The Hip book

Hand

Spiral Metacarpal Fractures

      – Discussion:     – tend to rotate which is poorly tolerated;     – 5 deg of MCP rotation leads to > 1.5 cm of digital overlap; – Operative Treatment:     – screw fixation for metacarpal frx           – screw menu           – when ORIF is … Read more

Spiral Oblique Proximal Phalanx Frx

– Disscusion     – these frx are inherently unstable, and requires internal fixation; – Percutaneous Fixation Technique:     – reduction is achieved w/ a tenaculum fracture reduction clamp;     – 2 or 3 0.28 inch K wires are inserted across fracture, perpendicular to long axis of phalanx & engage both cortices of the … Read more

Spiral Bands / Cords

– Discussion:     – spiral band is continuation of pretendinous cord;            – at a point just distal to the superficial transverse palmar ligament (which is just proximal to the metacarpal heads), the pretendinous cord bifurcates to form the spiral bands;     – spiral band passes deep to the … Read more

Space of Poirier

– See:     – Ligaments of the Wrist – Discussion:     – an atomical defect or weak spot in the floor of the carpal tunnel;     – it lies at the volar aspect of the proximal capitate, lying between the volar radiocapitate and volar radiotriquetral ligaments (see ligaments);     – area expands … Read more

Smith’s Fracture

– See:        – Barton’s Fracture – Discussion:      – extra-articular palmarly displaced distal radius frx;      – volar angulation of frx is referred to as “Garden Spade” deformity (reversed Colles Fracture);      – hand & wrist are displaced forward or volarly w/ respect to forearm;      – frx may … Read more

Snake Bite Wounds

– See: necrotizing fascitis – Discussion:     – snake bite resources     – snake types:          – pit vipers (crotaline) which include rattlesnakes, cottonmouths, and copperheads;                – crotalus (rattlesnakes)                – agkistrodon (copperheads, water moccasins)                – micrurus … Read more

Scapholunate Interosseous Ligament and Anatomy of SLD:

– Discussion: (see ligaments of the wrist and SLD)    – three main ligamentous structures which bind the scaphoid to lunate;              – volar radioscapholunate ligament (largest);              – radiocapitolunate ligament;              – scapholunate interosseous ligament (consists of dorsal, proximal, and palmar segments bridging the scaphoid and lunate);                        – dorsal portion:                                 – 2-3 mm thick with transversely oriented … Read more

SLD: Acute Ligament Tear – Repair Technique

– See: Ligaments of the Wrist – Discussion: – dorsal incision is centered of Lister’s tubercle; – dorsal capsule is reflected in line with the skin incision; – radial capsule is reflected from the scaphoid to its waist; – reduce lunate and scaphoid w/ K wire; – joysticks inserted in a dorsal to palmar direction; … Read more