00:01
Welcome back.
00:02
Thanks for joining me
on this discussion of classic fractures
in the section of orthopedic surgery.
00:08
It’s important to know
that we won’t be covering every
single fracture known to orthopedic surgery,
just the high-yield information.
00:17
Let's begin with Colles' fracture.
00:20
Colles' fracture is a wrist fracture.
00:23
And the mechanism of action
is usually due to a fall
on an outstretched hand.
00:28
You can imagine a scenario,
an elderly patient
who is a little unsteady on their feet,
walking about with a cane.
00:35
As they fall,
it's natural reflex for us to
have our hands stretched out.
00:42
And this is on physical
examination, the finding.
00:46
What you’ll notice is that
it’s a fracture of the distal radius and ulnar
just above the wrist.
00:51
Clearly, the hand here
and the upper wrist
looks like there is obvious deformity
and there's some swelling
in the region of the distal writst.
01:03
Let's get some imaging.
01:04
Here are plain x-rays.
01:06
And you’ll notice on the circled areas
are where we see a distal radius.
01:11
Once again,
you can imagine why this would
happen in an outstretched hand.
01:15
And it's also important,
as you can see,
based on these x-rays,
the radius and the ular
are not the biggest, strongest bones.
01:25
Let me pose a question to you.
01:28
Now that we’ve reviewed a Colles’ fracture,
what is a reverse Colles’ fracture?
I’ll give you a second
to think about this.
01:36
That’s right.
01:37
Instead of falling with an extended hand,
it is associated with a fall
on a flexed hand.
01:42
So instead of an extended hand,
we now have the fall
on the flexed hand,
but still landing on the wrist area.
01:48
This is still a high impact –
direct impact to the wrist.
01:52
Similarly, you can get the
ulnar or the radius fracture.
01:58
How do we fix it?
Well, it may require surgery
or they can simply be splinted
and immobilized for four weeks.
02:06
Remember,
before orthopedic surgery
became a specialty of medicine
and in old times,
people used to heal all the time.
02:13
Our bones actually have
amazing ability to heal.
02:19
Let's move on.
02:20
This is called the
snuff box fracture.
02:23
A snuff box fracture is important.
02:25
It also is due to a fall
on an outstretched hand,
causing extreme dorsiflexion
and forced to load on the scaphoid bone.
02:37
On physical examination,
notice the triangle demonstrating the snuff box.
02:41
This is called the anatomic snuff box.
02:44
Tenderness over this anatomic region
is suggestive that there
may be a snuff box fracture.
02:50
There may also be associated
bruising or swelling.
02:56
On imaging,
if you can see it on the x-ray,
the green arrow points to the snuff box
or scaphoid fracture.
03:04
However,
sometimes it’s difficult to detect
these fractures on plain x-rays alone.
03:11
And that's why orthopedic
surgeons often get an MRI.
03:17
These MRIs may help
detect an injury earlier.
03:21
And for snuff box injuries,
detection is better for outcomes.
03:28
How do we fix it?
Well, surgery is usually not recommended.
03:32
It's generally a thumb splint
and don't forget to reimage
several weeks later.
03:37
In fact, for all fractures,
usually, we recommend follow-up x-rays
to make sure things are healing
and healing in an aligned fashion.