The following is a list of common Hand and Wrist conditions:
- Hand Fractures
- Wrist fractures
- Carpal tunnel syndrome
- Lumps around the hand and wrist
- Ligament injuries
- Tendon injuries
- Arthritis affecting hand and wrist
- Wrist arthroscopy
- Dupuytrens contracture
Fractures of the hand are very common following a twisting injury, crush or direct contact in sports. Accurate assessment and prompt treatment with early mobilisation are essential to ensure full recovery without residual deficit in function.
Some examples of common hand fractures include:
Wrist fractures are very common following a fall. Often, the fracture is significantly displaced and if left untreated, will result in permanent deformity and loss of function. Significantly displaced fractures are often manipulated (reset) in the A&E department and a backslab (half plaster) is applied.
This represents first aid treatment only and almost certainly definitive treatment is required later. This is because certain fractures are inherently unstable and will predictably displace again once the acute swelling settles. Early treatment is therefore recommended to restore the fractured wrist back to its original position and alignment, before the fracture starts to heal in a suboptimal position.
Treatment options include:This is suitable only for certain fracture patterns which are minimally displaced and stable. It involves the application of a light weight fibreglass cast which immobilises the wrist for 6 weeks. It avoids the need for an operation but cannot adequately stabilise unstable complex fractures which may redisplace at later time. Hence, weekly x ray checks are essential to monitor the position carefully.
This involves placing smooth pins across the two fractured bone ends and supplementing the fixation afterwards with a plaster cast for 6 weeks. This technique has drawbacks including the need for plaster cast afterwards and therefore increased wrist stiffness as well as increased risk of infection as the pins are left protruding outside skin. Furthermore, the smooth pins cannot hold the reduction for complex fractures and redisplacement is likely.
With advances in surgical technology, small titanium plates with accompanying locking and non locking screws are now available to stabilise the bony skeleton and allowing it to heal in the correct position. With the improved stability, there is no need to be in plaster afterwards and early movement of the wrist is encouraged to prevent stiffness.
Through a small surgical incision of about 4-5cm, Mr Lam uses a small precontoured titanium plate which allows precise screw placement and creates an extremely stable construct that helps early movement while minimizing soft tissue irritation. It provides excellent fixation for acute fractures, malunions and nonunions of the distal radius.
Arthroscopic keyhole surgery for the wrist can be carried out for a variety of conditions including:
- Cartilage tear of the Triangular Fibrocartilage Cartilage complex (TFCC)
- Wrist arthritis
- Injury to the carpal ligaments and instability
- Ganglion
- Wrist synovitis
The procedure involves two tiny little stab incisions of about 2-3mm. Through these small holes, a needle like telescope (actual size is 1.9mm) and a variety of other instruments which are also of similar size can be passed into the wrist joint. Because the instruments are so small, only a very small incision needs to be made and following surgery, no suturing is required and the wound heals well with steristrips alone.
As the surgery is minimally invasive, patients have less pain afterwards and recover more quickly than with open surgery. Usually all patients following a wrist arthroscopy can go home on the day of surgery.