Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Traumatology and orthopaedics
Acute Trauma Management
Trauma in perspective
Principles of Primary Trauma Care
Six phases of Primary Trauma Care
Procedures
Orthopaedic Techniques
Traction
Casts and Splints
Application of external fixation
Diagnostic imaging
Physical therapy
Crania burr holes
Orthopaedic Trauma
Upper extremity injuries
The hand
Fractures of the pelvis and hip
Injuries of the lower extremity
Spine injuries
Fractures in children
Amputations
Complications
War related trauma
General Orthopaedics
Congenital and developmental problems
Bone tumours
Infection
Degenerative conditions
Trauma in Perspective
 

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS




Carpal fractures and fracture dislocations
Injuries to the carpal bones fall into three major categories:

:: Scaphoid fractures
:: Trans-scaphoid perilunate fracture/dislocations
:: Perilunate dislocations.


The scaphoid bone (S) bridges the proximal and distal rows of carpal bones, making it especially vulnerable to injury. Most commonly, fractures occur at the waist but may also involve the proximal or distal pole (Figure 18.33).

Figure 18.33
Figure 18.33


Perilunate dislocations occur with or without an accompanying scaphoid fracture. The lunate (L) stays in a volar position while the remaining carpal bones dislocate posteriorly (Figure 18.34).

Figure 18.34
Figure 18.34


Evaluation

The wrist appears swollen and painful to move.

:: Scaphoid fractures are tender in the anatomic snuff box and over the scaphoid tubercle on the volar aspect of the wrist. If a perilunate dislocation has occurred, these findings are diffuse about the wrist. X-rays are necessary to make a definitive diagnosis.
:: In perilunate dislocations, the lateral X-ray shows an anteriorly displaced lunate bone, with its concavity facing forward (Figure 18.34). The carpus is shortened and the proximal margin of the capitate does not articulate with the concavity of the lunate.
Figure 18.34
Figure 18.34


Treatment

:: Treat scaphoid fractures with minimal displacement in a thumb spica splint or cast. Healing time is between 6 and 20 weeks.
:: Perilunate dislocations require reduction followed by placement in a long arm thumb spica splint. The reduction is usually unstable over time and most patients will need surgical stabilization.

 

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS



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  Kep Points  
The injury results from a fall on the outstretched hand in hyperextension


Diagnosis is difficult and is often overlooked



 
Adequate X-rays are necessary for accurate diagnosis


 
Closed reduction is the initial treatment, but surgical stabilization may be necessary.