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