Hand injuries
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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

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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

  • Wrist extended

  • MPJs flexed

  • IPJs straight

  • Thumb abducted


Metacarpal fractures


  • Angular deformity :usually no interference

    with function

  • Rotational deformity : interferes


Shaft #

  • Direct force

  • Punching

  • Twisting force  spiral #


Rx

  • CR + volar or dorsal slab

  • Spiral # may need ORIF


Neck #

  • Usually 5th MCB

  • Usually due to punching

     Boxer`s #

  • May be open # (teeth)


Boxer`s #

  • Unstable

  • Palmar angulation : well tolerated

  • Needs reduction & K. wire to avoid malunion & 2ndary flexion of IPJ


Fractures of base of 1st MCB

  • Epibasal #

  • Bennett`s #

  • Rolando`s #


Epibasal #

  • Rx : reduction ± K. wire


Bennett`s #

  • Punching

  • Triangular piece remains attached to the trapezium while the rest of the thumb subluxates

  • CR + K. wire


Rolando`s #

  • Comminuted intraarticular # of the base of the 1st MCB

  • Rx : CR + K. wires or ORIF


Phalangeal fractures


Rx

  • Undisplaced # : buddy strapping 2-3 w


Rx

  • Displaced # : reduction by traction

     stable : buddy strapping

     unstable : IF


  • Intrinsic muscles  angulation with apex volar  counteract by MPJ flexion


Distal phalanx #

  • Tuft # : bone is shattered

    focus on swelling & nail injury

  • Shaft # : if displaced : CR + needle

  • Physeal # : Salter – Harris 2


  • Mallet finger : avulsion of the extensor tendon ± bone fragment

     mallet finger splint

  • Avulsion of the flexor tendon


CMJ dislocation

  • Usually the thumb

  • Reduction by traction & hyper-pronation

    ± K. wire


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

  • Rx : traction & buddy strapping


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

  • 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


  • Zone 2 = no - man`s land : adhesions are very likely


thanx


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