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This is a lecture by Dr. Christian Jacobus from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0. License: http://creativecommons.org/licenses/by-sa/3.0/.
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Project: Ghana Emergency Medicine Collaborative Document Title: Radiology: X-rays of the Hand and Wrist Author(s): Christian Jacobus MD, Maine Medical Center, 2007 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
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Radiology: X-rays of the Hand and Wrist
Christian Jacobus, MD April 11, 2007
3
Overview
n Brief review of normal radiographic anatomy
n Cases n I give you mechanism, complaint, and X-ray n You give me diagnosis, treatment, and
eponym
n Shameless unrelated entertainment
4
I Will not Cover…
n Phalanx fractures n Soft tissue injuries (except that can be
detected on plain film) n Cross sectional imaging
5
Carpal Bones
6 Source undetermined
Normal Wrist PA
7
Source undetermined
Normal Wrist Lateral
8 Source undetermined
Normal Hand PA
9 Source undetermined
Normal Hand Lateral
10 Source undetermined
Case 1
n Hyperextension n Tender and swollen
thumb
11 Source undetermined
Case 1
n Bennett Fracture n Fx-Disloc of base of
thumb MC n APL tendon
n Splint, Hand referral n Will need OR
12
Source undetermined
Case 2
n FOOSH, wrist pain n Deformity to dorsal wrist n Decreased sensation to volar palm
13
Case 2
14 Source undetermined Source undetermined
Case 2
n Peri-lunate dislocation n Lunate remains articulated with radius n Distal carpal bones translate dorsally n Emergent Hand consult
15
Case 3 n FOOSH, pain in wrist
16 Source undetermined Source undetermined
Case 3
n Lunate dislocation n Disruption of all lunate ligaments n Emergent Hand consultation
17 E-Hand.com, eatonhand.com
Case 4
n FOOSH n Pain in wrist
18
Case 4
19 Source undetermined
Source undetermined
Case 4
n Colles fracture
20
Sletuffe, Wikimedia Commons Abigor, Wikimedia Commons
Case 4
n Colles fracture n Distal metaphysis of the radius n Dorsal displacement and shortening
n Silver fork deformity
n Reduction, splinting n Be alert for elbow and scaphoid injuries
21
Case 5
n Skier n Tender and swollen
thumb
22 Source undetermined
Case 5
n Gamekeeper’s Thumb/Skier’s Thumb/ Breakdancer’s Thumb n Disruption of the UCL of the thumb MCP n Only visible on plain film when avulsion fx is
present
n Splint, Hand Referral n Will likely need OR
23
Case 5
24
Source undetermined
3-Point Products, 3pointproducts.com
Case 6
n Punched a wall n Wrist pain
25 Source undetermined
Case 6
n Die-punch or lunate load fracture
n Axial force along hand n Splint, urgent referral
26 Source undetermined
Case 7
n FOOSH n Pain and
tenderness to base of thumb and radial wrist
27 Source undetermined
Case 7
n Scapho-lunate dissociation n Terry Thomas/David Letterman sign
n Scapho-lunate space >4mm
n Splint n Urgent f/u
28
Source undetermined
Case 7
29 Source undetermined
Case 8
n Assaulted with bat n Wrist pain
30
Source undetermined
Case 8
n Chauffeur's/Backfire/Hutchinson Fracture n Direct blow to distal edge of radius n Often scapholunate dissociation n Splint, urgent referral
31
Case 9
n 13 yo, FOOSH n Pain to radial wrist
32 Source undetermined
Case 9
n Scaphoid fracture n Frequently missed n High litigation n Splint, urgent hand
33 Houston Methodist Orthopedics & Sport Medicine, methodistorthopedics.com
Case 9
34
Source undetermined Source undetermined
Case 9
n Scapholunate Advance Collapse
35
Source undetermined Source undetermined
Case 10
n Punched a wall n Hand pain
36 Source undetermined
Case 10
n Boxer's fracture n Splint n Hand referral
37
Source undetermined
Case 10
n Displacement in metacarpal fractures n Reduce
n > 10° in 2 and 3 n > 30° in 4 and 5 n Any rotation
38
Case 11
n FOOSH n Dorsal wrist pain
39 Source undetermined
Case 11
n Triquetrum fracture n Most dorsal bone on lateral n Dorsal fracture most common n Splint, referral
40
Case 12
n 14 yo boy n Basketball injury n Wrist pain
41
Source undetermined
Case 12
n Normal adolescent wrist n Partially closed physes n Splint
42
Case 13
n Thumb hyper-extension
n Tender and swollen thumb
43 Source undetermined
Case 13
n Rolando Fracture n AKA double-Bennett
n Splint, Hand referral n Will need OR
44 Source undetermined
Case 14
n Tried to catch falling wine glass
45 Source undetermined
Case 14
n Hand foreign body n Significant litigation
46
Case 15
n Nightstick injury
47 Source undetermined
Case 15
n Chauffeur fracture n Splint, routine Hand referral
48
Case 16
n Punched a wall n Wrist pain
49 Source undetermined
Case 16
n Die-punch/Lunate load fracture n Splint, urgent Hand referral
50
Case 17
n FOOSH n Wrist pain
51
Source undetermined
Case 17
n Scaphoid fracture n Thumb spica splint n Urgent Hand referral
52
Case 18
n Nintendo Wii accident n Thumb pain
53 Source undetermined
Case 18
n Gamekeeper's thumb n Thumb spica n Urgent Hand referral
54
Case 19
n Barfight n Hand pain
55 Source undetermined
Case 19
n Spiral fracture of second metacarpal n Splint, referral
56
Case 20
n MVC n Hand pain n Lateral?
57 Source undetermined
Case 20
n Lateral:
58 Source undetermined
Case 20
n Dislocation of MCC joints 3-5 n Hand consultation, reduction
59
Case 21
n Punched a bouncer
n Hand pain
60 Source undetermined
Case 22
n 5th MC body fracture n Reduction? n Splint
61
Case 23
n Fall on supinated hand
n Wrist pain
62
Source undetermined
Case 23
n Smith's fracture (aka reversed Colles) n Distal radius n Impaction and volar displacement n Reduction, splint
63
Case 24
n FOOSH n Wrist pain n Lateral?
64 Source undetermined
Case 24
n Lateral:
65 Source undetermined
Case 24
n Peri-lunate dislocation n Emergent Hand consultation
66
Case 25
n FOOSH n Wrist pain n Lateral?
67 Source undetermined
Case 25
n Lateral:
68 Source undetermined
Case 25
n Triquetral dorsal chip fracture n Splint n Urgent Hand referral
69
Case 26
n FOOSH n Wrist pain
70 Source undetermined
Case 26
n Scaphoid fracture n Thumb spica splint n Urgent Hand referral
71