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