Orthopedic Care and Consultation
Volar Barton fracture is intra-articular fracture of distal radius and this xray show a volar Barton fracture in a 31 years old male.
Volar Barton Fracture
The patient was advised open reduction and internal fixation using a volar plate for radius but the patient refuced for any surgery.
Option of ligamentotaxis was also discussed using external fixation device but refused.
The limb was splinted with plaster slab. The patient never followed up.
Xray of child of five years of age who fell from roof and fracture both bones of forearm radius and ulna in distal region
Distal Radius Ulna Fracture In Child
Closed reduction and above elbow slab was given to the child.
Midcarpal instability is characterized by a loss of normal alignment between proximal and distal carpal row bones following ligament injuries of the wrist, when placed under load. Midcarpal instability is a type of non dissociative carpal instability.
Types
There are four types of MCI
Midcarpal Instability Type I
It is also palmar midcarpal instability and occurs secondary to an injury to the palmar midcarpal ligaments
The injury may be to either or both the ligaments.
The direction of subluxation is palmar. [Read more...]
53 years old man, shopkeeper by profession, fell from stool and injured his wrist. The xray of the wrist revealed a fracture of distal radius which was not displaced.
Xray of Undisplaced Fracture of Distal End Radius
The fracture is marked with an arrow. The fracture was treated by below elbow cast.
Four corner arthrodesis involes excision of scaphoid and fusion of the remaining wrist bones in neutral alignment. It is motion preserving limited arthrodesis and provides pain relief and improved grip strength.
This arthrodesis is based on the principle that the radiolunate articulation is often spared from degenerative changes from conditions. [Read more...]
Scapholunate instability is spectrum of wrist instbilities that have occult scapholunate interosseous ligaments sprains on one side and scpaholunate advanced collapse on the other side.
Often the term is used interchangeably with scapholunate dissociation but in strict sense the scapholunate dissociation is one of the type of scapholunate instability.
Scapholunate instability is of following types. Each type also represents a higher stage of severity.
Occult
It is the mildest form of scapholunate instability. [Read more...]
Lunatotriquetral injury is an important cause of wrist instability. can occur either in isolation or as a part of perilunate dislocations. Lunatotriquetral joint is between the medial surface of the lunate and the lateral surface of the triquetrum.
Presentation
Lunatotriquetral injuries commonly result from a sudden axial load, such as a fall. The patient present with complaint of ulnar sided wrist pain.
The pain would be aggravated by activity.
On examination, there would be tenderness on the area of lunatotriquetral joint. In quite a number of cases, Stress loading of the LT joint (compression, ballottement, or shear) of the unstable triquetrum may be carried. [Read more...]
Tavernier’s maneuver is used for reduction of perilunate dislocations.
Method
The traction is applied to the wrist and it is brought in extension.The surgeon’s thumb is placed on the lunate volarly to prevent creating a volar lunate dislocation. Then,the wrist is flexed with traction still maintained.
This should result in an audible or palpable clunk signifying reduction of the capitate on the lunate and restoration of normal bony alignment. .
Most of the patients with perilunate dislocations are young males.
The injuries which lead to a progressive disruption of most capsular and ligamentous connections of the lunate result in perilunate dislocations.
The most common pattern of perilunate instability is the transscaphoid perilunate fracture dislocation.
Etiology
Most of these injuries occur due to fall on outstretched with hand in extension and ulnar deviation.
The axial loading forces the hand beyond the limits of extension and ulnar deviation causing midcarpal supination stress. This results in perilunate dissociation. [Read more...]
A study published in the October 2012 issue of Injury has said that calling all the wrist injuries with negative xrays [normal xrays] as “sprain” may not be right approach and have suggested change in definition of wrist sprain.
Present definition of wrist sprain is a partial ligament tear or injury.
The researched also suggested that magnetic resonance imaging should be used to make accurate diagnoses for wrist injuries.
The study done by Bergh and colleagues in Norway included 155 patients [age 18to 149 years] presenting to Accident and Emergency Department with acute wrist trauma. All 155 patients had normal X-rays.
Subsequent MRIs were done within 0 – 31 days.
125 out of these 155 patients showed findings on MRI in spite of xray being normal. [Read more...]
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