Fractures of the Forearm Wrist and Hand小儿骨折的前臂手腕和手课件.ppt

Scaphoid Fractures Not always obvious on plain films Scaphoid Fractures - Treatment Tender snuff box Immobilize until tenderness resolves If still tender at 1-2 weeks Repeat x-ray Confirmed fracture If non-displaced, immobilize in above elbow cast for 6 weeks then short arm cast 4-6 weeks Displaced fracture – ORIF 1 mm displacement, 10 degrees angulation Scaphoid Fixation Compression screw fixation is treatment of choice for displaced scaphoid fracture Import to achieve anatomic reduction Hand Fractures Metacarpal and phalangeal fractures If displaced, attempt closed reduction Correct both angulation and rotation Immobilize for 3-4 weeks Indications for ORIF Open fractures Displaced intra-articular fractures Inability to obtain / maintain reduction Phalangeal Fractures(Epidemiology) 43% proximal phalanx Commonly physeal – 37% of all physeal fractures Usually SH II (54%) 30% affect small finger 20% affect the thumb Distal Phalangeal Fractures Very common Usually crush injuries Address any associated nail bed injuries If open give appropriate antibiotics, ID If distal end amputated: May heal by secondary intent Can attach amputated part as composite graft Mallet Finger Salter Harris III injury of distal phalanx Extension splint for 6 weeks ORIF or pinning for: Large articular fragments (25%) DIP incongruity/volar subluxation Open Physeal Fractures “Seymore’s fracture” Associated with nail bed lacerations Germinal matrix can be incarcerated in physis Requires nail bed repair, ID, antibiotics Commonly get infected Often requires pinning Phalangeal Neck Fractures Distal fragment rotated and extended Blocks IP joint flexion Limited remodeling potential Closed reduction and percutaneous pinning Malunion may require osteotomy and pinning Middle and Proximal Phalangeal Fractures Most are SH I or SH II injuries Majority treated with closed management Buddy taping and/or position of function cast ORIF for displaced intra-articular fractures (SH III) or instability Ca