coach’s course hand wrist elbow trauma · if it recurs- surgery required. rotational malalignment...

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Coach’s Course Hand and Wrist

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Page 1: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Coach’s Course

Hand and Wrist

Page 2: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Pet peeves

The hand is frequently under treated or over treated just because it is small.

There is an idea that the hand can treated at a later date.

All you need is a pop-sicle stick and tape and you have treatment.

If the x-ray is negative, there is nothing wrong with the hand.

Page 3: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Pet Peeves-2

The “jammed” finger.

Haagen Daz treatment

Page 4: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

The Multi- System Hand

Skin (nail)

Bone

Nerves

Blood vessels

Tendons

Ligaments

Page 5: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

The hand gets into the

most amazing places!

Page 6: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Skin and Bone

“small ball”

Page 7: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Wrist Fractures

Page 8: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Mechanism of injury:

fall on outstretched hand

Page 9: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

“Dinner- fork” deformity

Page 10: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Fracture anatomy

Page 11: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

High Energy injuries

Many pieces

In the joint

Will need surgery

Can be career

ending

Late arthritis

Page 12: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Typical x-rays

Pediatric Adult

Page 13: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Forearm Fractures

Gross deformity : Check circulation and

sensation.

Splint as is !! Don’t try to fix !!!!

Page 14: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Open Fractures

More serious than closed injuries

Vascular injury

High risk of infection

Page 15: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Flexor tendon injuries

Page 16: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Check for nerve

and vessel injuries

Page 17: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

“Jersey” Finger

Page 18: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Overload injury to the finger

pulls the tendon off the bone

Page 19: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Ligament injuries:

sprains and dislocations

Ligaments form the

joint capsule

Minor injuries are

sprains

Complete tears will

result in joint

dislocation

Page 20: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Finger Dislocations

Page 21: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Double dislocation

Page 22: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

First degree sprains

Page 23: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

“Haagen Daz” treatment

Page 24: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Scaphoid Fractures

Tenuous blood

supply

Fall on outstretched

wrist

Delayed healing

common

Avascular necrosis

Page 25: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Scaphoid Fractures:

Treatment

Non-operative

Page 26: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Mallet Fingers:

axial injuries

Three types

Page 27: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Mallet fingers

treatment

This deformity is

permanent unless

treated

Splinting- 6 weeks

If it recurs- surgery

required

Page 28: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Rotational malalignment

A simple fracture Looks pretty good !

Page 29: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Now What !?!?

Page 30: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Sliding into third base

finger fracture

Page 31: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

“Boxer’s” fractures

Page 32: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Punch in the mouth !

Frequently

misdiagnosed

Eichenella

corrodens

Can lead to

gangrene if not

treated correctly and

promptly

Page 33: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Skier’s thumb

Page 34: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

“Tennis” elbow

Page 35: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Mechanism of injury

Page 36: Coach’s Course Hand Wrist Elbow Trauma · If it recurs- surgery required. Rotational malalignment A simple fracture Looks pretty good ! ... corrodens Can lead to gangrene if not

Thanks for your

attention!