Manual of fracture management – wrist wrist

Je sse B Jupite r | Douglas A Cam pbe ll | Fie sky Nuñe z Manual of Fracture Management Wrist Includ e s the e bo ok an d o n line te nt via QR co d e s Je sse B Jupite r | Douglas A Cam pbe ll | Fie sky Nuñe z Manual of Fracture Management Wrist Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Je sse B Jupite r | Douglas A Cam pbe ll | Fie sky Nuñe z Manual of Fracture Management Wrist Close to ,0 0 illustrations and im age s and 15 vide os Library of Congre ss Cataloging-in-Publication Data is available from the publishe r Ha z a rd s Gre at care has be e n take n to m aintain the accuracy of the inform ation containe d in this publication Howe ve r, the publishe r, and/ or the distributor, and/ or the e ditors, and/ or the authors cannot be he ld re sponsible for e rrors or any conse que nce s arising from the use of the inform ation containe d in this publication Contributions publishe d unde r the nam e of 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Distribution by Ge org Thie m e Ve rlag, Rüdige rstrasse 14, 70 69 Stuttgart, Ge rm any, and Thie m e Ne w York, 333 Se ve nth Ave nue , Ne w York, NY 10 01, USA ISBN: 978 3132428 416 E-book: 978 3132428 42 IV Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Fore word Foreword Thomas J Fischer, MD, FAOA, ASSH, AAOS, AOTK Hand Expert Group Clinical Associate Professor Indiana University School of Medicine Department of OrthopedicSurgery Section Chief Hand Surgery Ascension St Vincent, Indianapolis Indiana Hand to Shoulder Center 8501 Harcourt Rd Indianapolis, IN 46260 USA We are n ow in ou r 60th year o celebratin g th e su rgeon s th at cam e be ore u s an d started a u n iqu e organ ization or “workin g grou p” th e Arbeitsgem ein sch a t ü r Osteosyn th ese ragen , th e AO Th e AO h ad at its core an organ ization al stru ctu re th at worked to develop edu cation al program s, docu m en tation o ractu re care, research , an d in stru m en tation to m ake th eir prin ciples applicable to th e variety o ractu res In th e spirit an d in n ovation th at ch aracterized th e ou n ders o th e AO, th ese skilled su rgeon s h ave approach ed th is task with a passion to per orm better an d to teach better in a world wh ere on lin e edu cation is th e n orm Th ey h ave u sed th e written text as an an ch or an d plat orm to work rom an d go back to in order to u n derstan d th e com plex repairs o th is w on der u lly m ade join t In reality, th e w rist is a series o m u ltiple join ts workin g in h arm on y to place ou r h an d in space Th ey h ave broken down th e workin g com pon en ts an d th e com m on in ju ries to sh ow u s th e operative an d n on operative treatm en t th at covers th e m u ltitu de o in tern al deran gem en ts th at can occu r Th ese su rgeon s are m y valu ed colleagu es an d I am h on ored th at th ey asked m e to set th e stage or th is Manual of Fracture Management— Wrist It is th e logical ou tgrowth o all th e learn in g an d developm en t th at h as taken place sin ce th e rst developm en t o volar platin g or sh earin g ractu res an d extern al xation with pin xation or wildly m u lti ragm en ted ractu res It covers th e “lay o th e lan d” qu ite well an d gives u s th e m ap we n eed or li elon g learn in g in wrist trau m a care It was ou t o th is grou p a text was created, som e 30 years ago, called th e Manual of Internal Fixation Th is was th e sen su s an d widely sidered tech n ical m an u al o its tim e in developin g tech n iqu es or ractu re xation It provided a ram ework or su rgeon s to approach broken bon es an d disru pted join ts It provided th e in tegration o th ou gh t to per orm th e docu m en tation , in stru m en tation , an d edu cation o su rgeon s arou n d th e world, th u s u l llin g th e aim s o th e organ ization Now several decades an d th ou san ds o operation s later we n d ou rselves im m ersed in a m ou n tain o im plan ts with h igh ly adapted tech n iqu es th at ocu s n ely on a u n iqu e piece o h u m an real estate, th e wrist Drs Cam pbell, Ju piter, an d Nu n ez, th ree li elon g su rgeon edu cators, h ave tackled th is n ely ocu sed application o th e prin ciples o ractu re care an d h ave given u s a well-docu m en ted an d organ ized text Th e text lin ks electron ic m edia with th e written word to organ ize th e su rgical approach es to prim ary ractu re m an agem en t an d clearly docu m en ts th e eviden ce th at h elps u s ch oose ou r su rgical m eth ods an d ou r su rgical im plan ts Bu t th eir work does n ot stop with th e prim ary care o th e ractu re Th e book’s h ybrid approach to diagram s, case presen tation s, an d eviden ce-based decision m akin g can also be applied to th e described com plication s an d posttrau m atic dition s th at plagu e ou r patien ts V Pre face Preface A siderably greater u n derstan din g o trau m atic an d recon stru ctive problem s abou t th e wrist led u s to th e decision to revise th e in itial AO Manual of Hand and Wrist in to two distin ct texts Followin g com pletion an d pu blication o th e n d edition o th e h an d ractu res volu m e (n ow titled Manual of Fracture Management— Hand) in 2016, we n ow o er you th e n ew an d expan ded Manual of Fracture Management— Wrist Th e orm at o th e m an u al is en tirely case based, w h ich h as proven to be so su ccess u l or both train ees as w ell as season ed su rgeon s in h elpin g to approach an d treat both sim ple an d com plex in ju ries As w ith th e recen t h an d m an u al, w e h ave en h an ced ou r clin ical case presen tation s w ith illu stration s taken rom th e expan sive library o th e AO Fou n dation on lin e edu cation site, AO Su rgery Re eren ce, or u sed th e exception al skills an d resou rces o th e m edical illu stration an d graph ic design team s at AO Su rgery Re eren ce an d th e AO Edu cation In stitu te Recogn izin g th e su bstan tial advan cem en ts in th e u n derstan din g o th e com plex an atom y o th e w rist, expan ded su rgical approach es, an d tech n ological im provem en ts in im plan ts speci c to a variety o an atom ical sh apes an d in ju ry pattern s, th is volu m e covers a wide ran ge o in orm ation an d is divided in to ve speci c section s Section on e o ers th e reader ten di eren t su rgical approach es to th e distal radiu s, carpu s, an d distal u ln a Section tw o exam in es ractu res an d ractu re dislocation s o th e carpu s in clu din g sim ple an d m u lti ragm en tary ractu res o th e scaph oid, n on u n ion s, an d even th e u se o vascu lar pedicle gra tin g Th e th ird section ocu ses on problem s o th e distal u ln a an d distal radiou ln ar join t w h ile th e ou rth section covers a w ide variety o ractu re pattern s an d m eth ods o in tern al xation o th e distal radiu s, w ith VI som e ascin atin g clin ical cases in volvin g severe m u lti ragm en tation an d de orm ity Th e n al section provides th e reader w ith illu strated cases o variou s recon stru ctive problem s in clu din g n on u n ion an d m alu n ion s o th e distal radiu s as w ell as posttrau m atic dition s o th e radiocarpal an d in tercarpal join ts Th is w rist m an u al also ref ects th e experien ce an d expertise o m an y teach in g acu lty th at h ave tau gh t in AO Fou n dation h an d an d w rist cou rses, over m an y years, an d th rou gh ou t th e w orld Th eir cepts as w ell as clin ical exam ples h ave assisted an d in f u en ced th e editors th rou gh ou t its produ ction We w ish to especially ackn ow ledge th e ollow in g su rgeon s or th eir tribu tion s: Drs Diego Fern an dez, Ren ato Fricker, Fiesky Nu ñ ez Jr, Zh on g yu Li, Th om as Fisch er, an d Ju an Del Pin o, all o w h om tribu ted u n iqu e treatm en ts o speci c problem s th at are illu strated w ith in th e m an u al As w e rst iden ti ed in ou r origin ally pu blish ed AO Manual of Hand and Wrist, an d again em ph asized w ith th e recen t Manual of Fracture Management— Hand, th is w rist pu blication prim arily en com passes several exam ples o operative treatm en t It sh ou ld n ot be stru ed to be th e on ly w ay n or even n ecessarily th e best w ay to approach th e in dividu al problem s presen ted Likew ise it is n ot in ten ded to be an exh au stive text on th e su bject Still, w e h ope you w ill n d m an y h ou rs o learn in g an d pleasu re in th is text in retu rn or th e m an y h ou rs w e an d oth ers h ave dedicated in providin g th is book to you Jesse B Ju piter Dou glas A Cam pbell Fiesky Nu ñ ez Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Acknowle dgme nts Acknowledgments We are w ell aw are th at it w ou ld n ot be possible to produ ce an d pu blish th e Manual of Fracture Management— Wrist, n or an y o th e n e AO Fou n dation book pu blication s you see today, w ith ou t th e dedication an d assistan ce o a large n u m ber o tribu tors Th e com radery sh ow n by ellow AO m em bers to sh are resou rces, im ages, an d cases, an d th e h ou rs o edu cation w ork previou sly u n dertaken by w rist su rgeon colleagu es, plu s ad h oc in volvem en t o ou r ow n clin ical sta m ean s th at th ere tru ly is a lon g list o people to th an k Bu t w h ile th ere h ave been cou n tless people in volved in som e w ay in th e developm en t o th is book, w e w ou ld like to especially m en tion th e ollow in g in dividu als, com m ittees, an d grou ps: • Mem bers o th e AOTrau m a Edu cation Com m ission , or providin g th e opportu n ity to develop both th is w ork an d th e partn er pu blication th e Manual of Fracture Management— Hand • Urs Rü etsch i an d Robin Green e, rom th e AO Edu cation In stitu te, or providin g access to th e resou rces an d AOEI sta requ ired to brin g th is pu blication to ru ition • Ren ato Fricker, or h is tribu tion s both as an editor o th e Manual of Fracture Management— Hand an d as an au th or o th is w ork • Diego Fern an dez an d Ladislav Nagy or th eir previou s tribu tion s to h an d an d wrist edu cation at AO Fou n dation an d tribu tion s an d assistan ce with th is pu blication • Pro Tom Fisch er or kin dly providin g h is Forew ord • Carl Lau , Man ager Pu blish in g, an d Mich ael Gleeson , Project Man ager or both h an d an d w rist pu blication s, plu s th e en tire team o graph ic design an d m edical illu stration sta an d su ltan ts th at h elped brin g h an d draw n sketch es an d verbal ideas in to reality • Lars Veu m , Man ager AO Su rgery Re eren ce, an d th e team s o cu rren t an d orm er project m an agers, su rgeon au th ors an d editors, an d illu strators or th eir editorial an d illu stration w ork developin g th e AO Su rgery Re eren ce carpal an d distal radiu s m odu les • Fion a Hen derson an d An dreas Sch abert rom AO Fou n dation ’s pu blish in g partn er Th iem e • An d last bu t n ot least to ou r partn ers an d am ily or th eir tin u in g an d n ever-en din g su pport or ou r in volvem en t w ith th e AO Fou n dation ’s w orld-class books, cou rses, an d on lin e edu cation activities an d even ts VII Contributors Contributors Ed it o rs Jesse B Jupiter, MD Douglas A Campbell, ChM, FRCS Ed, FRCS(Orth), Fiesky A Nuñez Sr, MD Hansjorg Wyss/AO Professor of Orthopaedic Surgery FFSEM(UK) Associate Professor Harvard Medical School Consultant Hand and Wrist Surgeon Department of Orthopaedic Surgery Massachusetts General Hospital Leeds General Infirmary Wake Forest School of Medicine Yawkey Center, Suite 2100 Great George St Medical Center Boulevard 55 Fruit Street Leeds LS1 3EX Winston-Salem NC 27157-1010 Boston MA02114 United Kingdom USA Douglas A Campbell, ChM, FRCS Ed, FRCS(Orth), Diego L Fernández, MD Thomas J Fischer, MD, FAOA, ASSH, AAOS, AOTK FFSEM(UK) Professor of Orthopaedic Surgery Hand Expert Group Consultant Hand and Wrist Surgeon University of Bern Clinical Associate Professor Leeds General Infirmary Orthopedic Surgeon Indiana University School of Medicine Great George St Consultant, Hand and Upper Extremity Surgery Department of Orthopedic Surgery Leeds LS1 3EX Ch de la Côte du Bas 12 Section Chief Hand Surgery United Kingdom CH-1588 Cudrefin Ascension St Vincent, Indianapolis Switzerland Indiana Hand to Shoulder Center USA Au t h o rs 8501 Harcourt Rd Indianapolis, IN 46260 USA VIII Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Appendix Ga rcia -Elia s M, Co o n e y WP, An KN, e t a l Krim m e r H, Wie m e r P, Ka lb K Com parative Sh in EK, Ju p it e r JB Rad ioscaph olu n ate Wrist k in em atics a ter lim ited in tercar pal arth rodesis J Hand Surg Am 1989;14:791– 799 ou tcom e assessm en t o th e w rist join t— m ed iocar pal partial arth rodesis an d total arth rodesis Handchir Mikrochir Plast Chir 200 0;32:369 –374 Mu lfo rd JS, Ce u le m a n s LJ, Na m D, e t a l Prox im al row car pectom y vs ou r corn er u sion or scaph olu n ate (SLAC) or scaph oid n onu n ion advan ced collapse (SNAC) w rists: a system atic review o ou tcom es J Hand Surg Eur 2009;34(2):256 –263 Na g y L, Bü ch le r U Lon g-term resu lts o rad ioscaph olu n ate u sion ollow in g ractu res o th e d istal rad iu s J Hand Surg 1997;22:705 –710 Ozyu re ko glu T, Tu rke r T Resu lts o a m eth od o -corn er arth rodesis u sin g h ead less com pression screw s J Hand Surg Am 2012;37(3):486 –492 Pa lm e r AK, Do b yn s JH, Lin s ch e id RL Man agem en t o post-trau m atic in stability o th e w rist secon dar y to ligam en t ru ptu re J Hand Surg Am 1978;3:507–532 Sh in AY Fou r-corn er arth rodesis J Am Soc Surg Hand 2001;1:93 –111 arth rodesis or advan ced degen erative radiocar pal osteoarth ritis Tech Hand Up Extrem Surg 2007;11:180 –183 St u ch RJ Scaph olu n ate advan ced collapse an d scaph oid n onu n ion advan ced collapse arth ritis—u pdate on evalu ation an d treatm en t J Hand Surg Am 2011; 36(4):729 –735 Wa t s o n HK, Ba lle t FL Th e SLAC w rist: scaph olu n ate advan ced collapse pattern o degen erative arth ritis J Hand Surg Am 1984;9:358 –365 We is s APC, Ha s t in gs H Wrist arth rodesis or trau m atic d ition s: a stu dy o plate an d local bon e gra t application J Hand Surg Am 1995;20:50 –56 Wyrick JD, St e rn PJ, Kie fh a b e r TR Motion -preser vin g procedu res in th e treatm en t o scaph olu n ate advan ced collapse w rist: prox im al row car pectom y versu s ou r-corn er arth rodesis J Hand Surg Am 1995;20:965 –970 Go n zá le z d e l Pin o J, Ca m p b e ll D, Fis ch e r T, e t a l Variable an gle lock in g in tercar pal u sion system or ou r-corn er arth rodesis: In d ication s an d su rgical tech n iqu e J Wrist Surg 2012 Au g;1(1):73 –78 Ha s t in gs H Arth rodesis o th e osteoarth ritic w rist In : Gelberm an RH, ed Master Techniques in Orthopaedic Surgery The Wrist New York: Raven Press;1994:345 –350 Ha s t in gs H, We is s APC, Qu e n ze r D, e t a l Arth rodesis o th e w rist or post-trau m atic disorders J Bone Joint Surg Am 1996;78:897–902 Kra ka u e r JD, Bis h o p AT, Co o n e y WP Su rgical treatm en t o scaph olu n ate advan ced collapse J Hand Surg Am 1994;19:751–759 496 Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Distal radius and ulna AO/ OTA Fracture and Dislocation Classi cation Distal radius and ulna Hand and carpus For u rth er edu cation al m aterial abou t th e classi cation an d access to th e com plete Fractu re an d Dislocation Classi cation Com pen diu m , please u se th e QR code Appendix 498 Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Distal radius and ulna Distal radius and ulna 2R3/ 2U3 Lo ca tio n: Radius/ Ulna, dista l e n d se gm e n t 2R3/ 2U3 U R Type s: Radius, distal end segment, e xtra a rticu la r fra cture 2R3A Radius, distal end segment, p a rtia l a rticu la r fra cture 2R3B Radius, distal end segment, co m p le te a rticu la r fra ctu re 2R3C Ulna, distal end segment, e xtra a rticu la r fra cture 2U3A Ulna, distal end segment, pa rtia l a rticu la r fra cture 2U3B Ulna, distal end segment, co m p le te a rticu la r fra ctu re 2U3C 499 Appendix 2R3A Typ e : Radius, distal end segment, e xtra a rticu la r fra cture 2R3A Gro up : Radius, distal end segment, extraarticular, d ia l stylo id a vu lsion fra cture 2R3A1 Grou p : Radius, distal end segment, extraarticular, sim p le fra ctu re 2R3A2 Su b grou p s: Tra nsve rse , n o disp la ce m e n t / tilt (m a y b e sh o rte n e d ) 2R3A2.1 Do rsa l disp la ce m e n t / tilt (Co lle s) 2R3A2.2 Vola r d ispla ce m e n t / tilt (Sm ith’s) 2R3A2.3 Grou p : Radius, distal end segment, extraarticular, we d ge o r m u ltifra gm e n ta ry fra ctu re 2R3A3 Su b grou p s: Inta ct we d ge fra ctu re 2R3A3.1 500 Fra gm e n ta ry we d ge fra ctu re 2R3A3.2 Mu ltifra gm e n ta ry fra ctu re 2R3A3.3 Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Distal radius and ulna 2U3A Typ e : Ulna, distal end segment, e xtra a rticula r fra ctu re 2U3A Gro u p: Ulna, distal end segment, extraarticular, stylo id p ro ce ss fra ctu re 2U3A1 Su bgro u ps: Tip of st yloid fra ctu re 2U3A1.1 Ba se o f st yloid fra ctu re 2U3A1.2 Gro u p: Ulna, distal end segment, extraarticular, sim p le fra ctu re 2U3A2 Su bgro up s: Sp ira l fra ctu re 2U3A2.1 Ob liqu e fra ctu re (>_30°) 2U3A2.2 Tra n sve rse fra ctu re (< 30°) 2U3A2.3 > − 30° < 30° Gro u p: Ulna, distal end segment, extraarticular, m ultifra gm e n ta ry fra cture 2U3A3 501 Appendix 2R3B Typ e : Radius, distal end segment, p a rtia l a rticu la r fra ctu re 2R3B Grou p : Radius, distal end segment, partial articular, sa gitta l fra ctu re 2R3B1 Su b grou p s: In volvin g sca p h oid fossa 2R3B1.1 In volvin g lun a te fo ssa 2R3B1.3 Grou p : Radius, distal end segment, partial articular, d orsa l rim (Ba rto n’s) fra cture 2R3B2 Su b grou p s: Sim ple fra cture 2R3B2.1 Fra gm e n ta ry fra cture 2R3B2.2 With d o rsa l d islo ca tio n 2R3B2.3 Grou p : Radius, distal end segment, partial articular, vo la r rim (re ve rse Ba rto n ’s , Go yra n d -Sm ith ’s II) fra ctu re 2R3B3 Su b grou p s: Sim p le fra cture 2R3B3.1 502 Fra gm e n ta ry fra ctu re 2R3B3.3 Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Distal radius and ulna 2R3C Type : Radius, distal end segment, co m p le te a rticu la r fra ctu re 2R3C Gro u p: Radius, distal end segment, complete, sim p le a rticu la r a n d m e ta p h yse a l fra ctu re 2R3C1 Su bgro u ps: Dorsom e d ia l a rticu la r fra cture 2R3C1.1* Sa gitta l a rticu la r fra ctu re 2R3C1.2* Fro n ta l/ coro na l a rticu la r fra cture 2R3C1.3* *Qualif cations: t DRUJ stable u DRUJ unstable Grou p : Radius, distal end segment, complete, simple articular, m e ta ph yse a l m u ltifra gm e n ta ry fra ctu re 2R3C2 Su b grou p s: Sa gitta l a rticu la r fra ctu re 2R3C2.1* Fro n ta l/ co ro na l fra ctu re 2R3C2.2* Exte n din g in to th e d ia p hysis 2R3C2.3* *Qualif cations: t DRUJ stable u DRUJ unstable Gro u p : Radius, distal end segment, complete, a rticu la r m ultifra gm e n ta ry fra ctu re , sim ple o r m u ltifra gm e n ta ry m e ta p h yse a l fra cture 2R3C3 Su b grou p s: Simple metaphyseal racture 2R3C3.1* Metaphyseal multi ragmentary racture 2R3C3.2* Extending into the diaphysis 2R3C3.3* *Qualif cations: t DRUJ stable u DRUJ unstable Qu a lif ca tio n s are optional and applied to the racture code where the asterisk is located as a lower-case letter within rounded brackets More than one qualif cation can be applied or a given racture classif cation, separated by a comma For a more detailed explanation, see the compendium introduction 503 Appendix Ha n d a n d ca rp u s 78 An a to m ica l re gio n : Ha n d a n d ca rpu s 78 78 78 78 78 78 78 78 78 78 78 78 78 * 77 77 77 77 77 76 74 76 76 Bo n e s: Hand and Hand and Hand and Hand and Hand and Hand and Hand and Hand and Hand and 75 73 72 71 carpus, Lu n a te 71 carpus, Sca p h o id 72 carpus, Ca p ita te 73 carpus, Ha m a te 74 carpus, Tra p e ziu m 75 carpus, Oth e r ca rp a l b o n e s 76 carpus, Me ta ca rp a l 77 carpus, Ph a la n x 78 carpus, Cru sh e d , m u ltip le fra ctu re s 79 Qu a lif ca tio n s are optional and applied to the racture code where the asterisk is located as a lower-case letter within rounded brackets More than one qualif cation can be applied or a given racture classif cation, separated by a comma For a more detailed explanation, see the compendium introduction 504 Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Hand and carpus Lu n a te 71 Bo n e : Hand and carpus, lu n a te 71 Typ e s: Hand and carpus, lunate, a vu lsio n fra ctu re 71A Hand and carpus, lunate, sim p le fra ctu re 71B Hand and carpus, lunate, m u ltifra gm e n ta ry fra ctu re 71C Hand and carpus, scaphoid, sim p le fra ctu re 72B* Hand and carpus, scaphoid, m u ltifra gm e n ta ry fra ctu re 72C* Sca p h o id 72 Bo n e : Hand and carpus, sca p h o id 72 Typ e s: Hand and carpus, scaphoid, a vu lsio n fra ctu re 72A *Qualif cations: a Proximal pole b Waist c Distal pole Ca p ita te 73 Bo n e : Hand and carpus, ca p ita te 73 Typ e s: Hand and carpus, capitate, a vu lsio n fra ctu re 73A Hand and carpus, capitate, sim p le fra ctu re 73B Hand and carpus, capitate, m u ltifra gm e n ta ry fra ctu re 73C Hand and carpus, hamate, sim p le fra ctu re 74B Hand and carpus, hamate, m u ltifra gm e n ta ry fra ctu re 74C Hand and carpus, trapezium, sim p le fra ctu re 75B Hand and carpus, trapezium, m u ltifra gm e n ta ry fra ctu re 75C Ha m a te 74 Bo n e : Hand and carpus, h a m a te 74 Typ e s: Hand and carpus, hamate, h o ok fra ctu re 74A Tra p e ziu m 75 Bo n e : Hand and carpus, tra p e zium 75 Typ e s: Hand and carpus, trapezium, a vu lsio n fra ctu re 75A 505 Appendix Oth e r 76 _ Bo n e : Hand and carpus, o the r 76. Pisifo rm 76.1 Triq u e trum 76.2 Tra p e zo id 76.3 → The bone identi er (between two dots .) is added to the code after the anatomical region 76 Hand and carpus, p isiform 76.1 Typ e : Hand and carpus, other, pisiform, a vu lsio n fra ctu re 76.1.A Hand and carpus, other, pisiform, sim p le fra ctu re 76.1.B Hand and carpus, other, pisiform, m u ltifra gm e n ta ry fra ctu re 76.1.C Hand and carpus, other, triquetrum, sim p le fra ctu re 76.2.B Hand and carpus, other, triquetrum, m u ltifra gm e n ta ry fra ctu re 76.2.C Hand and carpus, other, trapezoid, sim p le fra ctu re 76.3.B Hand and carpus, other, trapezoid, m u ltifra gm e n ta ry fra ctu re 76.3.C 76 Hand and carpus, triq u e tru m 76.2 Typ e : Hand and carpus, other, triquetrum, a vu lsio n fra ctu re 76.2.A 76 Hand and carpus, tra p e zo id 76.3 Typ e : Hand and carpus, other, trapezoid, a vu lsio n fra ctu re 76.3.A 506 Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Hand and carpus Me ta ca rp a ls 77. Bo n e : Hand and carpus, m e ta ca rp a l 77. Metacarpal identifiers Distal Bone segment location Diaphyseal 1 Proximal → → → → The metacarpal bones are identi ed as follows: Thumb = 1, index = 2, long or middle = 3, ring = 4, and little = The metacarpal identi er is added (between two dots .) after the bone code The bone segment location is then added Example: Hand, 3rd metacarpal, proximal end segment = 77.3.1 Lo ca tio n: Hand and carpus, metacarpal, p roxim a l e n d se gm e n t 77. .1 → Example code for the 3rd metacarpal is indicated with an underline 77.3.1 Typ e s: Hand and carpus, metacarpal, proximal end segment, e xtra a rticu la r fra cture 77.3.1A Hand and carpus, metacarpal, proximal end segment, p a rtia l a rticu la r fra ctu re 77.3.1B Hand and carpus, metacarpal, proximal end segment, co m p le te a rticu la r 77.3.1C Lo ca tio n: Hand and carpus, metacarpal, d ia ph yse a l fra ctu re 77. .2 → Example code for the 3rd metacarpal is indicated with an underline 77.3.2 Typ e s: Hand and carpus, metacarpal, diaphyseal, sim p le fra ctu re 77 3.2A Hand and carpus, metacarpal, diaphyseal, we d ge fra ctu re 77 3.2B Hand and carpus, metacarpal, diaphyseal, m u ltifra gm e n ta ry fra ctu re 77 3.2C Lo ca tio n: Hand and carpus, metacarpal, d ista l e n d se gm e n t 77. .3 → Example code for the 3rd metacarpal is indicated with an underline 77.3.3 Typ e s: Hand and carpus, metacarpal, distal end segment, e xtra a rticu la r fra cture 77 3.3A Hand and carpus, metacarpal, distal end segment, p a rtia l a rticu la r fra ctu re 77 3.3B Hand and carpus, metacarpal, distal end segment, co m p le te a rticu la r fra ctu re 77 3.3C 507 Appendix Ph a la n x 78. . Bo n e : Hand and carpus, p h a la n x 78. . Finger Phalanges Distal Diaphyseal Bone segment location Proximal → The ngers and phalanges are identi ed as follows: Fingers: Thumb = 1, index = 2, long or middle = 3, ring = 4, and little = Phalanges: Proximal phalanx = 1, middle phalanx = 2, and distal phalanx = The nger identi er plus phalanx identi er are added (between dots . .) after the bone code → Example: Proximal thumb phalanx is 78.1.1 → The location is then added → An a to m ica l re gio n + b o ne Finge r.Pha la n x.Bo ne se gm e nt loca tio n → Example: Proximal thumb phalanx proximal end segment is 78.1.1.1 Loca tio n : Hand and carpus, phalanx, p roxim a l e n d se gm e n t 78.1.1.1 → Example code for proximal thumb phalanx is indicated with an underline 78.1.1.1 Typ e s: Hand and carpus, phalanx, proximal end segment, e xtra a rticu la r fra ctu re 78.1.1.1A Hand and carpus, phalanx, proximal end segment, p a rtia l a rticula r fra ctu re 78.1.1.1B Hand and carpus, phalanx, proximal end segment, co m p le te a rticu la r fra ctu re 78.1.1.1C Loca tio n : Hand and carpus, phalanx d ia ph yse a l fra ctu re 78.1.1.2 → Example code for proximal thumb phalanx is indicated with an underline 78.1.1.2 Typ e s: Hand and carpus, phalanx, diaphyseal, sim p le fra ctu re 78.1.1.2A Hand and carpus, phalanx, diaphyseal, we dge fra cture 78.1.1.2B Hand and carpus, phalanx, diaphyseal, m u ltifra gm e n ta ry fra ctu re 78.1.1.2C Loca tio n : Hand and carpus, phalanx, d ista l e n d se gm e n t 78.1.1.3 → Example code for proximal thumb phalanx is indicated with an underline 78.1.1.3 Typ e s: Hand and carpus, phalanx, distal end segment, Hand and carpus, phalanx, distal end segment, Hand and carpus, phalanx, distal end segment, e xtra a rticu la r fra ctu re p a rtia l a rticu la r fra ctu re co m p le te a rticu la r fra ctu re 78.1.1.3A 78.1.1.3B 78.1.1.3C 508 Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z Hand and carpus Cru sh e d , m u ltip le fra ctu re s 79 Hand and carpus, cru sh , m u ltip le fra ctu re s h a n d 79 Qua lif ca tion s are optional and applied to the racture code where the asterisk is located as a lower-case letter within rounded brackets More than one qualif cation can be applied or a given racture classif cation, separated by a comma For a more detailed explanation, see the compendium introduction 509 510 Ma n u a l o f Fra ct u re Ma n a ge m e n t—Wris t Je sse  B  Jupite r,  Douglas  A  Cam pbe ll,  Fie sky  Nuñe z