Download - 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
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2 -
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navicular bone
lunate bone
trapezium bone
1 metacarpal bone
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The wrist positioning toradiography in slantingulnar dorsal projection
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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
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2 -
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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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