2. INTRODUCTION
Most common fractures of the upper limb
Most common cause of functional
disability in labor population
Most common in males in the age of 1o-
40yrs
Most fractures are functionally stable
Outer rays of hand are most frequently
injured
Goal is rapid & full restoration of hand
function
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
4. SKELETAL ANATOMY OF HAND
5 metacarpal bone
Head
Shaft
base
14 phalanges 3 for each finger 2 for
thumb
Head
Shaft base
dr sumer yadav, mch plastic
surgery.
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11. Hand Functions
Grasping patterns
Hook, spheres, cylinders
Pinches
Key, tripod, inferior/superior
Fine motor manipulation
Sensation
Pain, touch, discrimination, object
identification, vibration
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
12. INDICATIONS FOR FIXATION OF
METACARPAL& PHALANGEAL#
Irreducible fractures
Malrotation
Intra articular fractures
Open fractures
Sub capital fractures
Segmental bone loss
Polytrauma with hand fractures
Multiple hand or wrist fractures
fractures With soft tissue injury
osteotomy
dr sumer yadav, mch plastic
surgery.
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13. METACARPAL#
Metacarpal head fractures
Rare, intraarticular
As a result of axial loading or direct
trauma, complex dorsal MCP
dislocations
IVX-x-ray-3 views—
PA,LATERAL,OBLIQUE,brewerton
skyline metacarpal
Ct scan
dr sumer yadav, mch plastic
surgery.
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14. Classification of fractures of
metacarpal head
1)epiphysael
Ligamentous avulsion
Osteochondral slices
Two part fractures in different
planes
Comminuted
Bone loss
Occult compression #
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
15. TREATMENT OF METACARPAL
HEAD #
1)displaced ligamentous avulsion &
osteochondral #-open reduction &
internal fixation with k-wire or
interfragmentary screws
2)for partial loss of bone->auto grafts
taken from toe
3)comminuted intra articular #-> open
reduction & internal fixation or skeletal
traction or silicone arthro plasty
4)open fractures->clean & open reduction
& internal fixation
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
16. complications
Most common- stiffness-it is due to
extensor tendon
adhesions,collateralligament or
dorsal capsule contractures
Epiphyseal growth arrest
Avascular necrosis
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
17. METACARPAL NECK FRACTURES
Boxers fracture
Commonly involves-ring & small
fingers
Occur when clenched MCP strikes
solid objects & angulates with apex
dorsal
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
18. Boxer’s Fracture
• Mechanism:
impaction force
exerted through the
distal end of the
metacarpal in
closed fist potion
• Pathology: Fracture
through the neck of
the fifth
metacarpal/volar
displacement
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
19. TREATMENT
For closed # with no pseudo clawing-cock
–up splint
Pseudo clawing-closed reduction with
JAHSS maneuver then buddy & give cock
up splint-check x-ray
For index & mid metacarpal neck #--
angulation >15* is unacceptable
For ring angulation of 30-40*is acceptable
For little finger-angulation of 50-60* is
acceptable
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
20. Cont…..
Immobilisation-12-14days & then
AROM exercises
After 6 weeks –join duty
If closed reduction fails---ORIF with
k-wire
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
22. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
23. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
24. transverse metacarpal shaft fracture
AXIAL LOADING
Indications for intervention-any
angulation for index & mid
finger,>20* ring finger,>30* for
little finger
Treatment-closed reduction &
internal fixation by k-wire,open
reduction & internal fixation by k-
wire,intramedullary fixation k-wire
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
25. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
26. OBLIQUE OR SPIRAL FRACTURES
IF ROTATION >10* GO FOR
INTERVENTION
Treatment-CRIF by k-wire
ORIF by k-wire
inter fragmentary screw fixation
Tran osseous wire+-k-wires
intra medullary fixation k-wire
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
27. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
28. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
29. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
30. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
31. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
33. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
34. dr sumer yadav, mch plastic
surgery.
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35. EXTERNAL FIXATION
Indications-severe comminuted
compound contaminated fractures
in which anatomic reconstruction is
not possible
Septic nonunion
Advantages-no osteo
penia,secondary reduction can be
carried ,provides ready access to
wounds
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
36. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
37. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
38. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
39. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
40. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
41. COMPLICATIONS OF INTERNAL
FIXATION
Pin tract infection
Osteomyelitis
Fracture through pin holes
Neuro vascular injury
Over distraction
Loss of reduction
Impair tendon excursion
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
42. OPEN REDUCTION & INTERNAL
FIXATION FOR METACARPAL
SHAFT #
Indications-displacement>10*--
second & third metacarpal
>20*--fourth metacarpal
>30*--fifth metacarpal
Most spiral & oblique #
Multiple meta carpal #
Soft tissue injury
Bone loss
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
43. BI ABSORBABLE FIXATION
Polyglycolic acid,poly lactic acid,poly
Para dioxanone
Disadvantage->non infectious
inflammatory response
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
44. METACARPAL BASE # &
CARPOMETACARPAL #
DISLOCATION
Treatment-for second & third –ORIF
—k-wire
For fourth & fifth—for simple # dis—
CRIF k-wire
For multiple # dis—ORIF-k-wire
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
45. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
46. dr sumer yadav, mch plastic
surgery.
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47. COMPLICATIONS OF METACARPAL
FRACTURES
1)mal union
2)dorsal angulation
3)malrotation
4)osteomyelitis
5)nonunion
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
52. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
53. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
54. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
55. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
56. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
57. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
58. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
59. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
60. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
61. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
62. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
63. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
64. dr sumer yadav, mch plastic
surgery.
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65. dr sumer yadav, mch plastic
surgery.
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66. UNICONDYLAR FRACTURES
Classification-Weiss &Hastings
Class1-oblique volar
Class2-longsaggital
Class3-dorsal coronal
Class4-volarcoronal
Treatment-CRIF OR ORIF with k-wire or
screws
AT 5-7DAys—arom, splint PIP in full
extension
Remove k wires 3-4 weeks
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
67. TREATMENT OF BYCONDYLAR
FRACTURES
ORIF WITH PLATES & SCREWS
Dynamic splint
External fixation
Interfragmentary screws
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
68. PSEUDOBOUTTONOUIRE
DEFORMITY
IN FRACTURES OF HEAD OF
PHALANX WHEN THERE IS
DISPLACED collateral ligamentous
injury & healing occurs ,when there
is adhesions between the adjacent
lateral band,& oblique retinacular
ligament& volar plate
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
69. Other fractures of head of phalanx
1)avulsion # of dorsal base of mid
phalanx->detachment of central
tendon insertions a result of ant pip
jt dislocation
Treatment- ORIF
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
70. CONT….
#lateral base of proximal or mid
phalanx—it represents collat
ligament avulsion
Treatment-a) uncomplicated—splint
for 10-14 days
B) complicated—ORIF with k-wire
# BASE OF PROXIMAL PHALANX-
Treatment-ORIF
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
72. NECK FRACTURES
Common in toddlers
Classification->type1-nondisplaced
type2-displaced with some bone
contact
Type3-completely displaced
Treatment-ORIF with k-wire or
dr sumer yadav, mch plastic
surgery.
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73. SHAFT FRACTURES
They can be transverse, oblique,
spiral, comminuted
Treatment
1)nondisplaced & stable-cock-up
position
2)displaced-stable after CR-cock-up
position slab
Displaced unstable after reduction-
A) spiral &oblique-CR& IF with kwire
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
74. CONT
Transverse#-ORIF with kwire& intra
osseous wire
Displaced unstable & comminuted-
external fixation,miniplate & screws
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
75. COMPLICATIONS OF PHALANGEAL
FRACTURES
MALUNION-classified-a)
malrotation,volar angulation,lateral
angulation,
It is usually seen after oblique or
spiral #
Treatment-osteotomy with plate
fixation,lateralwedge
osteotomy,corrective osteotomy
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
76. CONT…
Intrarticular malunion
Nonunion
Loss of motion
Pip joint extensor lag
infection
dr sumer yadav, mch plastic
surgery.
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77. Fractures of the thumb bones
Fractures of phalanx-a) extra
articular
B) Intra articular
EXTRA ARTICULAR-1)distalp-
longitudnal,transervse,tuft
Treatment-repair of dermal nail
matrix, application of splint,CRIF
WITH k wire, ORIF with k wire
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
78. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
79. dr sumer yadav, mch plastic
surgery.
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80. dr sumer yadav, mch plastic
surgery.
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81. dr sumer yadav, mch plastic
surgery.
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82. FRACTURES OF PROXIMAL
PHALANX
Head & neck#-CRIF WITH K WIRE
ORIF WITH K WIRE
Angulation of 20-30* is
unacceptable
dr sumer yadav, mch plastic
surgery.
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83. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
84. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
85. dr sumer yadav, mch plastic
surgery.
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86. dr sumer yadav, mch plastic
surgery.
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87. Intraarticular # & avulsion
1)dorsal base of distal phalanx-
mallet thumb
Treatment-external splint
2)ulnar base of proximal phalanx-
game keeper thumb
Treatment-reinsertion of collateral
ligament or CRIF with k wire
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
88. FRACTURES OF THUMB
METACARPAL
Metacarpal head fractures-displaced
Treatment-ORIF OR CRIFwith k
wire& repair of radial collateral
ligament
Shaft #-1)epibasal#-may extend
into trapezio-metacarpal joint
Treatment-CRIF with k wire
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
89. BENNET FRACTURE
#OF base of thumb metacarpal
True lateral view
It is # subluxation
Injury due to axial loading of
partially flexed thumb
Fragment- variable size, pyramidal
Goals of treatment-a) restore
stability of cmc joint
dr sumer yadav, mch plastic
surgery.
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91. TREATMENT
WHEN fragment is <15-20% of
articular surface-CRIF with k wire
if > 25%-ORIF
COMPLICATIONS-mal union
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
92. ROLANDO FRACTURE
# base of metacarpal with Y or T
shape
Any comminuted intraarticular # of
base of metacarpal
Treatment-ORIF with k wire or plate
& screws, bone graft
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
93. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com