Difference between revisions of "Hand and finger fractures"

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(Created page with "===Background=== * Splinting is used in the initial immobilization of, and often is the definitive treatment for, metacarpal fractures * Maintenance of the MCP joint in flexion...")
 
(Text replacement - "==References== " to "==References== <references/> ")
 
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===Background===
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[[File:Hand bones.svg|thumb|Hand bones]]
  
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==Types==
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{{Hand and finger fractures DDX}}
  
* Splinting is used in the initial immobilization of, and often is the definitive treatment for, metacarpal fractures
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==Differential Diagnosis==
* Maintenance of the MCP joint in flexion is important to avoid immobility contractures of the collateral ligaments
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{{Hand and finger injury DDX}}
=== ===
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==See Also==
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*[[Fractures (Main)]]
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*[[Hand Diagnoses (Main)]]
  
===Thumb metacarpal Fx===
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==References==
 
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<references/>
 
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[[Category:Orthopedics]]
* Classification
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* Type I (Bennett's Fx)
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* Fx-dislocation of the base of the metacarpal (intraarticular)
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* Type II (Rolando's Fx)
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* Comminuted version of a Bennett's fracture (intraarticular)
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* Type III
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* Extraarticular (transverse or oblique)
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* Type IV
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* Extraarticular pediatric fx involving the proximal physis
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* Examination
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* Important to distinguish tenderness at base of 1st MC from injury to scaphoid, trapezium, or distal radius
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* If pain or ecchymosis occurs more distally at the MCP (particularly on the ulnar side) consider ulnar collateral ligament injury (Game Keeper's Thumb)
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* Imaging
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* AP, lateral, oblique
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* Treatment
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* Splinting
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* Type I, II - Thumb-spica with the IP joint free and wrist in 30º of extension
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* Type III - Short arm thumb-spica extening to the IP joint and wrist in 30º of extension
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* RICE
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* Significant swelling or overly aggressive icing to radial side of thumb may result in temporary palsy to the superficial radial nerve (numbness over the dorsum of the thumb)
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* Reduction
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* Indicated for:
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* Angulated extraarticular fx if clinician is comfortable with the procedure 
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* Dispo
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* Refer within 3-5 days:
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* All intraarticular fractures warrant referral (most require sx)
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* Extraarticular fractures that cannot be adequately reduced
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=== ===
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===Non-Thumb Metacarpal Head Fx===
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* Intra-articular Fx
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* Examination
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* Swelling, decreased ROM, and TTP of MCP joint
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* Assess for rotational alignment (rotational malalignment is not tolerated)
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* Assess for skin integrity (r/o fight bite)
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* Imaging
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* AP, lateral, oblique
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* Angulation assessed on lateral view
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* Consider "Brewerton" view if collateral ligament avulsion fx suspected
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* Treatment
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* Ulnar or radial gutter splint
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* MCP joints in 70-90º flexion, wrist in 20-30º extension, PIP and DIP joints in 5-10º of flexion
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* Dispo
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* Almost always refer b/c are intraarticular and typically comminuted
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* Non-displaced fx can be splinted for 2-3 weeks followed by ROM exercises
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===Non-Thumb Metacarpal Neck Fx===
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* Examination
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* TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture
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* Loss of the normal knuckle contour
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* Due to dorsal angulation of fracture apex due to pull of the interosseous muscles
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* Assess angulation
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* Head-to-neck angle of the metacarpals is normally 15 degrees
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* Fracture angulation = measured angle minus 15º
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* Angle toleration (below which there is no adverse functional outcome)
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* 2nd MC < 10º
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* 3rd MC < 20º
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* 4th MC < 30º
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* 5th MC < 30º
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* Assess rotational alignment
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* Assess extensor apparatus
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* Assess skin integrity
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* Treatment
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* Gutter splint
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* MCP joints in 70-90º flexion, wrist in 20-30º extension, PIP and DIP joints in 5-10º of flexion
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* Acute reduction indicated:
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* Pseudoclawing
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* Significantly angulated 4th or 5th MC fx
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* Dispo
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* Refer for:
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* Comminution
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* Rotational malalignment
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===Non-Thumb Metacarpal Shaft Fx===
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* Examination
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* TTP along affected metacarpal
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* Flexion at MCP is difficult
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* Assess for extensor dysfunction; pt may exhibit "pseudo-clawing" during attempts at finger extension
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* Assess angulation
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* >10º in 2nd and 3rd and >20º in 4th and 5th metacarpal shaft fractures requires reduction
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* Assess rotational alignment
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* Imaging
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* Oblique fx are more prone to shorten and rotate
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* Transverse fx generally stable (particularly isolated 3rd or 4th MC shaft fx)
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* Treatment
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* Gutter splint
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* Acute reduction indicated if there is pseudo-clawing or significant angulation
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* Closed reduction generally corrects angulation but typically does not restore length
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* Dispo
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* Refer:
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* Malrotation
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* Comminution
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* Shortening > 5mm (refer all shortening if not familiar with fx management)
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* 2 or more metacarpal fractures
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* Unacceptable angulation
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* Long oblique fractres
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===Non-Thumb Metacarpal Base Fx===
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* Examination
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* Movement at the wrist elicits pain
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* Assess for ulnar deficits (finger abduction/adduction)
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* Assess for rotational alignment
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* Imaging
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* AP, lateral, oblique
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* 30º obliques pronated and supinated if usual films unable to visualize the MC bases
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* Consider CT if index of suspicion high for occult fx despite "negative" plain films
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* Treatment
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* Dorsal and volar splints with the wrist in 30º of extension and MCP joints free
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* Dispo
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* Refer for:
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* Intraarticular fx
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* Etraarticular fx with malrotation
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* Dislocation of metacarpal base CMC joint;
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* Ulnar nerve injury
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* 5th metacarpal base fx (typically require sx)
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==Source==
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UpToDate
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[[Category:Ortho]]
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Latest revision as of 01:13, 24 July 2017

Hand bones

Types

Hand and Finger Fractures

Differential Diagnosis

Hand and finger injuries

See Also

References