Wrist injury and management

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Wrist injury and management
2012-01-31 12:27:20

Wrist injury and management
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  1. What is a colles fracture
    • Transverse fracture of the distal radius
    • Dorsal angulation
    • Radial shortening
    • Dinner fork deformity
  2. What is the management of a colles fracture
    • Refer to orthos
    • Manipulation
    • Back slab
  3. When do colles fractures need manipulating
    • >10deg angulation
    • Significant shortening
  4. What is the MOI of a colles fracture
  5. What is a smiths fracture
    • Reverse colles fracture
    • Distal radius fracture
    • Volar angulation
  6. What is the MOI of a smiths fracture
    • Direct blow to back of hand
    • Fall onto flexed wrist
  7. Which is least stable, a colles or smiths fracture
  8. What is the management of a smiths fracture
    Always refer to orthos
  9. Which age group are most likely to suffer from a colles fracture
  10. With a colles fracture, which nerve is likely to show symptoms of parathesia
    • Median
    • Thumb, index, middle and radial border of ring finger, dorsal and palmar aspect
  11. What is a bartons fracture
    • Type of smiths fracture
    • Fracture through the articular surface and volar part of distal radius
  12. What is the management of a bartons fracture
    • Refer to orthos
    • Needs fixation
  13. What are the clinal features of a scaphoid fracture
    • ASB tenderness
    • Tenderness to scaphoid tubercle
    • Pain on axial compression
  14. What is the management of a ? Scaphoid fracture with clinical signs but normal X-ray
    • Splint
    • 1/7 fracture clinic
  15. What is the management of a scaphoid fracture seen on X-ray
    • Backslab
    • 1/7 fracture clinic
  16. Why must all patients with scaphoid views be followed up
    Fractures may not be seen on X-ray for 5-10 days
  17. What is a galleazzi fracture
    • Fracture if the radius with shortening
    • Dislocation of distal ulna
    • Dorsal angulation
    • Often compound
  18. What is a monteggia fracture
    • Fracture of the ulna
    • Anterior dislocation of the radial head
    • Dorsal angulation
  19. What is the mechanism of a monteggia fracture
    Direct blow to the forearm
  20. What is the management of a distal radius fracture with no displacement or angulation
    • Backslab
    • Elevate
    • Analgesia
    • Fracture clinic
  21. What is the management of a displaced fracture or fracture involving the articular surface
    • Backslab
    • Elevate
    • Analgesia
    • NBM
    • refer to orthos
  22. What must be remembered about fractures to the ulna shaft
    • Isolated fracture is rare
    • Look for an associated radial fracture or dislocation of the radial head
  23. What are common caused of non trauma wrist pain
    • Referred pain - cervical spondylosis
    • Arthropathies
    • Soft tissue disorders
  24. What are possible arthropathies affecting the wrist
    • Osteoarthritis
    • Rheumatoid arthritis
    • Septic arthritis
    • Crystal deposition - pseudo gout
    • Osteochondritis of the lunate
  25. How does septic arthritis present
    • No history of trauma
    • Hot swollen painful joint
    • Systemic sepsis
  26. What investigations are needed for septic arthritis
    • Bloods
    • ESR
    • CRP
  27. What possible soft tissue disorders affect the wrist
    • De Querains tenosynovitis
    • Ganglion
    • Carpal tunnel syndrome
    • Paratendonitis
  28. What is De Querains tenosynovitis
    • Washer woman's sprain
    • Thickening of the EPB and APL tendons
  29. What are the symptoms of De Querains tenosynovitis
    • Pain on gripping and lifting
    • Possible swelling over the radial styloid
    • Thumb extension and abduction is painful
    • Finkelsteins test positive
  30. What is the management if De Querains tenosynovitis
    • Futura splint
    • GP follow up
  31. What are the symptoms of carpal tunnel syndrome
    • Compression of the median nerve and symptoms relating to its distribution
    • Pain radiating to the elbow
    • Weakness or paralysis of the hand
  32. What is the management of carpal tunnel syndrome
    • Futura splint
    • GP for possible hydrocortisone Injection / referral to surgeons
  33. What is paratendonitis
    Inflammation of a specific tendon sheath
  34. What causes paratendonitis
    • Infection
    • Overuse
    • Rheumatoid disease
  35. What are the symptoms of paratendonitis
    • Swelling
    • Tenderness over the tendon
    • Creaking sensation on flexion and extension of the wrist
    • Increased pain on ulnar deviation
  36. What is the management of paratendonitis
    • Tubigrip or splint
    • NSAID
    • GP
  37. What is a greenstick fracture
    • A break in the periosteum on one side of the bone
    • The fracture doesn't pass through to the other side of the bone
  38. What is the MOI of greenstick / buckle fractures
    • An angulation force
    • FOOSH
  39. what is the management of an isolated radial buckle fracture
    • Splint of 3 weeks
    • Notes to fracture clinic
  40. When should a buckle fracture be backslabbed and sent to fracture clinic
    • Break through both cortexes
    • Fracture is too proximal (distance from the physis is > width of the physis)
    • Angulation >15deg
    • Ulnar buckle also
  41. What is the MOI of a torus fracture
    Axial crush of the bone
  42. How does a torus fracture appear on X-ray
    • No gap in the cortex
    • Bulge where impaction occurred