1. Hand Injuries Part 2
Dr Mark Putland

2. 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?

3. 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

4. Fingers
Proximal Phallanx
All unstable
All need ORIF

5. 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)

6. 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

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

8. Metacarpals
1st Metacarpal ?

9. 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

10. 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