Hand Injuries Part 2 Dr Mark Putland Fingers

Hand Injuries Part 2 Dr Mark Putland

Fingers Intra-articular middle phalangeal fracture • <30% of joint surface – Soft tissue injury • >30% of joint surface – fixation • Avulsion? Of what? • What soft tissues might be injured?

Fingers Volar Plate Injury • Bruising on volar aspect of PIPJ with no fracture after hyperextension injury • Beware the volar plate injury (sprain, tear of ligament or tendon) • Needs splinting and plastics OPD

Fingers Proximal Phallanx • All unstable • All need ORIF

Fingers Finger Dislocations Pull within 30 -90 min Digital block or nitrous Use patient’s weight X-ray first if in hospital Expect 1 st MCPJ to be difficult because of trapped ligaments • Refer to plastics clinic or hand therapy for assessment of ligament stability at 7 -10 days (after swelling has gone down) • • •

Metacarpals 1 st Metacarpal • Bennet’s Fracture – Not every proximal 1 st metacarpal fracture is a Bennet’s fracture – Single intra-articular fracture with subluxation/dislocation of metacarpal and a piece of volar bone still in place • Generally needs operative management • Acutely, thumb spica and early review • Stretch out, abduct-extend 1 st MC, pronate to reduce

Metacarpals 1 st Metacarpal • Bennet’s Fracture • Rolando Fracture – Three part fracture with both volar and dorsal fragment – May be conservatively managed if very messy ?

Metacarpals 1 st Metacarpal ?

Metacarpals Others • 2 and 3 – Need ORIF – Look for other injuries as this implies a big force • 4 th – <20° angulation ->no impairment • 5 th – <40° angulation -> no impairment • Do not hold position well so do not reduce. • Analgesia +/- block, gutter slab, sling, plastics clinic

Metacarpals Others • 2 and 3 – Need ORIF – Look for other injuries as this implies a big force • 4 th – <20° angulation ->no impairment • 5 th – <40° angulation -> no impairment • Do not hold position well so do not reduce. • Analgesia +/- block, gutter slab, sling, plastics clinic