Hand Trauma Flashcards
what are the four types of injuries associated with the hand?
- avulsion and ligamentous injuries
- impact fractures
- dislocations
- foreign bodies
name the two avulsion and ligamentous injuries associated with the hand
- mallett finger
- gamekeeper’s/skier’s thumb
name the two impact fractures associated with the hand
- boxer’s fracture
- Bennett’s fracture
describe mallett finger
a deformity of the finger caused when the extensor digitorum (tendon that straightens finger) is damaged
MOI for mallett finger
- something strikes the tip of the finger and causes ‘forced flexion’ of an extended digit
- this stretches the tendon away from the bone
- can also pull a fragment of bone with it causing an avulsion fracture
describe the radiographic appearance of mallett finger
- a fracture fragment is shown at the distal interphalangeal joint
- if there isn’t an avulsion fracture, ligamentous damage still appears
describe treatment for mallett finger
- usually non operative
- finger placed in extension and splinted for 6 weeks
- DIP joint kept immobile in extension for 6 weeks
- if fracture fragment is large will require ORIF (open reduction internal fixation) surgery using K-wires
describe the prognosis for mallett finger
- when treated immediately prognosis is good and full recovery
- skin ulcerations and nail deformities when healing
- untreated may lead to swan neck deformity and secondary arthritis
describe gamekeeper’s/skier’s thumb
tear of the ulnar collateral ligament (UCL) (medial ligament) at the metacarpo-phalangeal joint
gamekeeper’s - chronic
skier’s - acute
MOI for gamekeeper’s/skier’s thumb
the ligament can either tear due to a widened MCPJ or the ligament can tear and may pull a fragment of bone resulting in an avulsion fracture
describe the radiographic appearance of gamekeeper’s/skier’s thumb
- a fracture fragment can be seen at the insertion of the UCL (base of proximal phalanx)
- or if it is just ligamentous damage then this can be shown due to a widened MCPJ
describe treatment for gamekeeper’s/skier’s thumb
- splinting for 6 weeks
- if serious surgery to repair ligament
- surgical fixation with ORIF ligament repair
describe the prognosis for gamekeeper’s/skier’s thumb
- treated immediately prognosis is good
- complete tear repaired late can lead to long term weakness and pain
- increased long term arthritis
describe boxer’s/scrapper’s fracture
comminuted transverse fracture of
boxer’s - 2nd/3rd metacarpal
scrapper’s - 4th/5th metacarpal
MOI for boxer’s/scrapper’s fracture
direct blow with clenched fist against a solid surface
boxer’s - full force with wrist in neutral position
scrapper’s - swinging blow with less force and not as central
describe the radiographic appearance for boxer’s/scrapper’s fracture
comminuted transverse fracture to a metacarpal
describe treatment for boxer’s/scrapper’s fracture
- closed reduction aligns fragments of the fracture prior to immobilisation
- surgical intervention using k wires or ‘pin and plate’ fixation
- surgical reduction must minimise angulation of the fragments
describe Bennett’s fracture
- intra-articular fracture of the base of the first metacarpal with dislocation off the first carpometacarpal joint
- small fragment of metacarpal stays attached to the ligament and articulates with the trapezium
MOI for Bennett’s fracture
axial blow on a partially flexed first metacarpal (punch with clenched fist)
describe the radiographic appearance of Bennett’s fracture
oblique fracture line at the base of the first metacarpal with a triangular fracture fragment at base of the metacarpal
describe treatment for Bennett’s fracture
- minor fractures treated by closed reduction to align fragments
- immobilised in thumb spica for 6 weeks
- allow gradual mobilisation
- more serious require surgical intervention using K wires or ‘pin and plate’ fixation
describe prognosis for Bennett’s fracture
prognosis is usually good
complications include:
- osteoarthritis at carpometacarpal joint
- reduced movement at joint
- recurrent joint instability
- skin infections
- radial nerve injury
describe finger dislocations
dislocation of a phalanx from its normal anatomical position also the volar plate may rupture associating with an avulsion fracture
MOI for finger dislocations
forced hyper extension or flexion of a phalanx
- sporting injury, trapping in door, fall on outstretched hand
describe the radiographic appearance of finger dislocations
hyper extension:
phalanx moves posteriorly, fracture fragment may also be visible
hyper flexion:
phalanx moves anteriorly causing a volar dislocation
describe treatment of finger dislocations
- closed reduction to align phalanges
- splinting and immobilising for 6 weeks
describe prognosis for finger dislocations
good prognosis as long as no entrapment of ligaments during reduction
