professor gary hooper rn liz wyllie ms kerry cragggpcme.co.nz/pdf/2017...
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Professor Gary HooperHead of Department
Orthopaedic Surgery
Musculoskeletal Medicine
Christchurch School of Medicine
8:30 - 9:25 WS #68: Plaster and Splint Workshop - Fractures and
Hand/Finger Injuries
9:35 - 10:30 WS #78: Plaster and Splint Workshop - Fractures and
Hand/Finger Injuries (Repeated)
RN Liz WyllieRegistered Nurse
Orthopaedic Outpatient Department
CDHB
Christchurch
Ms Kerry CraggHand Therapist
Hand Therapy Unit
Christchurch Hospital
Christchurch
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Managing Common Hand Injuries
Liz Wyllie OOPD Christchurch
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Metacarpal Fractures
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Position of safe immobilisation (POSI)
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Assessing the injured hand
• Check the fingers for rotation by getting the patient to form a loose fist
• Check the nails are all following the same plane and there is no scissoring
• Compare with the other hand
• Rotation must be corrected if present using traction prior to casting or splinting
• Check the patient is able to extend finger to neutral
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Treating Metacarpal Fractures
• Neck of M.C. fracture reduction can be achieved by traction and volar pressure under the metacarpal head with dorsal counter pressure more proximally
• Shaft of M.C. fracture reduction requires traction and pressure along the M.C. dorsally
• Base of metacarpal fractures can be reduced in a similar way, but may require further imaging afterwards to confirm the joint is enlocated and congruent.
• Hand fractures, like fingers, generally heal quickly and a maximum of 4 weeks immobilisation is required
• Smoking can delay union and may necessitate longer casting
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Products we Use
• One Step
• Plaster Slab
• Plaster rolls
• Nemoa
• Delta Light
• Felt for Moulding
• Padding
• Bandages
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Volar Slab • New injuries while swollen can be treated in slab’s not full casts
• We normally use a local block prior to reducing acute fractures
• In Bone Shop we apply volar casts to the metacarpal heads only and buddy strap the fingers to prevent rotation. This allows movement of the MCP’s preventing stiffness
• We don’t use any stocking under casts for new injuries
• Felt padding is applied at the point where moulding will take place to prevent pressure sores
• This is one cast where finger prints are okay!
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Cobra Casts
• These casts are also frequently used for metacarpal fractures
• Fingers should have padding wrapped between them prior to casting to prevent maceration
• The hand must be in the POSI to safely rest the soft tissues and facilitate faster rehab after casting
• It is easiest to get the patient to hold their hand in this position for you.
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Full casts
• Complete casts can be applied, but plaster should be used acutely and the cast split to allow for swelling
• These can then be completed at 1 week post injury with synthetic
• The same cast can remain on for the whole time
• A full synthetic cast can be applied once swelling is reduced provided there is equipment available to remove it safely
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Thumb Injuries
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Treating Thumb Injuries
• The most common injuries we see for thumbs are metacarpal fractures and Ulna Collateral Ligament (UCL) Injuries
• Xray should be taken before stressing the UCL if there is an avulsion fracture it should not be stressed as this can displace the fracture
• When testing the UCL the thumb should be stressed flexed to isolate the tendon
• The other thumb should be assessed first for a comparison
• If there is significant laxity a thumb splint or cast will be needed for 3 weeks
• If there is no end point or uncertainty they should be referred for further management
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Video of testing UCL
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Scaphoid Fractures
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Treating Scaphoid Injuries
• Scaphoid fractures are treated in below elbow casts without the thumb included in Bone Shop unless indicated by pain on thumb movement
• Scaphoids can require extended time in cast to prevent non-union up to 12 weeks
• Clinical scaphoid fractures with tenderness in anatomical “snuff box” and on thumb loading but no radiological changes should be treated either in a wrist splint if not too sore or cast
• They should return in 10 – 14 days for re-xray and examination as the fracture may not show up initially
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Splints for Wrist
• Minor avulsions from other carpal bones can also be treated in a wrist splint for comfort
• We have Velcro wrist and thumb splints that come in several sizes and can be used for either side and hand therapy can also make thermos plastic splints.
• Thumb splints can be useful for minor sprains also without compromising other joints
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References
• Bone Shop House Surgeon Orientation Guide, Orthopaedic Outpatient Department, Christchurch Hospital
• Wheeless’s Textbook of Orthopaedics
• Occupational Therapist, Juliet Schneemannhttps://www.slideshare.net/anti_banme/4position-of-safe-immobilisation
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No Disclosures