Page 957 - TNFlipTest

Toronto Notes 2019 Hand
Specific Complications (see General Fracture Complications, OR7)
• mostcommon:nonunion/malunion(usebonegraftfromiliaccrestordistalradiuswithfixationto
heal)
• AVNoftheproximalfragment
• delayed union (recommend surgical fixation)
• scaphoidnonunionadvancedcollapse(SNAC)–chronicnonunionleadingtoadvancedcollapseand
Orthopedics OR23
arthritis of wrist
Prognosis
• proximalfifthfracture:AVNrate100%;proximalthirdfracture:AVNrate33% • waistfractureshavehealingratesof80-90%
• distalthirdfractureshavehealingratescloseto100%
The proximal pole of the scaphoid receives
as much as 100% of its arterial blood supply from the radial artery that enters at the distal pole. A fracture through the proximal third disrupts this blood supply and results in a high incidence of AVN/nonunion
Hand
• seePlasticSurgery,PL23 Spine
Pedicle
Vertebral body
Transverse process
Spinous process
Spinous process
Neural arch
Lamina
Figure 24. ORIF left scaphoid
Ulna
Radius Lunate Scaphoid
Superior articular process
Transverse process
Vertebral body
Triquetrum Trapezium
Pisiform Hamate
5 4 3 2
Trapezoid 1 Capitate
Metacarpal bones (1-5)
Pedicle
Vertebral foramen
Figure 25. Carpal bones
Inferior
articular process
Left Lateral View
Figure 27. Schematic diagram of vertebral anatomy
Superior View
Adapted from: Moore KL, Agur AMR. Essential Clinical Anatomy, 3rd ed. Philadephia: Lippincott Williams and Wilkins, 2007. p274
Fractures of the Spine
• seeNeurosurgery,NS34 Cervical Spine
General Principles
Compression
Burst
Fracture-dislocation
Figure 26. Compression, burst, and dislocation fractures of the spine
• C1(atlas):novertebralbody,nospinousprocess
• C2(axis):odontoid=dens
• 7cervicalvertebrae;8cervicalnerveroots
• nerverootexitsabovevertebra(i.e.C4nerverootexitsaboveC4vertebra),C8nerverootexitsbelow
C7 vertebra
• radiculopathy=impingementofnerveroot • myelopathy=impingementofspinalcord
Special Testing
• compressiontest:pressureonheadworsensradicularpain
• distractiontest:tractiononheadrelievesradicularsymptoms
• Valsalvatest:Valsalvamaneuverincreasesintrathecalpressureandcausesradicularpain
© Kimberly Chin
© Elisheva Marcus
© Paul Kelly 2011