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