1. MANO a MANO MI Zucker, MD

2. A dr Z Lecture

3. On… Injuries and some other stuff of the HAND.

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

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

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

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

12. 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)

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

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

18. VOLAR PLATE Fracture Forced hyperextension Rx: Splint

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

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

24. TUFT Fracture Crush Often, open Rx: Splint

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

28. METASTASIS Renal Cell Carcinoma Metastases to the fingers are uncommon

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

32. 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.

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

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

39. GOODBYE Copyright 2004 MI Zucker, MD