Hand and wrist injury

Carpal bone fractures

Scaphoid fracture

-       MCM carpal bone fracture 

-       Mechanism of injury

  • Elbow extension with forearm pronation

-       Clinical features

  • Pain
  • Swelling
  • Tender : Anatomical snuffbox 

-       Investigation

  • Plain X ray
    • Wrist (AP, Lateral, Oblique)
    • scaphoid view (AP ulnar deviation)
    • clenched-fist view

-       Classification

  • Mason classification
    • Type 1 : Non-displaced fracture
    • Type 2 : Displaced single fragment
    • Type 3 : Comminuted fracture

-       Treatment

  • Non-displaced fracture : short arm cast (thumb spica cast)
  • Displaced fracture : ORIF with headless compression screw

-       Complication

  • Avascular necrosis
  • Non union
  • SX when:
    • non-comminuted fracture > 25%
    • comminuted fracture

Metacarpal fracture

Metacarpal head fracture : intra-articular fracture

Metacarpal neck fracture (boxer’s fracture)

-       Closed reduction (Jahss maneuver)

-       Complications: loss of knuckle

Metacarpal shaft fracture

-       Treatment

  • closed reduction with immobilization (MCPJ flexion 70 Degree,PIPJ full extension )
  • Indication for ORIF : open fracture, multiple fractures, unstable fracture

Fracture of distal phalanx

-       MCM hand fracture

-       nail injury

-       Treatment

  • aluminum splint
  • SX when : intra-articular fracture> 25%

Fracture of the middle and proximal phalanges

-       Shaft fracture

-       Treatment

  • closed reduction with pinning
  • ORIF if failclosed technique

-       Base fracture

  • Volar base fracture of middle phalanx
    • > 40% à ORIF
  • Dorsal base fracture of middle phalanx
    • boutonniere deformity
  • Lateral base fracture of middle phalanx
  • Comminution intra-articular base fracture

Head fracture

Neck fracture

Fracture of the thumb

-       Bennett’s fracture

  • fracture-dislocation of thumb CMCJ
  • Mainly ORIF

-       Rolando’s fracture

  • Mainly ORIF

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