Important and common fractures of hand

1. FRACTURES
OF HAND

2. CONTENTS
1)BENNETT’S FRACTURE-DISLOCATION
2)ROLANDO’S FRACTURE
3)FRACTURES OF METACARPALS
4)FRACTURES OF PHALANGES
5)MALLET FINGER

3. BENNETT’S FRACTURE-
DISLOCATION
It is an oblique intra-articular fracture of the
base of the first metacarpal with subluxation
or dislocation of the metacarpal.
It is sustained as a result of a longitudinal
force applied to the thumb.

5. Treatment:-
Accurate reduction and restoration of the smooth joint surface
is important.
This is because being an intra-articular fracture, if not reduced
accurately, it will lead to incongruity of the articular surfaces.
This would increase the chances of developing osteoarthritis.
The following methods of treatment are used:
a) Closed reduction and percutaneous K-wire fixation under an
image intensifier is a good technique. K-wire is used and
incorporated in a plaster cast.
b) Open reduction and internal fixation with a K-wire or a screw
may be necessary in some cases.

6. Complications:-
Osteoarthritis develops if the joint surface is left irregular. It
may cause persistent pain and loss of grip, so the patient is
disabled when attempting heavy work.
Excision of Trapezium may be required in particularly
painful arthritis.

7. ROLANDO’S
FRACTURE
• This is a complete articular “T” or “Y” shaped fracture of the
first metacarpal.
• Perfect reduction is not as important as in Bennett’s
fracture-dislocation.
• Treatment is by accurate reduction and fixation with K-
wires and immobilisation in a thumb spica for 3 weeks.

9. FRACTURES OF THE
METACARPALS
• Fractures of the metacarpals are common at all ages .
The common causes are:
1. Fall on the hand
2. A blow on knuckles(as in boxing)
3. Crushing of the hand under a heavy object
• Fractures of one or more metacarpals may occur .
• The fracture may be classified ,according to the site ,
as follows:

10. A. Fracture through the base of the metacarpal , usually
transverse and displaced.
B. Fracture through the shaft- transverse or oblique. These
fractures are usually not much displaced because of the
splinting effect of the interossei muscles and adjacent
metacarpals. When more than one metacarpal shafts are
fractured ,this “auto-immobilisation” advantage is lost. Such
fractures are unstable and require operative treatment.
C. Fracture through the neck of the metacarpal- It commonly
affects the neck of the 5th metacarpal. The distal fragment is
tilted forwards. It is usually sustained when a closed fist hits
against a hard object (Boxer’s fracture)

12. Treatment:-
Conservative treatment is sufficient in most cases. It
consists of immobilisation of the hand in a light dorsal slab
for 3 weeks.
A minimal displacement is acceptable, but in cases with
severe displacement or angulation, reduction is necessary.
This is achieved in most cases by closed reduction; in some,
particularly those with multiple metacarpal fractures ,
internal fixation with K-wires or mini plates may be
required.

14. FRACTURES OF THE
PHALANGES
• These are common fractures , generally sustained
by fall of a heavy object on finger or crushing of
fingers .
• The fractures can have various patterns , and may
be displaced or undisplaced.

16. Treatment :-
♫Union is not a problem; the problem is maintaining proper alignment of
the fracture. Treatment is as follows:
a) Undisplaced fracture: Treatment is basically for the relief of pain. A
simple method of splintage is to strap the injured finger to an
adjacent finger for 2 weeks. After this, finger mobilisation is started.
b) Displaced fracture: An attempt should be made to reduce the fracture
by manipulation, and immobilised in a simple malleable aluminium
splint. Active exercises must be started not later than 3 weeks after
the injury. If displacement cannot be controlled by the above means, a
percutaneous fixation or open reduction and internal fixation using
K-wire, may be necessary. A comminuted fracture of the tip of the
distal phalanx does not need any special treatment, and attention
should be directed solely to treatment of any soft tissues injury.

18. MALLET FINGER (BASEBALL
FINGER)
Results from the sudden
passive flexion of the DIP joint
so that the extensor tendon of
the DIP joint is avulsed from its
insertion at the base of the
distal phalanx. Sometimes it
takes a fragment of bone with
it.
Clinically, distal phalanx is in
slight flexion.

19.  Treatment is by immobilising the DIP joint in
hyperextension with the help of an aluminium
splint or plaster cast.