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Hand Injuries

Dr. Wahby Ghalib CABMS, FJMC, MRCS


The most common cx after hand injury is stiffness Results from swelling & immobilization Usually #s heal in 4w clinical evaluation : more important than XR evidence of healing.

Safe immobilization

Wrist extended MPJs flexed IPJs straight Thumb abducted

Metacarpal fractures

Angular deformity :usually no interference with function Rotational deformity : interferes

Shaft #

Direct force Punching Twisting force  spiral #


Rx

CR + volar or dorsal slab Spiral # may need ORIF

Neck #


Usually 5th MCB Usually due to punching  Boxer`s #May be open # (teeth)

Boxer`s #



Unstable Palmar angulation : well tolerated Needs reduction & K. wire to avoid malunion & 2ndary flexion of IPJ

Fractures of base of 1st MCB

Epibasal # Bennett`s # Rolando`s #

Epibasal #

Bennett`s #


Punching Triangular piece remains attached to the trapezium while the rest of the thumb subluxates CR + K. wire

Rolando`s #



Comminuted intraarticular # of the base of the 1st MCB Rx : CR + K. wires or ORIF

Phalangeal fractures

Rx

Undisplaced # : buddy strapping 2-3 w

Rx


Displaced # : reduction by traction  stable : buddy strapping  unstable : IF

Intrinsic muscles  angulation with apex volar  counteract by MPJ flexion

Distal phalanx #

Tuft # : bone is shattered focus on swelling & nail injuryShaft # : if displaced : CR + needle Physeal # : Salter – Harris 2


Mallet finger : avulsion of the extensor tendon ± bone fragment  mallet finger splintAvulsion of the flexor tendon

CMJ dislocation

MPJ dislocation


Usually the thumbSimple : CRComplex : palmar plate lodged in the joint & MC head clasped between flexor tendon & the lumrical  CR or OR

IPJ dislocation


Rx : traction & buddy strapping

Injury to the ulnar collateral ligament of 1st MPJ

= gamekeeper or skier injuryPartial : thumb stable in extension  immobilize 4wComplete : thumb unstable in flexion & extension  repair

Zones of tendon injury

I : beyond insertion of FDS II : between distal palmar crease & insertion of FDS ( flexor sheath) III : between end of carpal tunnel & distal palmar crease IV : within carpal tunnel Proximal to carpal tunnel

Zone 2 = no - man`s land : adhesions are very likely




رفعت المحاضرة من قبل: Mubark Wilkins
المشاهدات: لقد قام عضوان و 122 زائراً بقراءة هذه المحاضرة








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