1. Fractures of the hand

2. Fracture of the Scaphoid bone
Injuries of the carpus
Fracture of the Scaphoid bone

3. 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

4. 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

6. 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

7. Complications Delayed union Non union
Avascular necrosis of proximal fragment
Osteoarthritis

8. Fractures of metacarpals and phalanges

9. 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

10. 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

11. 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.

12. 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

13. 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.

14. 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

15. 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