Post on 22-Jan-2018
WRIST FRACTURESA PRESENTATION BY THE CASUALTY CREW
TEXT
WHY SHOULD WE KNOW ABOUT THESE FRACTURES
▸ THESE ARE SOME OF THE MOST COMMON FRACTURES SEEN
▸ THEY ARE ALSO SOME OF THE MOST EASILY MISSED
▸ CAN LEAD TO SIGNIFICANT DISABILITY IF UNTREATED
▸ VERY EASY TO IDENTIFY ONCE YOU KNOW WHAT TO LOOK FOR
A NORMAL WRIST
‣ CAN YOU NAME THE BONES? ‣ NOTE THE 3 ARCS YOU SHOULD CHECK FOR ‣ NOTE THE NORMAL DISTANCES BETWEEN THE
CARPAL BONES
SL T
P
R U
TR TRC
H
THE ZONE OF VULNERABILITY
MOST FRACTURES/DISLOCATIONS WILL OCCUR HERE
▸ MOST INJURIES ARE DUE TO FOOSH (FALL ON OUT STRETCHED HAND)
▸ AS YOU PROGRESS FROM RADIUS TO ULNAR SIDE, THE SEVERITY OF INJURY INCREASES BUT THE FREQUENCY DECREASES
▸ I.E, A RADIAL STYLOID # IS COMMON BUT NOT SEVERE
▸ AN ULNAR STYLOID FRACTURE IS LESS COMMON BUT MORE SEVERE
▸ A SCAPHOID WAIST # IS MORE COMMON THAN A HAMATE #, BUT THE HAMATE # IS A MORE SEVERE INJURY (GOT IT?!)
▸ THIS APPLIES TO DISLOCATIONS/ FRACTURE-DISLOCATIONS AS WELL
NOW FOR SOME FRACTURES LET START WITH EASY ONES
1
2
3
COLLES #NOTE THAT THE DISTAL RADIUS IS DISPLACED POSTERIORLY
SMITHS #NOTE THAT THE DISTAL RADIUS IS DISPLACED ANTERIORLY
BARTONS #
NOTE THAT THERE IS RADIO-CARPAL SUBLAXATION THIS A VOLAR TYPE
NAME THE #
WHICH WAY DOES THE DISPLACEMENT GO?
NAME THE #
WHICH WAY DOES THE DISPLACEMENT GO?
FIND THE FRACTURE
WAS IT DIFFICULT?
▸ HOW COMMON IS IT?
▸ HOW SEVERE IS IT?
FIND THE #
WAS IT DIFFICULT?
▸ HOW COMMON IS IT
▸ HOW SEVERE IS IT
LETS TRY SOME CARPAL BONE #’S
FIND THE FRACTURE
WHAT IS IT CALLED?
▸ HOW COMMON IS IT
▸ HOW SEVERE IS IT
▸ WHAT IS THE DANGER OF THIS #
FIND THE FRACTURE
WAS IT DIFFICULT?
▸ THESE FRACTURES CAN BE SUBTLE
▸ CHECK FOR PAIN IN THE ANATOMICAL SNUFFBOX
▸ IF YOU ARE UNSURE THEN BETTER TO PUT IN A POP AND RE X-RAY IN 10-14 DAYS
LETS FIND SOME FRACTURES
BENNETS #
ONE MORE SET FOR FUN
TRIQUITRAL #
HAMATE #
SCAPHOID #
WHICH IS THE MOST COMMON?
WHICH IS THE MOST SEVERE?
LETS DO SOME DISLOCATIONS
A NORMAL LATERAL
VERY IMPORTANT FOR ASSESSING DISLOCATIONS
▸ CAN YOU NAME WHAT YOU SEE?
▸ C- CAPITATE , SITS IN THE L-LUNATE, SITS IN THE R-RADIUS
▸ APPLE (C) SITS IN THE CUP (L) SITS IN THE SAUCER (R)
C
L
R
WHAT IS OUT OF PLACE?
COMPARE TO THE PREVIOUS IMAGE
CAN YOU SEE IT NOW
THIS IS A LUNATE DISLOCATION
▸ THE LUNATE (CUP) IS DISPLACED FROM THE RADIUS (SAUCER)
▸ THE CAPITATE MAY BE IN VARIOUS POSITIONS BUT IS GENERALLY POSTERIOR
WHAT IS OUT OF PLACE?
THINK OF THE APPLE, CUP AND SAUCER
CAN YOU SEE IT NOW?
THIS IS A PERILUNATE DISLOCATION
▸ THE CAPITATE (APPLE) HAS DISLOCATED FROM THE LUNATE (CUP)
▸ BUT THE LUNATE (CUP) IS STILL ATTACHED TO THE RADIUS (SAUCER)
▸ EASY?
THE DIAGNOSIS IS NOT IMPORTANT
CAN YOU SEE THE DISPLACEMENTS
NOT SO DIFFICULT IS IT!
THIS IS A MIDCARPAL DISLOCATION
▸ BOTH THE CAPITATE AND LUNATE ARE DISPLACED
▸ THE MOST IMPORTANT THING IS TO SPOT THE DISPLACEMENT, THE FINAL DIAGNOSIS IS MADE BY AN ORTHOPAEDIC SPECIALIST
▸ BUT THEY WILL BE IMPRESSED IF YOU PICK IT UP
FINALLY
THIS IS A SCAPHO-LUNATE DISSOCIATION
▸ NOTE THE WIDE SPACE BETWEEN THE SCAPHOID AND THE LUNATE
▸ CAUSES AN UNSTABLE WRIST
▸ VERY EASY TO MISS
▸ SEVERE PAIN ON MOVEMENT IN THE ABSENCE OF A # SHOULD MAKE YOU GO BACK AND CHECK FOR THIS