www.glenelgorthopaedics.com.au Hand & Wrist Conditions Dr. Gavin Nimon Head of Upper Limb Surgery- QEH Senior Lecturer- University of Adelaide MBBS FRACS (Orth) FRCS (Ed)
www.glenelgorthopaedics.com.au Profile Gavin Anthony Nimon University of Adelaide-intern 1990 bst 91-93 Edinburgh/ Newcastle –Orthopaedic Registrar 1994 Advanced Trainee –Orthopaedics 1995-1998 Senior Registrar Year 1999 QEH Senior Registrar/ Consultant PMR Edinburgh Consultant DGRI 2000-2005 Senior Lecturer University of Adelaide- QEH Head of Upper Limb Specialty- The Queen Elizabeth Hospital
www.glenelgorthopaedics.com.au My Approach to Assessing and treating Orthopaedic Issues
www.glenelgorthopaedics.com.au
www.glenelgorthopaedics.com.au Metacarpal fracture Distal metacarpal (5 th = boxers fracture) Bennet’s fracture (unstable) Rolando’s fracture
www.glenelgorthopaedics.com.au Scaphoid fractures Acute:- Undsiplaced-Splint • Displaced-screw Fixation • Chronic:- ORIF and Bone Graft Important not to miss diagnosis • I see 1-2/year missed diagnosis • Can occur after Torquing injury • Futuro splint option if concern • CT scan very good for diagnosis • MRI
www.glenelgorthopaedics.com.au Wrist Fractures • Very Common • Many Osteoporotic- thus treatment later • Not all benign • Can cause significant functional problems • CT – great for work up
www.glenelgorthopaedics.com.au Wrist Dislocations ( perilunate )
www.glenelgorthopaedics.com.au Mallet Finger (extensor tendon Rupture) • Hit end of finger ( spiking ball/ making bed) • Tendon avulses/ tears • Stack finger splint 6 weeks
www.glenelgorthopaedics.com.au Wrist Pain- some common diagnoses Global- OA (x-ray changes) Tendinitis ( crepitus ) Radial- Radial styloid oa (xray) scaphoid fracture / Scapho-lunate (xray) deQuervains (u/s) CMC OA (xray) Ulnar-ECU tendinitis (u/s) TFCC (clinical) pisiform / triquetral oa (xray/ ct/ bone scan) Neurological - Carpal tunnel (ncs) Cubital tunnel (ncs) Referred from neck ( spurling’s test )
www.glenelgorthopaedics.com.au Wrist Arthroscopy- Investigative tool
www.glenelgorthopaedics.com.au Carpal Tunnel Syndrome • Very Common • Performed Under Local Anaesthesia • Wide awake no tourniquet surgery • Self- funded - cheaper as no assistant nor anaethetist required • Safe • Quick recovery
www.glenelgorthopaedics.com.au Stenosing Tenovaginitis DeQuervain’s Tenosynovitis Trigger Finger
www.glenelgorthopaedics.com.au OA and myxoid cysts
www.glenelgorthopaedics.com.au Ganglions
www.glenelgorthopaedics.com.au CMC Osteoarthritis CMC Fusion performed for arthritis – Very common – Degenerative (female> male) – Grind test +ve – Tx • Splint/ physiotherapy • Steroid Injection • Trapezectomy +/- suspensoplasty vs fusion • K wire and plaster 4-6 weeks
www.glenelgorthopaedics.com.au CMC Fusion
www.glenelgorthopaedics.com.au Scaphoid fracture/ scapho-lunate dissociation- oa Arthritis and scaphoid Non-union can be treated with scaphoid excision and partial fusion of wrist
www.glenelgorthopaedics.com.au Keinboch’s disease
www.glenelgorthopaedics.com.au Dupuytren’s Contracture – Very common in United Kingdom – Nordic Genes (Vikings) – Requires committed patient, for splinting, physiotherapy and wound care – High risk of recurrence – But results very good from surgery • Risks • Nerve damage • Infection
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