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Hand Injuries. Dr. Wahby Ghalib CABMS, FJMC, MRCS. The most common cx after hand injury is stiffness Results from swelling & immobilization Usually #s heal in 4w clinical evaluation : more important than XR evidence of healing. Safe immobilization.

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hand injuries

Hand Injuries

Dr. Wahby Ghalib

CABMS, FJMC, MRCS

slide2
The most common cx after hand injury is stiffness
  • Results from swelling & immobilization
  • Usually #s heal in 4w
  • clinical evaluation : more important than XR evidence of healing.
safe immobilization
Safe immobilization
  • Wrist extended
  • MPJs flexed
  • IPJs straight
  • Thumb abducted
slide5
Angular deformity :usually no interference

with function

  • Rotational deformity : interferes
shaft
Shaft #
  • Direct force
  • Punching
  • Twisting force  spiral #
slide10
Rx
  • CR + volar or dorsal slab
  • Spiral # may need ORIF
slide11
Neck #
  • Usually 5th MCB
  • Usually due to punching

 Boxer`s #

  • May be open # (teeth)
boxer s
Boxer`s #
  • Unstable
  • Palmar angulation : well tolerated
  • Needs reduction & K. wire to avoid malunion & 2ndary flexion of IPJ
fractures of base of 1 st mcb
Fractures of base of 1st MCB
  • Epibasal #
  • Bennett`s #
  • Rolando`s #
epibasal
Epibasal #
  • Rx : reduction ± K. wire
bennett s
Bennett`s #
  • Punching
  • Triangular piece remains attached to the trapezium while the rest of the thumb subluxates
  • CR + K. wire
rolando s
Rolando`s #
  • Comminuted intraarticular # of the base of the 1st MCB
  • Rx : CR + K. wires or ORIF
slide23
Rx
  • Undisplaced # : buddy strapping 2-3 w
slide25
Rx
  • Displaced # : reduction by traction

 stable : buddy strapping

 unstable : IF

distal phalanx
Distal phalanx #
  • Tuft # : bone is shattered

focus on swelling & nail injury

  • Shaft # : if displaced : CR + needle
  • Physeal # : Salter – Harris 2
slide34
Mallet finger : avulsion of the extensor tendon ± bone fragment

 mallet finger splint

  • Avulsion of the flexor tendon
cmj dislocation
CMJ dislocation
  • Usually the thumb
  • Reduction by traction & hyper-pronation

± K. wire

mpj dislocation
MPJ dislocation
  • Usually the thumb
  • Simple : CR
  • Complex : palmar plate lodged in the joint & MC head clasped between flexor tendon & the lumrical

 CR or OR

ipj dislocation
IPJ dislocation
  • Rx : traction & buddy strapping
injury to the ulnar collateral ligament of 1 st mpj
Injury to the ulnar collateral ligament of 1st MPJ
  • = gamekeeper or skier injury
  • Partial : thumb stable in extension  immobilize 4w
  • Complete : thumb unstable in flexion & extension  repair
zones of tendon injury
Zones of tendon injury
  • I : beyond insertion of FDS
  • II : between distal palmar crease & insertion of FDS ( flexor sheath)
  • III : between end of carpal tunnel & distal palmar crease
  • IV : within carpal tunnel
  • Proximal to carpal tunnel
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