Peggers Super Summary of Hand Factures

Peggers’ Super Summary of Hand Factures Anatomy:  Extra-articular >300 angulation METACARPALS - 30% of injuries  Intra-articular  They form longitudinal and transverse aches of o Bennett’s – unstable Abductor PL the hand o Rolando’s  Flexibility is only seen in ring finger and little P1/2 finger CMCJ  >1mm displaced condylar #  3 palmar and 4 dorsal interossei flex MCPj  Comminuted fractures of articulation (NB – PHALANGES severe comminution may be treated closed if  15% of injuires P1 # angulate into 20 to deemed not constructible) interossei  Volar articulation lip #>30% o Proximal flexed by interossei  >1mm displacement of dorsal lip (central slip o Distal extended by central slip avulsion)  45% of injuries P3 injuries are usually crush  P2 extra-articular fractures not reducible by closed splinting Injury Mechanism:  P2 pilon fracture – Mx Suzuki frame  Axial load or jamming P3  Torsional or twisting  ?mallet injuries with >25% of articular surface  Bending or hyperextension  Volar lip due to FDP avulsion  crushing  Significant nailbed injuires  Basal Physeal injury can trap germinal matrix Open finger injuries: Anderson Classification – seymour fracture  Type I – clean wound no delay = 1.4% risk of infection Joint dislocations:  Type II – one of the following = 14% risk of CMCj infection  High energy often need fixing o Gross contamination with dirt or  Assc ulnar nerve injury debris  If hamate involved get CT to evaluate injury o Human or animal bite  Mx dorsal or intra-articular # need CRIF or o Lake or river injury ORIF o Farm MCPj o Presentation >24 hrs  Usually extension injuries causing subluxation o Systemic illness  Reduce by 10 flexion of finger +/- wrist to relax tendons (avoid traction) When to operate:  Mx dorsal dislocations are stable unless appear  Multiple # in bayonet position (here volar plate stuck in BASE OF FINGER METACARPAL joint)  # dislocation of base of 5th metacarpal and  Mx volar dislocations are unstable & require hamate – unstable from pull of ECU ligament fixation SHAFT OF FINGER METACARPAL THUMB MCPj  >100 for 2-3 MC  Test UCL of thumb and image by making a  >400 for 4-5 MC diamond stress view  Rotation  Partial tear if unstable in flexion only  Transverse and spiral # - unstable  Complete tear if unstable in extension too – NECK OF FINGER METACARPAL likely a Stener lesion will occur  >100 for 2-3  Adductor aponeurosis can block ligament  >30-400 for 4th healing aka Stener Lesion  >40-700 for 5th THUMB METACARPAL Page 1 of 2 Peggers’ Super Summary of Hand Factures  Mx most treated in plaster consider operative fixation in Stener, volar or irreducible lesions

PIPj  Congruence of lateral radiograph key to Dx Conservative Management of # residual subluxation UNDISPLACED  Assess  Buddy strap as functional splintage  Mx immediate active ROM with buddy DISPLACED strapping for rotatory volar, dorsal and isolated  Basal # with extension – held with 900 of 1 collateral injuries MCP flexion  Mx dorsal subluxed require 4 weeks of dorsal  Angulated basal # - are manipulated with a blocked splint pencil and buddy strap  Mx Volar dislocation with central slip  Spiral # - tape with tension to prevent rotation rupture require 4-6 weeks PIPj extension  Transverse # - gutter splint splint and then 2 weeks static extension  Mallet # - hyperextension check x ray, keep splinting (keep DIPj free during all of this) PIPj free and wash daily for 6 weeks  Mx volar skin split from dorsal dislocation are  Tendinous Mallet – 8 weeks then 4 weeks at reduced once volar skin debrided from wound night DIPj  P1 volar # dislocation – extensor locking  NB dislocations without tendon injury or splint at 400 reduced extension slowly over 4 isolated collateral / volar plate injury are weeks RARE LIGAMENT:  Conservative Mx if stable mobilise  Mild no treatment immediatelyif unstable keep in 200 flexion for  Severe sprain splint in extension for 2-3 weeks 3 weeks  If index of middle finger unstable consider  Operative Mx open dislocations and delayed > repair 3/52 presentation +/- k wire for < 4weeks  Partial UCL tears – 2-4 weeks in cast avoid pinch for 8 weeks Simplified M x options: Non surgical Complications:  POP Early  MUA + POP  Infection if open Surgical Late  Percutaneous  Stiffness o Intramedullary bucket  Mal or non-union o K wire  Loss of motion  Open  OA o Lag screw o plate  Ex-fix o Bridging o Non bridging . Suzuki frame