Fractures of the hand

Fracture of the Scaphoid bone Injuries of the carpus Fracture of the Scaphoid bone

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

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

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

Complications Delayed union Non union Avascular necrosis of proximal fragment Osteoarthritis

Fractures of metacarpals and phalanges

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

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

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.

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

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.

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

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