– See: – Burns of the Hand – Thrombolytic Therapy – Ischemia of the Hand: – History: – infection, cold intolerance, pain, tenderness, of mass, cyanosis – Treatment of digital ischemia with liposomal bupivacaine. – Diff dx: – Aneurysms of the Upper Extremity … Read more
– See: – Blood Supply to the Wrist – Kienbock’s Disease – Discussion: – majority of lunates have both dorsal & palmar vessels & are thus as well vascularized as the other carpal bones; – neither single intraosseous nor extraosseous disruption alone will cause avascular necrosis … Read more
– See: Radiographic Imaging – Discussion: – unstable scaphoid fractures not only impact the potential for healing with non operative treatment, but they also impact on the position of healing (and possible scaphoid non union or malunion); – indicators of instability: – trans-scaphoid perilunate dislocation; … Read more
– Discussion: – distal radioulnar subluxation/dislocation (see TFC Injury) – tear of the lunotriquetral – ulnocarpal impingement syndromes – pisotriquetral osteoarthritis – pisotriquetral loose bodies – subluxation/dislocation of the pisiform – fractures (ulnar styloid Process) – chondromalacia – calcific tendinitis – medial carpal instability – radioulnar arthritis – subluxation of the ECU The ulnar impaction … Read more
– See: – Blood Supply to the Wrist – Triquetrolunate Dissociation – Discussion: – triquetrium is the 3rd most commonly fractured carpal bone; – ular side of the wrist is supported by TFC, which articulates w/ both lunate and the triquetrum; … Read more
– Discussion: – 20% of all ganglia – most common site at volar wrist crease between the FCR and APL at the scaphotrapezoid joint; – volar ganglions may be less amenable to aspiration than dorsal ganglions since the radial artery may be adjacent to the cyst – recurrence … Read more
– Open Resection: – short transverse incision directly over the mass; – dorsal ganglions are often located between the EPL and EDC tendons; – retinaculum is incised between the 2nd and 4th extensor compartments (EPL tendon sheath need not be incised); – main cyst and its pedicle … Read more
– See: Trans-scaphoid Perilunar Dislocation – Discussion: – occurs as oblique frx through radial styloid, extending thru scapholunate ligament and around the lunate, through the triquetral attachments; – due to the radiocapitate ligament, the fractured styloid process migrates with the distal carpal row; – because styloid is held by radiolunate … Read more
– Discussion: – often more stable than pure perilunate dislocation if waist frx is transverse and the scapholunate ligament has remained intact; – it is usually more unstable than an isolated scaphoid frx because of ligament damage; – consider internal fixation for the scaphoid frx and a capsular repair … Read more
– Discussion: – primary internal fixation is treatment of choice for unstable scaphoid frxs; – frx treated by primary internal fixation, avg time for return to work is 3.7 wks w/ union rate, 97 %; – this compares very favorably with conservative treatment; – indications for surgery: – main indication is an unstable scaphoid frx … Read more