This document provides information on fractures of the metacarpals and phalanges in the hand. It discusses the anatomy of these bones and classifies common types of fractures such as boxer's fractures, Bennett's fractures, and fractures of the metacarpal heads and necks. Treatment approaches are outlined depending on the location and severity of the fracture, including closed or open reduction with internal fixation using K-wires, plates, or external fixation. Complications like malunion are also reviewed. The goal is rapid restoration of hand function through appropriate splinting and surgical techniques when needed.

1. FRACTURES OF METACARPALS AND PHALANGES

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 10- 40yrs
⦁ Most fractures are functionally stable
⦁ Outer rays of hand are most frequently injured
⦁ Goal is rapid & full restoration of hand function

3. Wrist/ hand Anatomy - bones
⦁ Carpals
● (proximal row)
● (distal row)
⦁ Metacarpals
⦁ Phalanges

4. SKELETAL ANATOMY OF HAND
⦁ 5 metacarpal bone
Head
Shaft
base
⦁ 14 phalanges 3 for each finger 2 for
thumb
Head
Shaft base

5. HAND ANATOMY
BONY ANATOMY
CARPALS
1. Scaphoid
2. Lunate
3. Triquetral
4. Trapezium
5. Trapezoid
6. Hamate
7. Pisiform
KEY SKELETAL ELEMENT
⦁ Has 3 arches,2 transverse
arches & 1longitudinal arch

8. SPLINTING POSITION
Position of Function
NO
Position of Safety

9. THUMB SPICA
BASIC SPLINTING
POSITION OF “SAFETY”

10. Hand Functions
⦁ Grasping patterns
● Hook, spheres, cylinders
⦁ Pinches
● Key, tripod, inferior/superior
⦁ Fine motor manipulation
⦁ Sensation
● Pain, touch, discrimination, object
identification, vibration

11. 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

12. 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

13. Classification of fractures of metacarpal
head
⦁ 1)epiphysael
⦁ Ligamentous avulsion
⦁ Osteochondral slices
⦁ Two part fractures in different
planes
⦁ Comminuted
Bone loss
⦁ Occult compression #

14. 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

15. complications
⦁ Most common- stiffness-it is due to
extensor tendon
adhesions,collateralligament or
dorsal capsule contractures
⦁ Epiphyseal growth arrest
⦁ Avascular necrosis

16. METACARPAL NECK FRACTURES
⦁ Boxers fracture
⦁ Commonly involves-ring & small
fingers
⦁ Occur when clenched MCP strikes
solid objects & angulates with apex
dorsal

17. 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
•

18. 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

19. Cont…..
⦁ Immobilisation-12-14days & then
AROM exercises
⦁ After 6 weeks –join duty
⦁ If closed reduction fails---ORIF with
k-wire

20. METACARPAL SHAFT FRACTURES
⦁ CLASSIFICATION—transverse,
oblique
comminuted

21. dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com

23. TRANSVERSE METACARPAL SHAFT FRACTURE
AXIAL LOADING
⦁ Indications for intervention-any
angulation for index & mid finger
⦁ >20* ring finger
⦁ >30* for little finger
Treatment:
1. Closed Reduction & Internal Fixation By K-wire
2. Open Reduction & Internal Fixation By K- Wire
3. Intramedullary Fixation K-wire

25. 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

31. RIGID FIXATION
⦁ Indications-multiple #,isolated
transverse#,malunion,pseudo
arthrosis,bone loss
⦁ Types –interfragmentary
compression screws, plates &
screws

34. 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

40. COMPLICATIONS OF INTERNAL FIXATION
⦁ Pin tract infection
⦁ Osteomyelitis
⦁ Fracture through pin holes
⦁ Neuro vascular injury
⦁ Over distraction
⦁ Loss of reduction
⦁ Impair tendon excursion

41. 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

42. BI ABSORBABLE FIXATION
⦁ Polyglycolic acid,poly lactic acid,poly Para
dioxanone
⦁ Disadvantage->non infectious
inflammatory response

43. 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

46. COMPLICATIONS OF METACARPAL
FRACTURES
⦁ 1)mal union
⦁ 2)dorsal angulation
⦁ 3)malrotation
⦁ 4)osteomyelitis
⦁ 5)nonunion

47. PHALANGEAL FRACTURES
⦁ FRACTURES OF DISTAL PHALANX
⦁ Classificatuion:1)tuft #
🞆
🞆
simple #
comminuted#
⦁ Shaft #---transverse—stable or
unstable
🞆 ----longitudinal
⦁ Articular#---volar, epiphyseal,dorsal

49. TREATMENT OF DISTAL PHALANGEAL #
⦁ TUFT #-drain subungual hematoma
🞆 finger splint
⦁ Shaft #-- CRIF—k-wire
⦁ Epiphyseal #--ORIF
⦁ Complications– nonunion
🞆 -malunion

50. FRACTURES OF MID & PROXIMAL
PHALANX
⦁ ARTICULAR #(london)--1)condylar
#
⦁ Type1-stable #without
displacement
⦁ Type2-unicondyle,unstable
⦁ Type3-bicondyle,comminuted

65. 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

66. TREATMENT OF BYCONDYLAR FRACTURES
⦁ ORIF WITH PLATES & SCREWS
⦁ Dynamic splint
⦁ External fixation
⦁ Interfragmentary screws

67. 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

68. 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

69. 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

70. Cont…
⦁ SHAFT # INVOLVING JOINT-
⦁ Treatment ORIF
⦁ Proximal traction phalanx splint-
noninvasive, minimal stiffness,
comminuted#

71. NECK FRACTURES
⦁ Common in toddlers
⦁ Classification->type1-nondisplaced
🞆 type2-displaced with some bone
contact
⦁ Type3-completely displaced
⦁ Treatment-ORIF with k-wire or

72. 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

73. CONT
⦁ Transverse#-ORIF with kwire& intra
osseous wire
⦁ Displaced unstable & comminuted-
external fixation,miniplate & screws

74. 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

75. CONT…
⦁ Intrarticular malunion
⦁ Nonunion
⦁ Loss of motion
⦁ Pip joint extensor lag
⦁ infection

76. 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

81. FRACTURES OF PROXIMAL PHALANX
⦁ Head & neck#-CRIF WITH K WIRE
🞆 ORIF WITH K WIRE
⦁ Angulation of 20-30* is
unacceptable

86. 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

87. 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

88. 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

89. Bennett’s Fracture

90. TREATMENT
⦁ WHEN fragment is <15-20% of
articular surface-CRIF with k wire
🞆
🞆
if > 25%-ORIF
COMPLICATIONS-mal union

91. 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