Hand injuries

Question 1

Volar plate injuries
Definition
Exam
Management

Answer 1

PIPJ palmar surface
Hyper-extension injury
Common with ball sports
Can be with or without avulsion fracture

Pain/tenderness and bruising on palmar surface PIPJ
Pain with passive hyper-extension
Loss of pinch power

If fracture >30% joint surface refer to hands same day
Otherwise dorsal blocking splint with finger in 30’ flexion and refer to hand therapy
Failure to provide care leads to swan-neck deformity of finger

Question 2

UCL rupture test/Skiiers thumb

Answer 2

Valgus stress of thumb at MCPJ at full flexion (accessory collateral ligament stress test) and 30’ flexion (UCL stress test).
30’ of movement or 15’ more than other side is suggestive of complete rupture

Question 3

Flexor tendon injuries of hand

Answer 3

Jersey finger
-DIPJ flexor tendon avulsion (FDP)

Volar plate injury
-PIPJ flexor injury

Question 4

Extensor tendon injuries of hand

Answer 4

Mallet finger
-DIPJ

Central slip
-PIPJ

MCP/thumb CMC
-fight bite
-saggital band rupture (“boxer’s knuckle”/RA). Radial side 90%, middle finger 50%

Question 5

Tendon injury hands complications

Answer 5

Adhesions
Re-rupture
Deformities eg boutonniere’s (PIPJ flexion + DIPJ extension), swan-neck (DIPJ flexion + PIPJ hyper-extension)
Joint contracture
Trigger finger

Question 6

Mallet finger

Answer 6

DIPJ
-held in flexion
-usually trauma
-repair if >50% joint surface (maybe) or lacerated tendon or molar subluxation or incomplete reduction/passive extension

Question 7

Boutonnaire deformity

Answer 7

PIPJ flexion and DIPJ extension
-RA or trauma (rupture of central slip) means extension force passes over PIPJ to exert on DIPJ, pro phalanx pushes through injured central slip causing “buttonhole” appearance
-use Elson’s test of extension strength to diagnose
-PIP splinting with DIP movement

Question 8

Jersey finger

Answer 8

-DIPJ flexor tendon avulsion
-ring finger 75%
-resting extension of DIPJ
-avulsion fracture may be present
-tx with tendon repair +/-ORIF of avulsion fragment
(irreparable after 7-10/7)

Question 9

Finger dislocation referral criteria

Answer 9

Unable to reduce
Associated fracture (any)
Volar dislocation
NV injury
Open injury
MCP dislocation
Collateral ligament disruption
Incomplete ROM post reduction

Question 10

1st metacarpal fracture referral criteria

Answer 10

Rolando fractures (intra-articular)
Severely comminuted
Extra-articular with >30’ angulation after reduction

Question 11

Metacarpal referral criteria

Answer 11

Open
Rotational deformity
Multiple
Tendon/NV injury
Intra-articular
Severely displaced

Otherwise volar slab

Question 12

Acceptable metacarpal neck fracture rotation

Answer 12

Index/middle - 10-15’
Ring - 30-40’
Little - 50-60’

Question 13

Metacarpal shaft fracture acceptable rotation and management

Answer 13

Index/middle - <10’
Ring/little - <20’
Beware shortening esp with transverse fractures
Check for malrotation

Volar slab

Question 14

Metacarpal base fracture management

Answer 14

Exclude subluxation esp between hamate and base of 4th and 5th
Otherwise volar slab