Wrist Trauma, An Issue of Hand Clinics

Steven Papp

Description

Articles in this issue include: Anatomy and Approaches of the Wrist; Chronic Scaphoid Nonunion; External Fixation of Distal Radius Fractures; Complications of Distal Radius Fractures; Perilunate Dislocations; Plate Fixation of Distal Radius Fractures; Post Traumatic Malunion of Distal Radius Fractures; Traumatic Problems of The Distal RadioUlnar Joint; Acute Scaphoid Fractures; Distal Radius Fractures; When should we Operate? What is the Evidence? Carpal Bone Fractures; Physical Exam of the Wrist; Closed Management of Distal Radius Fractures; Management of SL injuries.

Sujets

• Medical
• Médecine
• Orthopedics

Informations

• Publié par: Saunders
• Date de parution: 15 janvier 2010
• Nombre de lectures: 0
• EAN13: 9781455700349
• Langue: English
• Poids de l'ouvrage: 5 Mo

Extrait

Hand Clinics
Wrist Trauma
Steven Papp
Ottawa Civic Hospital, Department of Orthopaedic Surgery, University of Ottawa, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9
ISSN  0749-0712
Volume 26 • Number 1 • February 2010

Contents

Contents
Forthcoming Issues
Preface
Wrist Anatomy and Surgical Approaches
Physical Examination of the Wrist
Distal Radius Fractures—Classification of Treatment and Indications for Surgery
Distal Radius Fractures: Nonoperative and Percutaneous Pinning Treatment Options
External Fixation of Distal Radius Fractures
Plating for Distal Radius Fractures
Management of Post-Traumatic Malunion of Fractures of the Distal Radius
Complications of Distal Radius Fractures
Acute Scaphoid Fractures
Management of Scaphoid Nonunions
Carpal Bone Fractures
The Diagnosis and Treatment of Scapholunate Instability
Perilunate Injuries
Traumatic Injuries of the Distal Radioulnar Joint
Index
Hand Clinics , Vol. 26, No. 1, February 2010
ISSN: 0749-0712
doi: 10.1016/S0749-0712(09)00121-8

Forthcoming Issues
Hand Clinics , Vol. 26, No. 1, February 2010
ISSN: 0749-0712
doi: 10.1016/j.hcl.2009.08.016

Preface

Steven Papp, MD, MSc, FRCS(C)
Ottawa Civic Hospital, Department of Orthopaedic Surgery, University of Ottawa, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9
E-mail address: [e-mail]


Steven Papp, MD, MSc, FRCS(C) Guest Editor
It is an honor to act as guest editor for this edition of Hand Clinics of North America . I currently practice in Ottawa, Ontario—home to the largest skating rink in the world. For the months of January to March, the Rideau Canal is transformed into an 8-kilometer skating rink for people to enjoy or even skate to work! Unfortunately, experienced and beginner skaters alike commonly have falls on this amazing but sometimes treacherous rink. Our volume of radius fractures, scaphoid fractures, and other wrist injuries dramatically goes up during these months. As I am sure many other orthopedic surgeons have experienced, the increased population, increased life expectancy, and increased general activity level have all translated into a great demand on physicians that deal with these problems. In Canada, the shortage of orthopedic specialists can compound this problem. Correct treatment can have a great impact on the patient and on society in terms of health care costs.
In this issue, leading authors and researchers from around North America have contributed articles on various topics in wrist trauma. The authors have vast experience with many research publications in this field, many of whom I look up to greatly.
In the first two articles, the anatomy and physical examination of the wrist serve as the building blocks for making a diagnosis in a patient who has a wrist injury. The next six articles cover various topics and treatment options related to distal radius fractures, as this is probably the most common problem a treating physician will encounter. There has been an explosion of literature and implants available to deal with this common problem. The remaining articles cover scaphoid fractures, carpal bone fractures, distal radio-ulnar joint injuries, and ligament injuries common to the wrist. My hope is the orthopedic surgeon or training resident can use this issue as a reference for injuries to the wrist.
I have enjoyed the experience of putting this issue together immensely. Asking some of my senior colleagues to contribute was daunting, but luckily all of the authors were happy to contribute. I would like to thank them for their hard work and excellent and thoughtful articles. I would like to thank Deb Dellapena, the editor of this issue, for her diligent work on this project. I dedicate this issue to my wife Brenda and my children—Rosemary, Ryan, and Renée for their great support.

This article originally appeared in Orthopedic Clinics of North America 2007;38(2):ix
Hand Clinics , Vol. 26, No. 1, February 2010
ISSN: 0749-0712
doi: 10.1016/j.hcl.2009.08.009

Wrist Anatomy and Surgical Approaches

Roy Cardoso, MD, Robert M. Szabo, MD, MPH *
Department of Orthopaedic Surgery, University of California, Davis, School of Medicine, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
* Corresponding author.
E-mail address: [e-mail]

Abstract
Appreciation and knowledge of anatomy as it relates to surgical approaches is critical for planning treatment of traumatic wrist injuries. This article discusses the pertinent anatomy and some of the more commonly used approaches to wrist trauma.

Keywords
• Wrist • Anatomy • Surgical approach • Surgical exposure • Carpus • Radius
Appreciation and knowledge of anatomy as it relates to surgical approaches is critical for planning treatment of traumatic wrist injuries. This article discusses the pertinent anatomy and some of the more commonly used approaches to wrist trauma.

Surface landmarks
Important dorsal landmarks include the styloid process of the long-finger metacarpal, anatomic snuffbox, Lister’s tubercle, lunate fossa, the radial styloid, and the head of the ulna ( Fig. 1 ).

Fig. 1 Dorsal wrist landmarks. ( Reproduced from Doyle JR, Botte MJ. Surgical anatomy of the hand and upper extremity. Philadelphia: Lippincott Williams and Wilkins; 2003. p. 486–529; with permission.)
The anatomic snuffbox is formed by the third dorsal compartment (extensor pollicis longus) ulnarly, the first dorsal compartment (abductor pollicis longus, extensor pollicis brevis) radially, and the extensor retinaculum proximally. Its contents include the dorsal continuation of the radial artery and branches of the radial sensory nerve.
Lister’s tubercle, a dorsal prominence over the distal aspect of the radius, redirects the extensor pollicis longus, which lies just ulnar to it, approximately 0.5 cm proximal to the radiocarpal joint. 1 The lunate fossa is a palpable depression found in line with the third metacarpal. The lunate bone lies directly below this depression.
Important landmarks on the palm and volar aspect of the wrist are illustrated in Fig. 2 . Kaplan described his cardinal line in 1953. 2 As a surface marker, this line helps localize deeper structures in the hand and wrist. Although experts disagree on the exact manner in which the line is drawn and its relationship to deeper structures, it continues to be an important and widely used tool. 3

Fig. 2 Palmar wrist landmarks. ( From Trumble TE. Principles of hand surgery and therapy. Philadelphia: W.B. Saunders; 2000. p. 1–18; with permission.)
Kaplan’s line is made by extending a transverse line across the palm, in line with the distal aspect of the thumb metacarpal. Additionally, longitudinal lines are drawn perpendicular to Kaplan’s line, along the radial aspect of long finger and the ulnar aspect of the ring finger. The intersecting lines form a grid whose points demarcate underlying neurovascular structures ( Fig. 3 ).

Fig. 3 Kaplan’s cardinal line and associated structures. ( Reproduced from Carlson GC. Surgical approaches to the hand and wrist. In: Chapman MW, editor. Chapman’s orthopaedic surgery. 3rd edition. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 1239–46; with permission.)

Osteology and joint anatomy
The skeletal components of the wrist include the distal radius and ulna, eight carpal bones, and the proximal ends of the five metacarpals ( Fig. 4 ). The articular surface of the distal radius is typically tilted with 22° of radial inclination, 11° of volar tilt, and 12 mm of radial height ( Fig. 5 ). Its articulation is composed of two fossae—the ovoid-shaped lunate fossa and triangular scaphoid fossa—which articulate with the lunate and scaphoid bones, respectively ( Fig. 6 ). The radiocarpal joint allows multiple axes of motion, including flexion, extension, radial deviation, and ulnar deviation. 4 On the ulnar aspect of the distal radius, the sigmoid notch articulates with the distal ulna to form the distal radioulnar joint (DRUJ). The DRUJ, a pivot joint, permits pronation and supination of the wrist. Although the arc of curvature of the sigmoid notch varies, it is typically greater than that of the ulnar head. This incongruity permits both translation and rotation of the DRUJ. Consequently, the ulna translates dorsally in pronation and volarly in supination. Although the joint is primarily stabilized by the triangular fibrocartilage complex (TFCC), additional stability is imparted by the joint capsule, interosseous membrane, pronator quadratus, and extensor carpi ulnaris. 5

Fig. 4 Osseous Anatomy of the wrist. ( From Steinburg BD, Plancher KD. Clinical anatomy of the wrist and elbow. Clin Sports Med 1995;14(2):299–313; with permission.)

Fig. 5 The various angles to assess in distal radius fractures. ( A ) Radial inclination (RI), normal, 22°. ( B ) Radial length (RL), normal, 12 mm. ( C ) Ulnar variance (UV), normal, 0–2 mm. ( D ) Radial tilt (RT), normal, 11° volar. ( Reproduced from Graham TJ. Surgical correction of malunited fractures of the distal radius. J Am Acad Orthop Surg 1997;5:270–81; with permission.)

Fig. 6 Articular surface of the distal radius. (Illustration by Elizabeth Martin, © 1993. Reprinted with permission from Bowers WH. The distal radioulnar joint. In: Green DP, Hotchkiss RN, Pederson WC, editors. Operative hand surgery. 3rd edition. New York: Churchill Livingstone