Fractures of the hand

1. Fractures of the hand

2. Injuries of the carpus Fracture of the Scaphoid bone

3. Fractures of the schapoid bone • Common in in young adult • Usually caused by fall on to outstretched hand • Always transversely through the middle or waist of the scaphoid • Proximal and distal fragment equal in size • Through the proximal pole rarely • Usually no displacement of fragments. • If occurs Favors development of degenerative arthritis

4. Diagnosis • Asymptomatic or slight pain • Examination slight tenderness over scaphoid • Investigation X ray wrist- AP lateral and two obligatory views MRI most sensitive Radioisotope bone scanning

6. Treatment • Immobilize 2-3 weeks • No displacement no reduction needed • Plaster the first metacarpal and proximal segment of the thumb • Interphalangeal joint of thumb and palm left free beyond the proximal transverse skin crease • Allow full range of finger movements • If displacement occurs operative reduction and fixation

7. Complications • Delayed union • Non union • Avascular necrosis of proximal fragment • Osteoarthritis

8. Fractures of metacarpals and phalanges

9. Metacarpal fractures Two fractures of base of metacarpal • Fracture not involving the joint (transverse short oblique fracture)- Relatively stable • Enters joint with upward displacement (Bennett fracture subluxation)-Difficult to control by plaster

10. Management • Manipulation under anesthesia – often difficult in oblique fractures and need full reduction. If the reduction can not be maintained by plaster alone Operation should be advised Percutaneous kirshner wire • Complications : Osteoarthritis

11. Other fractures of metacarpal bones • Fracture through the base of MC, usually transverse and undisplaced. • Fracture through the shaft. This may be transverse or oblique. Transverse may be undisplaced. • Fracture through the neck of metacarpal. There may be marked forward tilting of the distal fragment.

12. Management • Undisplaced – most common- management is simple, perfect recovery of function maybe expected without treatment. Pain relief should be given. • Displaced – manual reduction and external splinter or operation will be required depending on the nature of individual fracture

13. Fractures of the phalanges • Undisplaced fracture of the shaft – fragments are held together by periosteal sheath. No fear of displacement. Treatment is unnecessary except pain relief. • A simple method without immobilization – bind the phalanges of the injured finger lightly to corresponding segment of an adjacent normal finger, so it supports the injured one.

14. Management • Undisplaced – most common- management is simple, perfect recovery of function maybe expected without treatment. Pain relief should be given. • Displaced – manual reduction and external splinter or operation will be required depending on the nature of individual fracture

15. Problems with immobilization after fractures • Metacarpo-phalangeal joint stiffens when extended • Interphalangeal stiffen most if held flexed So the correct method of immobilization is: MC-P joint best held about 70 of flexion and IP joint fully extended