Scaphoid fracture

1. What is the usual mechaism of a scaphoid fx?
2. What are complications of a scaphoid fx?
3. How are scaphoid fx's classified?
4. What is seen clinically in scaphoid fx?
5. What are the borders of the anatomical snuff box?
6. What imaging is done to assess scaphoid fx?
7. What is the treatment of scaphoid fx?

Answers:
1. Fall on dorsiflexed wrist.
2. Osteonecrosis due to poor blood supply (supply is mainly to the distal 1/3 of bone) with carpal collapse.
3. By location: tubercle, distal pole, waist, proximal pole.
4. Swelling and tenderness around anatomical snuff box.
5. Base is scaphoid bone, lateral is APL and EPB, medial is EPL.
6. Plain films in ulnar deviation.
7. Fx may not appear on X-ray so treat anyway if suspicioius. If nondisplaced (<2mm),>2mm or not healing, need to consider surgery.

Distal radius fracture

1. What is the most common type of distal radius fracture?
2. What are other types of distal radius fracture?
3. What is the usual mechanism of distal radius fx?
4. What is the treatment of distal radius fx?

Answers:
1. Colles fx: fracture of distal radius with DORSAL angulation.
2. Smith's fx: fx of distal radius with VOLAR angulation (reverse Colles).
3. Fall on an outstretched arm.
4. Ortho referral for closed reduction.

Osteonecrosis of the lunate

1. What is another name of osteonecrosis of the lunate?
2. What is osteonecrosis of the lunate? What are predisposing factors?
3. What is seen clinically?
4. What imaging is used for diagnosis?
5. What is the treatment?

Answers:
1. Klenbock's disease.
2. Idiopathic loss of blood supply to lunate, causing necrosis of the bone and degenerative changes. Etiology is likely repetitive trauma or possibly short ulna.
3. Ulnar sided pain and swelling over dorsal wrist, reduced grip strength.
4. Plain films may show fracture/flattening/sclerosis of lunate, bone scan, MRI.
5. Ortho referral.

Ganglion cyst of the wrist

1. What is a ganglion cyst?
2. What is seen clinically?
3. What is the treatment?

Answers:
1. Cyst that arises from the synovial sheath of the joint and is filled with synovial fluid.
2. Small smooth mass, pain with pressure or ranging of wrist.
3. Immobilization, aspiration of cyst (90% recur), surgical removal (10% recur).

DeQuervain's tenosynovitis

1. What is the mechanism of DeQuervain's?
2. What is seen clinically?
3. What is Finkelstein's test?
4. What is the treatment of DeQuervain's?

Answers:
1. Repetitive or direct trauma to the sheath of the EPB and APL (first extensor compartment of the wrist).
2. Pain and tenderness on the radial side of the wrist.
3. Flex thumb into palm of hand, making a fist, while examiner ulnarly deviates the wrist. Pain is positive.
4. Thumb spica splint, NSAIDs, steroid injection. ?Surgery.

Arthritis of the wrist

1. What are two different kinds of arthritis that affect the wrist?
2. What is seen clinically in Rheumatoid arthritis?
3. What is a swan-neck deformity?
4. What is Boutonniere's deformity?
5. What is seen clinically in osteoarthritis?
6. Where is wrist osteoarthritis most common?

Answers:
1. Rheumatoid arthritis (autoimmune attack on synovial tissue, which destroys the articular cartilage and leads to bone destruction) and osteoarthritis (deterioration of articular cartilage and formation of new bone at joint margins).
2. Swelling of the wrists, MCP and PIP, ulnar deviation of the wrist, dorsal subluxation of the ulna, erosion of the ulnar styloid.
3. Contracture of hand intrinsics, resulting in MCP flexion, PIP hyperextension, DIP flexion.
4. Tearing of the extensor hood, resulting in MCP hyperextension, PIP flexion, and DIP hyperextension.
5. Heberden's (DIP) and Bouchard's (PIP) nodules, tenderness along the area of involvement and crepitus of the wrist, cyst formation in the joint space.
6. First CMC joint.

Wrist anatomy

1. What are the carpal bones?
2. What are the wrist flexors?
3. What are the wrist extensors?
4. How many extensor compartments are there in the wrist?

Answers:
1. Proximal: Scaphoid, Lunate, Triquetrum, Pisiform; Distal: Trapezium, Trapezoid, Capitate, Hamate. (Some Lovers Try Positions That They Can't Handle)
2. FCR, FCU, palmaris longus, FDS, FDP, FPL.
3. ECRL, ECRB, ECU, extensor digitorum, EDM, EIP, EPL.
4. Six.