fractures and dislocations of hand and forearm k.mozafarian
TRANSCRIPT
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FRACTURES AND FRACTURES AND DISLOCATIONS OF DISLOCATIONS OF
HAND AND FOREARMHAND AND FOREARM
K.MOZAFARIAN K.MOZAFARIAN
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COMMON TERMINOLOGYCOMMON TERMINOLOGY
DEFINITION OF FX;DEFINITION OF FX;SITE OF FX: side, bone anatomic locationSITE OF FX: side, bone anatomic locationType of fx: trans, short oblique, spiral, Type of fx: trans, short oblique, spiral, comminuted, segmental, buterflycomminuted, segmental, buterflyAngulationAngulationTranslation or displacementTranslation or displacementOverridingOverridingRotation Rotation
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Radial head fracturesRadial head fractures
Type 1: nondisplacedType 1: nondisplaced
Type 2: partial displacedType 2: partial displaced
displacement < 2mmdisplacement < 2mm
displacement >2mmdisplacement >2mm
Type 3: total comminuted Type 3: total comminuted
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TreatmentTreatment
All type one and most type 2 fractures : All type one and most type 2 fractures : sling , immediate motionsling , immediate motion
Some type 2 fractures that blocs rotation, Some type 2 fractures that blocs rotation, some partial fx c displacement >2mm and some partial fx c displacement >2mm and repairable c fracture dislocations of repairable c fracture dislocations of forearm and elbow : ORIFforearm and elbow : ORIF
Comminuted fx : excision , prosthesis in Comminuted fx : excision , prosthesis in case of elbow or forearm instability or in case of elbow or forearm instability or in most young pt most young pt
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Deforming forcesDeforming forces
Pronator quadratus Pronator quadratus
Pronator teres Pronator teres
Supinator Supinator
Biceps Biceps
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FX OF RADIUS AND ULNAR FX OF RADIUS AND ULNAR SHAFTSHAFT
Anatomic reduction is Anatomic reduction is mandatory (no mandatory (no rotation ,no rotation ,no angulation)angulation)
Otherwise it results in Otherwise it results in severe loss of severe loss of functionfunction
Open reduction and Open reduction and internal fixation is internal fixation is always indicatedalways indicated
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Treatment planTreatment plan
ORIF by plate and screwsORIF by plate and screws
ORIF by intra medulary rodORIF by intra medulary rod
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Forearm shaft fracture in Forearm shaft fracture in childrenchildren
Long arm cast except for stable distal third Long arm cast except for stable distal third fractures in >4y/o child which is treated by fractures in >4y/o child which is treated by short arm castshort arm cast
Duration: 6-8 wks, more time in bayonet Duration: 6-8 wks, more time in bayonet positionposition
Few more weeks of splinting until the Few more weeks of splinting until the transverse lucent sign disappear and all 4 transverse lucent sign disappear and all 4 cotices has unioncotices has union
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Acceptable reductionAcceptable reduction
Angulation: Distal 3Angulation: Distal 3rdrd : 20 degree : 20 degree
Middle 3Middle 3rdrd : 15 degree : 15 degree
Proximal 3Proximal 3rdrd: 10 degree: 10 degree
Provided that 2 y of growth remainingProvided that 2 y of growth remainingo Translation 100 percent if shortening is <1 Translation 100 percent if shortening is <1
cmcmo Rotation: up to 45 degreeRotation: up to 45 degree
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Complications: Complications: 1- Redisplacement : the most common, occure 1- Redisplacement : the most common, occure
in 10%in 10%
2-forearm stiffness:18-72% show at least mild 2-forearm stiffness:18-72% show at least mild deficits, mostly pronation contracture, deficits, mostly pronation contracture,
3- Refracture: more than any other fracture, 4-3- Refracture: more than any other fracture, 4-8%, average at 6 m, male 3times than 8%, average at 6 m, male 3times than female, older children ( 12 y/o), diaphyseal, female, older children ( 12 y/o), diaphyseal,
Treatment is ORIF by some authors but others Treatment is ORIF by some authors but others are ifo closed reduction are ifo closed reduction
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ComplicationsComplications
4- Malunion4- Malunion
5- Delayed and nonunion5- Delayed and nonunion
6- Cross union 6- Cross union
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MONTEGGIA FX-DISLOCATIONMONTEGGIA FX-DISLOCATION
FX of the proximal or FX of the proximal or middle third of the middle third of the ulna with dislocation ulna with dislocation of the radial headof the radial head
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Types of the Monteggia fx- Types of the Monteggia fx- dislocationdislocation
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Treatment Treatment
Ulnar fx : open reduction and internal Ulnar fx : open reduction and internal fixation by plate and screws or by tension fixation by plate and screws or by tension band wiringband wiring
Radial head dislocation: open reduction Radial head dislocation: open reduction when it can not be reduced by reduction of when it can not be reduced by reduction of the ulnar fxthe ulnar fx
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Galeazzi fx- dislocationGaleazzi fx- dislocation
Fx of the distal radius with dislocation of Fx of the distal radius with dislocation of the ulnar headthe ulnar head
It should be treated by open redution and It should be treated by open redution and internal fixation as the ruleinternal fixation as the rule
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Fx of distal radiusFx of distal radius
A- Extraarticular fx:A- Extraarticular fx:
COLLES FX: dorsal displacement and COLLES FX: dorsal displacement and
volar angulationvolar angulation
SMITH FX: dorsal angulation and volar SMITH FX: dorsal angulation and volar
displacementdisplacement
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Colles fractureColles fracture
Dorsal displacement Dorsal displacement and volar angulationand volar angulation
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Treatment of extraarticular fx Treatment of extraarticular fx
Extra articular fx can usually be treated by Extra articular fx can usually be treated by closed redution and castingclosed redution and casting
If the reduction can not be obtained by If the reduction can not be obtained by closed methods open reduction and closed methods open reduction and internal fixation by pins or plate is internal fixation by pins or plate is indicatedindicated
If reduction is obtained but is unstable If reduction is obtained but is unstable PCP or external fixator is the Rx of choicePCP or external fixator is the Rx of choice
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Acceptable reduction of the distal Acceptable reduction of the distal radiusradius
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Acceptable reductionAcceptable reduction
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Intra articular fracturesIntra articular fractures
Intraarticular fx should usually be treated Intraarticular fx should usually be treated by PCP or external fixatorby PCP or external fixator
Anatomical reduction of the articular Anatomical reduction of the articular surface is mandatory for good resultssurface is mandatory for good results
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Carpal bone fracturesCarpal bone fractures
Scaphoid fx is the most common fracture Scaphoid fx is the most common fracture of the carpusof the carpus
Circulation of the scaphoid is from distal Circulation of the scaphoid is from distal to proximalto proximal
Chance of avascular necrosis and Chance of avascular necrosis and nonunion is higher nonunion is higher
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Scaphoid fracture Scaphoid fracture
Diagnosis of the fractureDiagnosis of the fracture
Radiographic examination: PA- LAT-AP Radiographic examination: PA- LAT-AP with 30 degree supination and ulnar with 30 degree supination and ulnar deviation(scaphoid view)deviation(scaphoid view)
Fx displacement can be demonstrated by Fx displacement can be demonstrated by motion seriesmotion series
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Types of fractureTypes of fracture
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Treatment of scaphoid fractureTreatment of scaphoid fracture
Undisplaced fractures: thumb spica cast for 12 Undisplaced fractures: thumb spica cast for 12 weeksweeks
Displaced fractures : step>1mmDisplaced fractures : step>1mm
S-L angle>60S-L angle>60
lunocapitate>15lunocapitate>15
-closed reduction and thumb spica -closed reduction and thumb spica
-otherwise : open reduction and pin or screw -otherwise : open reduction and pin or screw fixationfixation
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LUNATE FRACTURE ; LUNATE FRACTURE ; KIENBOCK DISEASEKIENBOCK DISEASE
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Lunate fracture: Kienboch Lunate fracture: Kienboch diseasedisease
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Hand fracturesHand fractures
Fx of metacarpal bones Fx of metacarpal bones
Fx of proximal phalanxFx of proximal phalanx
Fx of distal phalanxFx of distal phalanx
Fx of middle phalanxFx of middle phalanx
Multiple fxMultiple fx
Open fxOpen fx
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Hand fxHand fx
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