Elbow wrist and Hand

Question 1

Boxer’s fracture

Answer 1

Metacarpal neck fracture of 4th or 5th digit.Non-op Tx of gutter splint with bracing of adjacent finger

Question 2

Metacarpal shaft fractures

Answer 2

Plate HW fixation, No strengthening until fracture is healed.

Question 3

Bennets fracture

Answer 3

Fracture / dislocation of the base of the 1st MC at CMC joint
MOI: FOOSH resulting in hyperextension or hyper-abduction force across the volar aspect of the CMC joint.
Crepitus and / or joint subluxation. Pull of abductor pollicis longus causes subluxation in a dorsal, radial, and proximal direction
X-rays confirm diagnosis

Question 4

Bennets fracture

Answer 4

Treatment -ORIF, Thumb spica splinting x 6 weeks (cast vs. splint)

Early motion AROM only of MCP joint.
Full AROM/PROM of IP joint.
Full AROM/PROM @ 6 weeks. Strengthening @ 8 weeks or when clinically healed.
RTP 6-8 weeks in throwing positions, 2-3 in others.

Question 5

Proximal Phalanx Fractures

Answer 5

Non-displaced, stable fractures: Buddy taping or hand based intrinsic plus splint
AROM at 3-4 weeks.
Deformity of finger crossing is not acceptable.
Splint: Duck bill to avoid flexion contracture and increased effusion. Also allows extensor tendon to be over the PIP and the extensor hood to be distal to provide compression.

Question 6

Middle Phalanx fractures

Answer 6

Least common
When it does occur, will include avulsion to PIP
Buddy tapping
Unrestricted motion at 3 weeks.

Question 7

Stable Middle Phalanx fractures vs. Unstable

Answer 7

Will include K-wires, no motion x weeks due to possible deformity by FDS muscle

Question 8

Distal phalanx fracture split

Answer 8

volar gutter splint or tip protector splint.

Question 9

PIP dislocations “Sprain” Grades

Answer 9

G1
Asymmetric swelling and tenderness over collateral ligament
No instability with stress testing
Partial tear of collateral ligament

G2
-1-3 days of immobilization (only to quiet inflammation)
-Edema control (ice, coban wrapping)
Active flexion and extension exercises (including isolated blocking), Buddy tapes
Splint initially - in slight flexion (10-20 degrees)
Gradually increase to full extension over 3-4 weeks
G3
-Complete disruption of collateral ligament
-Volar plate intact
-Less than 20 degrees deviation with stress testing and presence of firm end point.
- GOAL: protect volar plate

Question 10

PIP Dislocations - Dorsal dislocations

Answer 10

Dislocations will most often occur in dorsal diretion with injury to VOLAR plate
Treatment:
-Immobilization of the PIP joint is NOT recommended.
-Dorsal block splint (PIP in slight flexion) with buddy tapes for 4-6 weeks.

Question 11

PIP dislocations - Volar Dislocation

Answer 11

Boutonniere deformity can be a result
Rupture of the central slip
Treatment: Immobilize in full extension for 6-8 weeks
DIP joint is left free for ROM
Isolated DIP flexion / blocking (with PIP splinted in full extension) wil help prevent Boutoneirre deformity