Hand Injuries
Dr. Wahby Ghalib CABMS, FJMC, MRCSThe 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 abductedMetacarpal fractures
Angular deformity :usually no interference with function Rotational deformity : interferesShaft #
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
RxUndisplaced # : buddy strapping 2-3 w
RxDisplaced # : 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 2Mallet finger : avulsion of the extensor tendon ± bone fragment mallet finger splintAvulsion of the flexor tendon
CMJ dislocation
MPJ dislocationUsually 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