ORTHOPAEDICS - ADULT
WRIST
Prompt
ResponseGrossly deformed swollen left wrist consistent with colles fractrio fo distal radius +/- ulnar
Obvious dorsal angulation of distal radius suggesting significant fracture angularion and displacement requiring urgent reduction
Skin breach with bleeding over site of maximal swelling indicating compound fracture
Obvious dorsal angulation of distal radius suggesting significant fracture angularion and displacement requiring urgent reduction
Skin breach with bleeding over site of maximal swelling indicating compound fracture
Prompt
Response
Extra Articular/intraarticular distal radius fracture
Comminution
25% Posterior displacement
45 deg dorsal angularion
Minimally displaced ulna styoid fracture
Extra Articular/intraarticular distal radius fracture
Comminution
25% Posterior displacement
45 deg dorsal angularion
Minimally displaced ulna styoid fracture
PromptManagement
ResponseAnalgesia
Assess for neurovascular compromise (Median nerve in particular)
XR followed by urgent reduction to minimise neurovascular compromise
splint/immobilisation (Dorsal and volar backslab)
Prophylactic antibiotics
ADT
Assess for precipitant/contributing factors of fall (ECG, bloods)
Assess for neurovascular compromise (Median nerve in particular)
XR followed by urgent reduction to minimise neurovascular compromise
splint/immobilisation (Dorsal and volar backslab)
Prophylactic antibiotics
ADT
Assess for precipitant/contributing factors of fall (ECG, bloods)
PromptAnatomic targets with distal radius reduction
ResponseRadial inclination 23 deg (accept <5 deg change)
volar tilt 11 deg (Accept <5 deg dorsal angulation)
Radial height 13mm ( Accept 5mm shortening)
Articular stepoff/anatomic height - Radius >4mm distal to ulna
volar tilt 11 deg (Accept <5 deg dorsal angulation)
Radial height 13mm ( Accept 5mm shortening)
Articular stepoff/anatomic height - Radius >4mm distal to ulna
PromptComplications
ResponseAcute
Median nerve injury
Compartment syndrome
Long term
Malunion, radioulnar, radiocarpal instability
Arthritis - wek, stiff and painful joint
Median nerve injury
Compartment syndrome
Long term
Malunion, radioulnar, radiocarpal instability
Arthritis - wek, stiff and painful joint
PromptMedian nerve injury examination findings
ResponseShort term: Pain, parastheisa, numbness in median nerve distribution (volar aspect of radial 3-½ digitits)
Long term: wasting of thenar eminence and weakness in thumb abduction
Long term: wasting of thenar eminence and weakness in thumb abduction