Thumbs up! Thumb injuries and their management
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The correct care of thumb injuries is very important. They are the way we interact with the world and problems with the thumb can have massive implications on occupation and ability to look after yourself. You need to be aware of the anatomy, common injuries and their management if you are going to reduce morbidity
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1) Bennett's fracture is an intra-articular fracture of the thumb metacarpal that causes disruption of the carpometacarpal joint. It occurs due to an axial blow against the partially flexed metacarpal.
2) Rolando's fracture is another type of rare, intra-articular fracture of the thumb metacarpal that results in a Y- or T-shaped fracture pattern. It has a poor prognosis.
3) Extra-articular fractures of the thumb metacarpal are the most common and usually do not require surgery. They can be treated with closed manipulation and casting.
fractures of hand bones
Fractures of the metacarpals and phalanges are common injuries that often require treatment to restore hand function. The document discusses the anatomy of the hand bones and various types of fractures including boxer's fractures, metacarpal neck fractures, and fractures of the phalanges. Treatment may involve closed or open reduction with internal fixation using methods like K-wires, plates, or external fixation to ensure proper healing and limit complications like malunion. The goal is to address displacement through minimally invasive fixation and allow early motion exercises to regain hand function.
Fractures and dislocations of hand
This document discusses fractures and dislocations of the hand. It begins with basic hand anatomy and principles of management for hand injuries. It then discusses specific injuries including Bennett's fracture of the thumb, Rolando fracture of the thumb base, and fractures of the thumb carpometacarpal joint. It also covers fractures of the finger metacarpophalangeal and interphalangeal joints. Treatment options including splinting, pinning, and plating are described for various injuries. The goal is to address the injury while maximizing joint mobility and function.
Hernia
Hernia is defined as an abnormal protrusion of an organ or tissue through an opening. The inguinal region is a common area for hernias due to weaknesses in the abdominal wall muscles. There are two main types of inguinal hernia: indirect and direct. Indirect hernias are more common in younger patients while direct hernias are more common in elderly patients. Treatment involves herniotomy to remove the hernia sac, with herniorrhaphy or hernioplasty used to repair the abdominal wall defect. Hernioplasty utilizing a mesh is now the preferred treatment approach.
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Thumbs up! Thumb injuries and their management
- 1. Thumbs Up!(for) Dr Paul Teed
- 2. “You can't shake hands with a clenched fist” - Indira Gandhi • 9 individual muscles, which are controlled by all 3 major hand nerves
- 3. Testing Motor Function • “Thumbs up!” = Thumb Extension = Radial Nerve • “Okay sign” = Flexor Pollicus Longus + Flexor Digitorum Profundus = Median Nerve • Normal = Flex both Abnormal = Unable to • Thumb Opposition = Opponens Pollicus = Median Nerve • “Fingers crossed” (Index + Middle) = Ulnar Nerve • Froment’s Sign = Ulnar Nerve Palsy = weak Adductor Pollicus = Flex Flexor Pollicus Longus to compensate to pinch rather than grip
- 4. Bennett’s Fracture • Most common fracture • Intraarticular at base of 1st metacarpal at Carpometacarpal joint (CMC) • Usually associated subluxation or dislocation due to unopposed APL action • Most will need surgical fixation • Thumb Spica
- 5. Rolando Fracture • Technically a 3 part fracture but commonly used to describe all comminuted thumb metacarpal base fractures. • Worse prognosis • Thumb Spica
- 6. Ulnar Collateral Ligament Injury • Also known as “Gamekeepers or Skiers Thumb” • Due to forced abduction of the MCP joint • Can be torn partially or fully and there can be an associated avulsion fracture of the volar base of the proximal phalanx • If no fracture check for stability of joint • Thumb Spica
- 7. de Quervains Tenosynovitis • Stenosing tenosynovitis of APL & EPB tendons at the styloid process of the radius; - inflammation causes thickening & stenosis of synovial sheath - most common in women between 30 - 50 yrs • Finklestein Test • Thumb Spica
- 8. Mallet Thumb • Usually occurs due to forceful flexion of the interphalangeal joint. • Avulsion of the extensor tendon causing the thumb to be stuck in moderate flexion • Mallet Splint