiffness, decreased grip strength

Treatment of SLAC wrist early vs late

early: splinting and activity mods

late: proximal row capectomy or 4 corner fusion

MOI of gamekeepers thumb

FOOSH with forceful thumb ABD

Gamekeepers thumb injuries are common with

skiing, football, basketball, goalies, cops

Clinical presentation of gamekeepers thumb

pain at base of thumb, swelling/bruising, weak grip, weak pinch strength, thumb instability,

What ligament tears in gamekeepers thumb

thumb ulnar collateral ligament

Special test for thumb UCL rupture

UCL/MCL stress test for 1st MCP (thumb valgus)

Mallet finger is a rupture of what tendon

extensor

Jersey finger is a rupture of what tendon

flexor

MOI of mallet finger

forced flexion of extended finger

Clinical presentation of mallet finger

fingertip droops, mild pain/swelling

Mallet finger can lead to what kind of deformity

swan-neck

Mallet finger leads to swan neck deformity due to

tension at central slip bc of increased tension as lateral bands migrate dorsally

If swan neck deformity occurs, what is standard

splint

Treatment for mallet finger

Continuous Extension Splinting for at least 6 weeks.

What are the guidelines for splints in mallet finger

never take the brace of

After splinting for mallet finger, you can start performing

gradual DIP flexion and gentle extension strengthening exercises

MOI of jersey finger

flexed PIP as DIP is hyperextended

Jersey finger can lead to what deformity

boutonniere deformity

Clinical presentation of jersey finger

cannot bend DIP, finger rests in slight extension

How long do you have to catch and correct jersey finger before it is too late

7-10 days

Why is it important to catch jersey finger ASAP

can permanently lose PIP function

MOI of boutonniere deformity

injury to central slip of extensor tendon at PIP d/t trauma, RA, laceration

MOI of swan neck deformity

chronic mallet finger, RA, ligament laxity leads to PIP hyperextension and DIP flexion

Structure injured in mallet finger

extensor tendon (DIP)

Structure injured in jersey finger

flexor tendon (FDP)

Structure injured in boutonniere

central slip (extensor)

Structure injured in swan neck

volar plate/imbalance

Mallet finger positon

DIP stuck bent

Jersey finger positon

DIP stuck straight