REIDER PART 131
Chafter 4_Hand and Wrist 121
(Fig. 4-29A-D). Whcn flexcd as a group, they should stay in parallel alignmcnt with each other (Fig. 4-29£). Rotational malalignment following an acute or malunited fracture of one of the metacarpals or phalanges causes the associated finger to deviate from the normal flexion alignment, possibly causing the adjacent fingers to diverge or cross (scissor) when they are flexed simultane-ously (Fig. 4-29F).
Wrist. The wrist may also be the site of posttraumatic or rheumatoid deformities. When fractures of the distal radius occur, the hand and distal radius are most com-monly pushed dorsally. If this is incompletely reduced, the distal radius and hand remain dorsally displaced, resulting in a permancnt step-off (see Fig. 4-12C). Dislocations or fracturc-dislocations at the radiocarpal or midcarpal joints can also produce step-off deformities, although the details may be ąuickly obscured by the dra-matic swelling that can accompany such injuries.
Rangę of Motion
A thorough assessment of the rangę of motion (ROM) of the joints of the hand and wrist should include an evalu-ation of forearm rotation as describcd in Chapter 3, Elbow and Forearm, because forearm rotation reąuires
Figurę 4-29. Normal flexion alignment of fingers. A, lndex. B, Long. C, Ring. D, Little.
(Continued)
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