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Distalradial and ulnar Management of distal radial and ulnar # Dupuytrens contracture = progressive, painless fractures. • Manipulation shouldbe undertaken thickening of the palmar fascia with skin puckering using regionalanaesthesia (Bier’s block) and thickening. Primarilyring and little finger is Colles fracture = extra- articular # of distal radius • Volar displacedfractures areunstable bilateral andsymmetrical. MCP joint flexion with dorsal displacement and should have open reduction and Associations = smoking, diabetesantiepileptics. of the distal radius. plate fixations. Management= ifthe patient cannot place their hand flat on the table= surgery = fasciectomy. • Stable fracture ofthe distal radius should Smith’s fracture (reverse have early mobilisationfrom a splint if colles) = volar pain allows. De quervains tenosynovitis = thickening and displacement and • Plastar cast should be in neutral flexion tightening of the first extensor compartment. angulation of the distal Signs = pain is worsewhen the tendons are • Surgical intervention of dorsally radial fragment. displaced fractures should beperformed stretched (making a fist) +VE finkelsteins sign. Pain within 72 hrs of injury and one week if and swelling near the base of thumb Barton’s fracture = intra- extra-articular. Associations = chronic overuse ofwrist tendons. articular fracture Treatment = 1 = rest, ice , NSAIDS, 2 =nd • by Gregor ramage and Dr Shaheer corticosteroidinjectionat tendon site. 3 =d involving dorsal aspect of the distal radius. Aslam Joiya decompressionof the tendons. Chauffeurs fracture = Wrist # and trauma Carpal tunnel syndrome= compression of the fracture of the radial medial nerve as it passes under the flexor styloid Scaphoid fracture retinaculum. Presentation = pain inthe anatomical snuff box Signs = tingling or pain in the thumb, index and Monteggia fracture = following a fall on to an outretched hand. middle fingers, patient flicks orshakes wrist to fracture of theproximal relive pain.Most common at night and after Complications = can result in avascular necrosis 1/3 ulnar with dislocation due todisruptionof bloodsupply to the wrist. repetitive actions. Weakened grip. of the radial head. Imaging = request scaphoid specific X-rays Tests = Phalen’s flexing test and tinnels tapping Management = ifconfirmed fracture = scaphoid +Ve. Galeazzi fracture = distal Management = 1 line = rest and splints. plaster, ifunconfirmed= still immobilize in Corticosteroidinjections for short term pain relief, radial shaft fracture with futuro splint and x-ray again in 7-10days. associated dislocationof then surgery = flexorretinaculum release. the distal radioulnar joint. Ulnar nerve – C8-T1 = inability tocross the fingers . Severe can result in claw hand.Sensory innervation Nightstick fractures = to little finger and medial half of ring finger. isolated ulnar shaft # caused by a direct blow to a forearm, requires a Radial nerve – C5-T1 = wrist drop. Sensory innervationtobase ofth umb and lateral halfof large force. dorsum of the hand.