Fall on an outstrtched hand

BY SHAHID

1. Injuries due to FALL ON AN OUTSTR e TCHED HAND SHAHID

2. Colles ’ fracture S mith’s fracture Galeazzi fracture Monteggia fracture Scaphoid fracture Supracondylar fracture of humerus Fracture of head of radius Clavicular fracture

3. COLLES’ FRACTURE First described by Abraham colles . Colles fracture is the fracture at the distal end of radius, at its cortico cancellous junction (about 2cm from distal articular surface). Most common age group- above 40 years, occuring most common in female.

4. Mechanism of injury

5. PATHOANATOMY Displacement-The fracture line runs transversely at cortico-cancellous junction. In many cases one or more displacements may occur as follows: Impaction of fragments Dorsal displacement Dorsal tilt Lateral displacement Lateral tilt Supination

6. CLINICAL FEATURES Pain Swelling Deformity-classical ‘ dinner-fork deformity ’ Radial styloid process lies in the same level or little higher than the ulnar styloid process.

7. DIAGNOSIS Radiological features: It is important to differentiate colles ’ fracture from other fractures occuring at same time, such as Smith’s fracture, Barton’s fracture by looking at the displacements.

8. X-RAY Lateral view: Dorsal tilt- detected by looking at the direction of distal articular surface of radius. AP view: Lateral tilt- similarly it can be detected by looking at articular surface if it faces medially it is normal, if it becomes horizontal or faces laterally, a lateral tilt is present.

9. TREATMENT Conservative method: For undisplaced fracture- immobilization in a below-elbow plaster cast for 6 weeks. For displaced fracture- Manipulative reduction followed by immobilization

10. Manipulative reduction Step 1- Disimpact the fragments by firm longitudinal traction against the counter-traction by an assistant. Step 2- Press the distal fragment into palmer flexion and ulnar deviation by using thumb of other hand. Step 3- Now hand is drawn in pronation , palmer flexion and ulnar deviation. A plaster cast is applied extending from below elbow to metacarpal heads.

11. Surgical methods Closed reduction and per- cutaneous fixation using K- wire. Open reduction and plate fixation.

12. COMPLICATIONS Stiffness of joints Malunion Subluxation of inferior radio- ulnar joint Carpel-tunnel syndrome Sudeck’s osteodystrophy Rupture of extensor pollicis longus tendon.

13. SMITH’S FRACTURE Smith fracture(reverse colle’s ) is the fracture of distal radius where the distal fragment displaces anteriorly . Bimodal- distribution: young males( most common) and elderly females.

14. SCAPHOID FRACTURE A scaphoid fracture is more common in young adults. It is rare in children and in elderly people. Commonly, fracture occurs through the waist of scaphoid . Rarely it occurs through the tuberosity . It may be either a crack fracture or a displaced fracture.

15. BLOOD SUPPLY

16. CLINICAL FEATURES Pain Swelling On/E- Tenderness at scaphoid fossa (anatomical snuff box) Decrease thumb movement

17. X-RAY PA view Semipronated view Semisupinated view Ziter view-

18. TREATMENT Conservative treatment- Affected hand is immobilized in a scaphoid cast for 3-4 months. Scaphoid cast is applied from below elbow to metacarpel heads, includes thumb. Wrist is maintained at little dorsiflexion and radial deviation( glass holding position).

19. COMPLICATIONS Avascular necrosis Delayed union and non-union Wrist osteoarthritis

20. MONTEGGIA FRACTURE This is a fracture of upper-third of ulna with dislocation of head of radius. Types: Extension type - where the ulna fracture angulates anteriorly and the radial head dislocates anteriorly . Flexion type - where the ulna fracture angulates posteriorly and the radial head dislocates posteriorly .

21. TREATMENT This is very unstable fracture. Reduction is attempted under general aneasthesia . If closed reduction is not possible, an open reduction and internal fixation using a plate is performed.

22. GALEAZZI FRACTURE This is a fracture of lower-third of radius with dislocation or subluxation of distal radio- ulnar joint. Displacement-Radius fracture is angulated medially and anteriorly and dorsal dislocation of distal end of ulna.

23. TREATMENT It is difficult to achieve and maintain perfect reduction by conservative methods( except in children). Open-reduction and internal fixation of radius with plate is done in adults.

24. THANK YOU