fractures and dislocations of hand and forearm k.mozafarian

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FRACTURES AND FRACTURES AND DISLOCATIONS OF DISLOCATIONS OF HAND AND FOREARM HAND AND FOREARM K.MOZAFARIAN K.MOZAFARIAN

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  • FRACTURES AND DISLOCATIONS OF HAND AND FOREARMK.MOZAFARIAN

  • COMMON TERMINOLOGYDEFINITION OF FX;SITE OF FX: side, bone anatomic locationType of fx: trans, short oblique, spiral, comminuted, segmental, buterflyAngulationTranslation or displacementOverridingRotation

  • Radial head fracturesType 1: nondisplacedType 2: partial displaced displacement < 2mm displacement >2mmType 3: total comminuted

  • TreatmentAll type one and most type 2 fractures : sling , immediate motionSome type 2 fractures that blocs rotation, some partial fx c displacement >2mm and repairable c fracture dislocations of forearm and elbow : ORIFComminuted fx : excision , prosthesis in case of elbow or forearm instability or in most young pt

  • Deforming forcesPronator quadratus

    Pronator teres

    Supinator

    Biceps

  • FX OF RADIUS AND ULNAR SHAFTAnatomic reduction is mandatory (no rotation ,no angulation)Otherwise it results in severe loss of functionOpen reduction and internal fixation is always indicated

  • Treatment planORIF by plate and screws

    ORIF by intra medulary rod

  • Forearm shaft fracture in childrenLong arm cast except for stable distal third fractures in >4y/o child which is treated by short arm castDuration: 6-8 wks, more time in bayonet positionFew more weeks of splinting until the transverse lucent sign disappear and all 4 cotices has union

  • Acceptable reductionAngulation: Distal 3rd : 20 degree Middle 3rd : 15 degree Proximal 3rd: 10 degreeProvided that 2 y of growth remainingTranslation 100 percent if shortening is
  • Complications: 1- Redisplacement : the most common, occure in 10%2-forearm stiffness:18-72% show at least mild deficits, mostly pronation contracture, 3- Refracture: more than any other fracture, 4-8%, average at 6 m, male 3times than female, older children ( 12 y/o), diaphyseal, Treatment is ORIF by some authors but others are ifo closed reduction

  • Complications4- Malunion5- Delayed and nonunion6- Cross union

  • MONTEGGIA FX-DISLOCATION

    FX of the proximal or middle third of the ulna with dislocation of the radial head

  • Types of the Monteggia fx- dislocation

  • Treatment Ulnar fx : open reduction and internal fixation by plate and screws or by tension band wiring

    Radial head dislocation: open reduction when it can not be reduced by reduction of the ulnar fx

  • Galeazzi fx- dislocationFx of the distal radius with dislocation of the ulnar head

    It should be treated by open redution and internal fixation as the rule

  • Fx of distal radiusA- Extraarticular fx: COLLES FX: dorsal displacement and volar angulation SMITH FX: dorsal angulation and volar displacement

  • Colles fractureDorsal displacement and volar angulation

  • Treatment of extraarticular fx Extra articular fx can usually be treated by closed redution and castingIf the reduction can not be obtained by closed methods open reduction and internal fixation by pins or plate is indicatedIf reduction is obtained but is unstable PCP or external fixator is the Rx of choice

  • Acceptable reduction of the distal radius

  • Acceptable reduction

  • Intra articular fracturesIntraarticular fx should usually be treated by PCP or external fixator

    Anatomical reduction of the articular surface is mandatory for good results

  • Carpal bone fracturesScaphoid fx is the most common fracture of the carpus

    Circulation of the scaphoid is from distal to proximal

    Chance of avascular necrosis and nonunion is higher

  • Scaphoid fracture Diagnosis of the fracture

    Radiographic examination: PA- LAT-AP with 30 degree supination and ulnar deviation(scaphoid view)

    Fx displacement can be demonstrated by motion series

  • Types of fracture

  • Treatment of scaphoid fractureUndisplaced fractures: thumb spica cast for 12 weeks

    Displaced fractures : step>1mm S-L angle>60 lunocapitate>15 -closed reduction and thumb spica -otherwise : open reduction and pin or screw fixation

  • LUNATE FRACTURE ; KIENBOCK DISEASE

  • Lunate fracture: Kienboch disease

  • Hand fracturesFx of metacarpal bones Fx of proximal phalanxFx of distal phalanxFx of middle phalanxMultiple fxOpen fx

  • Hand fx