Injuries of Wrist and Hand

8/3/2019 Injuries of Wrist and Hand

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Injuries of Wristand Hand


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Some anatomiclandmarks on a wrist

and hand


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SCAPHOID FRACTURES

Mechanism of trauma is direct and indirect

fall onto outstretched handor direct blow on palm

punch or fallonto clinched fist


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Direct mechanism of trauma


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CLASSIFICATION

(Herbert)


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Variants of fracturesof a navicular bone

1, 2 splinters atfracture;

3 fracture of

tubercle of navicularbone


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Clinical presentation

slight edema and palpatory tenderness inregion of radiocarpal articulation (especially in

region of anatomic snuffbox) axial load along I and II fingers is painful

movements in a joint are painful and limited,

especially in dorsal and radial direction weakness of a catch of objects by the hand

impossibility of complete compression hand to

fist


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The wrist positioning toradiography in lateral projection

1 -

2 -

5 -

9 -

navicular bone

lunate bone

trapezium bone

1 metacarpal bone


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The wrist positioning toradiography in slantingulnar dorsal projection

1 -

2 -

3 -

4 -

7 -

8 -

9 -

10 -

navicular bone

lunate bone

triangular bone

pisiform bone

capitate bone

hamate bone

1 metacarpal bone

5 metacarpal bone


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The wrist positioning toradiography in slantingulnar palmar projection

1 -

2 -

3 -

4 -

5 -

6 -

7 -

8 -

9 -

10 -

navicular bone

lunate bone

triangular bone

pisiform bone

trapezium bone

trapezoid bone

capitate bone

hamate bone

1 metacarpal bone

5 metacarpal bone


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X-ray

fracture of the navicular bone in middle part(direct and three fourth projections)


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SCAPHOID FRACTURES

Non-union and AVN


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Treatment of a navicular fractures

without displacement of splinters

fracture of tubercle of a navicular bone:immobilization 4 6 weeks

fracture of body and distal one-third of anavicular bone: immobilization 10 12 weeks

The hand is in position ofslight flexion and radial

deviation. The first fingeris fixated in position of

moderate abduction.


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Complications, such as a delayed union, a falsejoint or aseptic necrosis, may be even at

absent of a displacement of splinters and at

sufficient immobilization. It depends on adegree of blood supply disturbance ofa navicular.

Complications

Variants of circulation at

fractures of a navicular bone


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Indications to operativetreatment

fractures of a navicular bone withconsiderable displacement

a delayed union

a false joint

aseptic necrosis


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The methods ofosteosynthesis

Autologous bone grafting bya bone nail

Osteosynthesisby wires


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Postoperative treatment

Immobilization of a hand in medium-physiological position during 6 8

weeks exercise therapy

physiotherapy


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SEQUELAE OF SCAPHOIDFRACTURES

1. Delayed union

2. Non-union

3. Avascular necrosis

4. Scaphoid Non-union Advanced

Collapse (SNAC)

demigauntlet bandage


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The kinds ofperilunate

dislocations in dorsal-palmar direction

1 - perilunar dislocation

2 - transscaphoperilunate d.

3 - transscaphoid-transtriquetral dislocation

4 - periscaphoperilunate d.

5 - transtriquetralperilunate d

6 - peritriquetralperilunate dislocation

7 - transscaphoid-transcapitate-perilunate d.

8 - transcapitate-perilunate dislocation


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Perilunate dislocations anddislocations of a lunate bone

- perilunate dislocation, - perilunate dislocation withsubluxation of a lunate bone. Dislocations of lunate bone: - I, - II, - III degree (enucleation of a lunate bone)


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The mechanism of a rupture of the metacarpophalangealjoints ligaments at skiers, cyclists, motorcyclists and the like

outstretched


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Fractures of 1 metacarpalbone

Mechanism of trauma

direct

indirect


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Kinds of fractures of the firstmetacarpal bone

a. Benets fracture,b. Rolands fracture,

c. transverse

fracture of a shaft,d. oblique fracture of

a shaft.

a. b.

c. d.


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Flexible Thumb Splint


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Fracture of a shaft of a

metacarpal bone, as a rule,

is result of a directmechanism of a trauma.

The fracture is astable with

volar angular displacementbecause of prevalence of a

tonus of palmar

interosseous muscles.


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Usually fractures of a neck of a

metacarpal bone are instable as

they have small splinters of acortical bone on volar surface.

Here, as a rule, it is established

indications to a little invasive

osteosynthesis.

So-called 90 90 themethod of reduction

allows reducing and

holding splinters, but it

cannot be used as the

method of fixation

Splintered fractures of heads of metacarpal


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Splintered fractures of heads of metacarpalbones are a subject to open anatomical reduction

and little invasive osteosynthesis by wires

B i h d f i i i i


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Basic methods of minimum invasiveosteosynthesis after closed reduction

Minimuminvasive

osteosynthesis is

an atraumatic

technique of afixation with the

purpose of

preservation of

thevascularization of

bony fragments

The lose reduction is one of the principles of an osteosynthesis


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Documents

Injuries of Wrist and Hand