GEMC: Radiology: X-rays of the Hand and Wrist: Resident Training
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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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GEMC: Radiology: X-rays of the Hand and Wrist: Resident Training
- 1. 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/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1
- 2. Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair. 2
- 3. Radiology: X-rays of the Hand and Wrist Christian Jacobus, MD April 11, 2007 3
- 4. Overview 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 n Shameless unrelated entertainment 4
- 5. I Will not Cover… Phalanx fractures n Soft tissue injuries (except that can be detected on plain film) n Cross sectional imaging n 5
- 7. Normal Wrist PA Source undetermined 7
- 8. Normal Wrist Lateral Source undetermined 8
- 9. Normal Hand PA Source undetermined 9
- 10. Normal Hand Lateral Source undetermined 10
- 11. Case 1 Hyperextension n Tender and swollen thumb n Source undetermined 11
- 12. Case 1 n Bennett Fracture Fx-Disloc of base of thumb MC n APL tendon n Splint, Hand referral n Will need OR n Source undetermined 12
- 13. Case 2 FOOSH, wrist pain n Deformity to dorsal wrist n Decreased sensation to volar palm n 13
- 14. Case 2 Source undetermined Source undetermined 14
- 15. Case 2 Peri-lunate dislocation n Lunate remains articulated with radius n Distal carpal bones translate dorsally n Emergent Hand consult n 15
- 16. Case 3 n FOOSH, pain in wrist Source undetermined 16 Source undetermined
- 17. Case 3 Lunate dislocation n Disruption of all lunate ligaments n Emergent Hand consultation n E-Hand.com, eatonhand.com 17
- 18. Case 4 FOOSH n Pain in wrist n 18
- 19. Case 4 Source undetermined Source undetermined 19
- 20. Case 4 n Colles fracture Abigor, Wikimedia Commons Sletuffe, Wikimedia Commons 20
- 21. Case 4 n Colles fracture Distal metaphysis of the radius n Dorsal displacement and shortening n n Silver fork deformity Reduction, splinting n Be alert for elbow and scaphoid injuries n 21
- 22. Case 5 Skier n Tender and swollen thumb n Source undetermined 22
- 23. Case 5 n Gamekeeper’s Thumb/Skier’s Thumb/ Breakdancer’s Thumb 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 n 23
- 24. Case 5 Source undetermined 3-Point Products, 3pointproducts.com 24
- 25. Case 6 Punched a wall n Wrist pain n Source undetermined 25
- 26. Case 6 Die-punch or lunate load fracture n Axial force along hand n Splint, urgent referral n Source undetermined 26
- 27. Case 7 FOOSH n Pain and tenderness to base of thumb and radial wrist n Source undetermined 27
- 28. Case 7 Scapho-lunate dissociation n Terry Thomas/David Letterman sign n n Scapho-lunate space >4mm n Splint n Urgent f/u Source undetermined 28
- 30. Case 8 Assaulted with bat n Wrist pain n Source undetermined 30
- 31. Case 8 Chauffeur's/Backfire/Hutchinson Fracture n Direct blow to distal edge of radius n Often scapholunate dissociation n Splint, urgent referral n 31
- 32. Case 9 13 yo, FOOSH n Pain to radial wrist n Source undetermined 32
- 33. Case 9 Scaphoid fracture n Frequently missed n High litigation n Splint, urgent hand n Houston Methodist Orthopedics & Sport Medicine, methodistorthopedics.com 33
- 34. Case 9 Source undetermined Source undetermined 34
- 35. Case 9 n Scapholunate Advance Collapse Source undetermined Source undetermined 35
- 36. Case 10 Punched a wall n Hand pain n Source undetermined 36
- 37. Case 10 Boxer's fracture n Splint n Hand referral n Source undetermined 37
- 38. Case 10 Displacement in metacarpal fractures n Reduce n > 10° in 2 and 3 n > 30° in 4 and 5 n Any rotation n 38
- 39. Case 11 FOOSH n Dorsal wrist pain n Source undetermined 39
- 40. Case 11 Triquetrum fracture n Most dorsal bone on lateral n Dorsal fracture most common n Splint, referral n 40
- 41. Case 12 14 yo boy n Basketball injury n Wrist pain n Source undetermined 41
- 42. Case 12 Normal adolescent wrist n Partially closed physes n Splint n 42
- 43. Case 13 Thumb hyperextension n Tender and swollen thumb n Source undetermined 43
- 44. Case 13 n Rolando Fracture n AKA double-Bennett Splint, Hand referral n Will need OR n Source undetermined 44
- 45. Case 14 n Tried to catch falling wine glass Source undetermined 45
- 46. Case 14 Hand foreign body n Significant litigation n 46
- 47. Case 15 n Nightstick injury Source undetermined 47
- 48. Case 15 Chauffeur fracture n Splint, routine Hand referral n 48
- 49. Case 16 Punched a wall n Wrist pain n Source undetermined 49
- 50. Case 16 Die-punch/Lunate load fracture n Splint, urgent Hand referral n 50
- 51. Case 17 FOOSH n Wrist pain n Source undetermined 51
- 52. Case 17 Scaphoid fracture n Thumb spica splint n Urgent Hand referral n 52
- 53. Case 18 Nintendo Wii accident n Thumb pain n Source undetermined 53
- 54. Case 18 Gamekeeper's thumb n Thumb spica n Urgent Hand referral n 54
- 55. Case 19 Barfight n Hand pain n Source undetermined 55
- 56. Case 19 Spiral fracture of second metacarpal n Splint, referral n 56
- 57. Case 20 MVC n Hand pain n Lateral? n Source undetermined 57
- 59. Case 20 Dislocation of MCC joints 3-5 n Hand consultation, reduction n 59
- 60. Case 21 Punched a bouncer n Hand pain n Source undetermined 60
- 61. Case 22 5th MC body fracture n Reduction? n Splint n 61
- 62. Case 23 Fall on supinated hand n Wrist pain n Source undetermined 62
- 63. Case 23 Smith's fracture (aka reversed Colles) n Distal radius n Impaction and volar displacement n Reduction, splint n 63
- 64. Case 24 FOOSH n Wrist pain n Lateral? n Source undetermined 64
- 66. Case 24 Peri-lunate dislocation n Emergent Hand consultation n 66
- 67. Case 25 FOOSH n Wrist pain n Lateral? n Source undetermined 67
- 69. Case 25 Triquetral dorsal chip fracture n Splint n Urgent Hand referral n 69
- 70. Case 26 FOOSH n Wrist pain n Source undetermined 70
- 71. Case 26 Scaphoid fracture n Thumb spica splint n Urgent Hand referral n 71