Hand injuries


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Hand injuries

  1. 1. HAND INJURIES<br />
  2. 2. GENERAL PRINCIPLES<br />The initial evaluation and primary care of an injured hand are critical<br />It provides the best opportunity to assess accurately the extent of damage and to restore the altered anatomy<br />
  3. 3. History<br />Age<br />Hand dominance<br />Occupation<br />Details about the injury<br />Mechanism? <br />Where did the injury occur? <br />How much time has elapsed since the injury? <br />Has any treatment been given and by whom?<br />
  4. 4. Examination 1<br />Local swelling <br />Deformity<br />Angulation <br />Displacement <br />Rotational malalignment<br />
  5. 5. Examination 2<br />Soft tissue injury<br />Open wound <br />Location <br />Skin loss <br />Contamination <br />Damage to nerves, tendons, and blood vessels<br />
  6. 6. Investigations<br />Plain radiographs <br />posteroanterior (PA), lateral, and oblique<br />All injuries <br />fractures and joint injuries are missed<br />Computed tomography (CT) scan <br />Magnetic resonance imaging (MRI)<br />Ultrasound <br />
  7. 7. SPECIFIC INJURIES<br />Metacarpal and Phalangeal Fractures<br />Thumb Metacarpal Base Fracture- Dislocations<br />Proximal Interphalangeal Joint Fracture-Dislocations<br />Thumb Metacarpophalangeal Joint Collateral Ligament Injuries<br />
  8. 8. Metacarpal and Phalangeal Fractures 1<br />Most are treated nonsurgically<br />Surgical indications include: <br />inability to obtain or maintain an acceptable reduction using closed means <br />displaced articular fractures<br />open fractures<br />multiple hand or wrist fractures<br />fractures in the polytraumatized patient.<br />
  9. 9. Metacarpal and Phalangeal Fractures 2<br />Coronal plane angulation and malrotation may lead to digital overlap<br />Best assessed by physical examination<br />
  10. 10. Metacarpal and Phalangeal Fractures 3<br />With flexion, there should be no digital scissoring, and the injured finger should point to the scaphoid tuberosity.<br />
  11. 11. Metacarpal and Phalangeal Fractures 4<br />Fracture stability depends on:<br />fracture pattern<br />fracture displacement<br />supporting structures<br />
  12. 12. Metacarpal and Phalangeal Fractures 5<br />Displaced oblique, spiral, and articular fractures tend to be unstable<br />
  13. 13. Metacarpal and Phalangeal Fractures 6<br />Surgical Techniques<br />closed reduction and percutaneous fixation using K-wires or screws<br />open reduction <br />K-wires alone<br />interfragmentary compression screws<br />tension band technique<br /> plate fixation. <br />
  14. 14. Thumb Metacarpal Base Fracture-Dislocations 1<br />Bennett's fracture<br />fracture-dislocation of 1st CMCJ <br />Rolando's fractures <br />T- or Y-shaped intra-articular fractures <br />frequently require ORIF. <br />
  15. 15. Thumb Metacarpal Base Fracture-Dislocations 2<br />Nondisplaced Bennett's fractures without joint instability are treated with a thumb spica cast<br />Most displaced Bennett's fractures can be reduced closed but require internal fixation. <br />
  16. 16. Thumb Metacarpal Base Fracture-Dislocations 3<br />Anatomic reduction of Bennett's fractures is important to avoid painful carpometacarpal instability and posttraumatic arthrosis.<br />
  17. 17. PIPJ Fracture-Dislocations 1<br />Proximal interphalangeal (PIP) joint fracture-dislocations most often involve the base of the middle phalanx<br />
  18. 18. PIPJ Fracture-Dislocations 2<br />Treatment depends on the amount of articular surface involved:<br />30% or less usually stable when treated by closed reduction and extension block splinting<br />more than 40% to 50% usually require ORIF<br />more than 60% may require dynamic external fixation<br />
  19. 19. Thumb MCPJ Collateral Ligament Injuries 1<br />Ulnar collateral ligament (UCL)<br />provides stability against radially directed stress<br />Tear = Gamekeeper’s / Skier’s thumb<br />Radial collateral ligament<br />less commonly injuried<br />acute injuries are best managed by immobilization<br />
  20. 20. Thumb MCPJ Collateral Ligament Injuries 2<br />UCL tear may be incomplete or complete <br />Complete UCL tear<br />More than 35º of joint laxity on valgus stress testing, with the joint in 30º of flexion and in extension. <br />XR findings of proximal phalanx volar subluxation and radial deviation <br />Arthrography, ultrasound, and MRI <br />
  21. 21. Thumb MCPJ Collateral Ligament Injuries 3<br />Treatment<br />incomplete tears 3weeks of immobilization <br />complete ligament tears require surgical repair. Anatomic repair performed within 3 weeks of injury will achieve good or excellent results in 90% of patients. <br />
  22. 22. THANK YOU<br />