Hand

Scaphoid fracture

MC carpal bone fracture, articulates with multiple bones in hand, forms lateral border of carpal tunnel
Poor vascular supply to proximal part ➔ ↑ risk of avascular necrosis or nonunion
Anatomical snuffbox tenderness/wrist pain
X-ray (PA, lateral, oblique, schaphoid views) repeated in 10d if negative
TX with thumb spica x6wks (distal fx ➔ short arm; proximal fx ➔ long arm)
- > 1 mm of displacement or proximal pole fractures ➔ need ortho (operative fixation)

Thumb Spica

Surgery if neurovascular injury, open, severe angulation
Punched teeth (hx) & abrasions (PE) ➔ augmentin
Shaft
- Transverse fracture MC from punching something (4th-5th MC - boxer's fracture)
- Gutter splint non-displaced metacarpal shaft fractures
Base
- Dorsal AND volar forearm splint‎. Wrist at ~30° of extension with MCPs free
- 5th (MC base) fracture usually requires surgery
Head
- Ulnar gutter or short arm to PIP
Neck
- Reduction and radial or ulnar gutter (likely needs to see hand)

Ulnar Gutter

4th/5th metacarpal shaft fracture

Radial Gutter

2nd/3rd metacarpal shaft fracture

Forced flexion of DIP ➔ ruptured extensor digitorum tendon
SSX: unable to extend
Get xray to r/o avulsion fracture of distal phalanx
Splint DIP in hyperextension for 6wks, (don't splint PIP), surgery if angulated > 45°

SSX: Pain with passive extension, affected finger is slightly flexed at rest
DeQuervian: Excessive/repetitive thumb abduction & extension
- SSX: Pain (may radiate to radial styloid/thumb/elbow) ↑ with grasping
- DX: Finkelstein - pull traction on thumb across palm
Stenosing tenosynovitis: Metaplasia ➔ ↓smoothness of finger flexion
- SSX: Finger locks when flexed then pops back (trigger finger)
TX non-infectious tenosynovitis with NSAIDs, splinting for 6 wks, tendon sheath GCS injection

Penetrating trauma (IVDA, thorns ➔ fungal, bites), spread of systemic infxn (TB, gonorrhoeae)
Can have fever, leukocytosis
TX infectious tenosynovitis with debridement and broad spectrum IV abx

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