MANO a MANO MI Zucker, MD

A dr Z Lecture

On… Injuries and some other stuff of the HAND.

BENNETT’s Fracture Base of the 1st MC A fracture-subluxation Unstable Rx: Surgery

ROLANDO’s Fracture Comminuted fracture base of 1st MC Guarded prognosis Rx: Surgery or molded cast

METACARPAL SPIRAL Fracture Axial loading Closed reduction if significant rotation Rx: Cast

BOXER’s Fracture or MACHO Fracture: “Men Angrily Cuffing Hard Objects” (C. Blackmore) Rx: Closed reduction, cast

GAMEKEEPER’s or SKIER’s THUMB Forced abduction Rx: Cast if incomplete or nondisplaced tear of medial collateral ligament, surgery if complete and displaced MCL tear (Stener lesion)

SPIRAL Fracture of Phalanx Axial loading Rx: Closed reduction, cast

SALTER-HARRIS Lesion Type II Rx: Closed reduction, cast

VOLAR PLATE Fracture Forced hyperextension Rx: Splint

DISLOCATION PIP Joint Even more forced hyperextension Rx: Closed reduction and splint. If tendon entrapment, may required open reduction

MALLET or BASEBALL Finger Forced flexion Rx: Splint; if large fragment, surgery

TUFT Fracture Crush Often, open Rx: Splint

ENCHONDROMA Pathologic fracture Most common true neoplasm of fingers, usually benign Rx: Curettage and pack lesion

METASTASIS Renal Cell Carcinoma Metastases to the fingers are uncommon

INFECTION Pyogenic bacterial osteomyelitis and septic arthritis Note that this destructive lesion crosses the joint, a common occurrence in infection

NECROTIZING FASCIITIS Life threatening infection of subcutaneous tissues, often from trivial open injury Rx: Emergency extensive surgical debridement and I.V. antibiotics. May have to amputate.

Foreign Body: GLASS Usually, glass is visible, but negative films do not exclude it

WE’RE ALMOST DONE! Two obvious ones: Injury by nail gun and amputation by power saw

GOODBYE Copyright 2004 MI Zucker, MD