0071643192.pdf

ORTHOPEDICS

DIAGNOSIS

■ Swelling and tenderness over the ulnar side of the MP joint of the thumb.

■ Pinch strength is markedly reduced and causes pain.

■ Stress testing may differentiate incomplete (< 30° laxity) versus complete

(≥30°–45° laxity) tears.

TREATMENT

■ Incomplete tear: Thumb spica, follow-up with hand surgeon

■ Complete tear: Surgical repair

BENNETT’SFRACTURE

■ Intra-articularfracture at base of thumb metacarpal with associated sub-

luxation or dislocationat the CMC joint

■ Treat with thumb spica, orthopedic consult.

ROLANDO’SFRACTURE

■ Comminuted intra-articularfracture of the thumb at the base of the

metacarpal

■ Treat with thumb spica, orthopedic consult.

■ Prognosis is worse than with Bennett’s fracture.

METACARPALNECKFRACTURE(BOXER’SFRACTURE)

MECHANISM

Usually dominant hand involved from an altercation involving direct impaction

forces. A fracture of the fifth metacarpal neck is referred to as a boxer’s

fracture.

DIAGNOSIS

X-ray reveals fracture of metacarpal neck with volar angulation.

TREATMENT

■ Fractures without significant angulation (see Figure 4.3) may be treated

with an ulnar gutter splint.

■ Fracture with unacceptable degrees of angulation or with rotational defor-

mity require orthopedic evaluation for closed/open reduction.

Wrist Injuries

SCAPHOIDFRACTURE

Most common carpal fracture

MECHANISM

Fall on outstretched hand (FOOSH)

DIAGNOSIS

Suspect diagnosis ifsnuff box tendernessis present. Wrist and scaphoid X-rays

should be obtained, but may be negative in the setting of acute fracture.

A boxer’s fracture with

angulation >40° may result in

functional impairment and

must be reduced.

Carpal bones (start-

ing at articulation

with radius)—

SomeLoversTry

PositionsThatThey

Can’tHandle

Scaphoid

Lunate

Triquetrum

Pisiform

Trapezium

Trapezoid

Capitate

Hamate