Hand Injuries Part 2 Dr Mark Putland

Fingers <30% of joint surface – Soft tissue injury Intra-articular middle phalangeal fracture <30% of joint surface – Soft tissue injury >30% of joint surface – fixation Avulsion? Of what? What soft tissues might be injured?

Fingers Volar Plate Injury Bruising on volar aspect of PIPJ with no fracture after hyperextension injury Beware the volar plate injury (sprain, tear of ligament or tendon) Needs splinting and plastics OPD

Fingers Proximal Phallanx All unstable All need ORIF

Fingers Finger Dislocations Pull within 30-90min Digital block or nitrous Use patient’s weight X-ray first if in hospital Expect 1st MCPJ to be difficult because of trapped ligaments Refer to plastics clinic or hand therapy for assessment of ligament stability at 7-10 days (after swelling has gone down)

Metacarpals 1st Metacarpal Bennet’s Fracture Not every proximal 1st metacarpal fracture is a Bennet’s fracture Single intra-articular fracture with subluxation/dislocation of metacarpal and a piece of volar bone still in place Generally needs operative management Acutely, thumb spica and early review Stretch out, abduct-extend 1st MC, pronate to reduce

Metacarpals 1st Metacarpal ? Bennet’s Fracture Rolando Fracture Three part fracture with both volar and dorsal fragment May be conservatively managed if very messy

Metacarpals 1st Metacarpal ?

Metacarpals Others 2 and 3 4th 5th Need ORIF Look for other injuries as this implies a big force 4th <20° angulation ->no impairment 5th <40° angulation -> no impairment Do not hold position well so do not reduce. Analgesia +/- block, gutter slab, sling, plastics clinic

Metacarpals Others 2 and 3 4th 5th Need ORIF Look for other injuries as this implies a big force 4th <20° angulation ->no impairment 5th <40° angulation -> no impairment Do not hold position well so do not reduce. Analgesia +/- block, gutter slab, sling, plastics clinic