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ע"<br />
שת/<br />
תבט/<br />
ג"<br />
י<br />
16<br />
Scaphoid fractures<br />
Nonunion: wide # zone, sclerosis (resorption); shortening,<br />
fragments discrepancy, angulation<br />
Delayed union: wide # zone, NO sclerosis (after 4m)<br />
Unstable: 1) displacement + any step-off v>=1mm<br />
2) angulation<br />
3) motion of fracture<br />
4) association with carpal instability<br />
Treatment: 1) Immobilization – stable & non-displaced<br />
* Thumb spica cast – long, for first 6w, short afterwards<br />
2) Internal fixation – unstable # & displaced<br />
3) Bone grafting: only if severe comminution<br />
Preiser’s disease: idiopathic avascular necrosis; ~40y old, steroid usage<br />
Tx: revascularization / resection + prox. Row carpectomy<br />
LUNATE FRACTURES<br />
Possible #: body, palmar / dorsal<br />
Tx: Cast immobilization (6w)<br />
KienbÖck’s disease: avascular necrosis<br />
From repeated trauma; male workers,<br />
18-40y; short ulna; fragmentation-collapse-<br />
-loss of carpal alignment-carpal arthrosis<br />
TRAPEZIUM FRACTURES<br />
Rare<br />
Direct blows<br />
Rx mostly enough<br />
Closed vs. open reduction<br />
TRAPEZOID FRACTURES<br />
The list frequently injured<br />
Dorsal dislocation by palmar<br />
forces on M2<br />
Anatomic reduction + stabilize.<br />
CAPITATE FRACTURES<br />
Rare<br />
Prox. 2/3 (perilunate injuries)<br />
Non-displaced # - immobilize<br />
fragments – open reduction<br />
TRIQUETRIUM FRACTURES<br />
Common<br />
With ligs. & bony damage<br />
Mostly dorsal cortex chip fractures<br />
Tx: immobilize for 4-6w.
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