Hand- Images to description

Question 1

Answer 1

The distal phalanx is the most commonly fractured bone of the finger.

Distal phalangeal fractures are classified into three types:

• tuft fractures
• shaft fractures
• intraarticular fractures

There is an oblique fracture of the terminal tuft of the left index finger distal phalanx with slight distraction.

Question 2

Answer 2

• Avulsion fracture at the dorsal aspect of the base of the right little finger distal phalanx.
• The fracture involves the DIP joint.
• There is a resultant mallet deformity

Question 3

Answer 3

Mallet Deformity

The same mechanism; rupture of the extensor tendon without associated fracture.

Question 4

Answer 4

Boutonniere

• Extension of DIP joint and flexion of PIP joint indicating possible tendon injury.
• Appearance is consistent with a boutonniere deformity.
• No bony injury has been demonstrated

Question 5

Answer 5

Swan Neck Deformity

Hyperextended PIP joint and a flexed DIP joint.

Chronic inflammation of the PIP joint puts a stretch on the volar plate

• Volar plate becomes weakened and stretched
• PIP joint becomes loose and begins to easily bend back into hyperextension

DIP joint flexes

Question 6

Answer 6

FDP Avulsion

• Avulsion of a large fragment of bone from palmar aspect of right little finger distal phalanx.
• Fragment has been displaced proximally and is lying anterior to the PIP joint.
• Appearance indicates probable rupture of the flexor tendon

Question 7

Answer 7

FDP Avulsion

• Forced hyperextension of an actively flexed finger
• Known as “rugger jersey finger”
• Clinically: straight, extended DIP joint with an inability to flex the digit.
• Tendon may rupture directly from its insertion into the bone, or it may avulse bone fragment from the base of distal phalanx

Ringfinger is most often involved (75%)

Question 8

Answer 8

Volar Plate Fracture

Forced hyperextension at the PIP joint, with or without a dorsal dislocation, may damage the volar plate.

Fracture at the distal attachment at the base of middle phalanx

Question 9

Answer 9

Proximal Phalanx Fracture

Potentially the most disabling fractures in the hand

Direct blow = transverse or comminuted fracture

Twisting injury = oblique or spiral fracture

Extra articular or condylar

Complications:

• Rotational deformity
• Slow to heal
• Impaired flexor tendon movement

Question 10

Answer 10

Proximal Phalanx Fracture

• Unstable fracture of the proximal phalanx typically present with volar angulation
• Tends to be pulled into hyperextension by the central slip acting on the base of the middle phalanx

Question 11

Answer 11

Condylar Fractures

(a) An undisplaced unicondylar
(b) A displaced unicondylar
(c) and (d) Two displaced bicondylar fractures (d is best demonstrated with an oblique view)

Question 12

Answer 12

Metaphyseal Buckle Fracture

• Oblique, metaphyseal (Salter Harris type 2) fracture of the proximal phalanx of the left ring finger
• Metaphyseal buckle fracture at the base of the left little finger.

Question 13

Answer 13

PIPJ Dislocation

• Anterior (volar) dislocation of the PIP joint of the left ring finger
• Typically sports-related,resulting in axial stress and hyperextension
• Volar finger PIP joint dislocations are extremely uncommon

Question 14

Answer 14

IP Joint Dislocations

Dislocations of the proximal interphalangeal (PIP) joint of the second through fifth digits are the most common dislocations within the hand

DIPJ dislocations are relatively uncommon because of the stability afforded by the DIP joint’s flexor and extensor tendinous attachments

Dorsal dislocations occur most frequently

Question 15

Answer 15

Metacarpophalangeal Subluxation

• Dorsal subluxation of the left 2ndMCPJ
• Traumatic dislocation of the MCPJ is a relatively uncommon injury (hyperextensioninjury)
• More commonly subluxations are seen with inflammatory disease i.e. RA

Question 16

Answer 16

Subluxation Thumb CMCJ

• Dorsal subluxation of the left thumb carpometacarpal joint.
• Thumb function constitutes about 50% of hand function as a whole.

Question 17

Answer 17

Subluxation MCPJ

• There is loss of congruency of the right thumb MCP joint indicating subluxation. This is probably the result of a ruptured radial collateral ligament.
• UCL injury = sudden, forced abduction
• RCL injury = forced adduction
• Gamekeepers thumb = chronic UCL injury

Question 18

Answer 18

Fracture dislocation

• Commonly referred to as a Bennetts fracture
• Intra-articular fracture dislocation of the base of the thumb
• Metacarpal shaft displaced laterally due to the pull of the abductor pollicislongus.

Question 19

Fractures at the base of the thumb metacarpal

Answer 19

Question 20

Answer 20

5th Metacarpal Fracture

• Intra-articular – axial loading (punch injury/sporting injury)
• Simple falls in elderly
• Palmar displacement
• Good blood supply – heal well.

Question 21

Answer 21

Metacarpal Shaft Fractures

• Extra-articular; caused by longitudinal compression, torsion, or direct impact that may result from a fall, blow, or crushing force
• Shaft fractures are slower to heal than more distal or proximal because of the predominantly cortical bone

Question 22

Answer 22

CMCJ Fracture/Dislocation

• Not easily seen!
• Check all your joint margins for congruency
• Ensure the patients hand is as flat as practicable
• A lateral view should always be done if there is suspicion of a CMC injury