Hand Fractures and Dislocations

Adam C Watts Consultant Hand and Upper Limb Surgeon, Wrightington Hospital

Visiting Professor, Manchester University

Hand Fractures and Dislocations

Edinburgh Hand Course

www.wrightington.com

www.wrightington.com 3

Principles


History

Age Sex Hand Dominance Occupation

Mechanism of injury Low energy / high energy Crush Penetrating


Hand Fractures Diagnosis

Neurovascular

Soft tissue envelope

X-rays

CT (rarely)


Considerations

Open/closed Intra-articular/extra-articular Site Undisplaced/displaced Rotation Stable/unstable Compliant patient


Associated Injuries


Emergency Management

9


General Principles

10

Early mobilisation

Minimum soft tissue disruption

if stable = mobilise

if unstable = splint / fixation


Hand Splintage

Buddy Zimmer Dynamic finger Mallet


Edinburgh position of immobilisation


Complications

Malunion

Finger stiffness

Post traumatic OA

Non-union

Specific Injuries

Distal Interphalangeal Joint

14


Mallet Injury


Paediatric Distal Phalanx fracture - Seymour Lesion

Beware Subluxation Epiphyseal injury Nail bed injury

Specific Injuries

Phalangeal and PIPJ

26


Phalangeal Shaft Fractures

Transverse fractures usually stable and are immobilized for 3 weeks

Spiral fractures unstable and should be stabilized.


Normal alignment and rotational deformity

Beware Malrotation


Phalangeal Fractures -extraarticular CRIF

30


Phalangeal Fractures -extraarticular ORIF


Phalangeal Intra-Articular


Basal phalangeal fractures – intra-articular


ORIF Basal Phalangeal fractures –Pilon Fractures


Dislocation PIPJ


Extensor Tendon Injuries - Zone 3

50



51



52


ORIF Basal Phalangeal fractures –intra-articular

Screws and wires

Specific Injuries

Metacarpal

62


Boxer’s fracture

Jahss Manoeuvre


Metacarpal Fractures

Minimally displaced or angulated fractures can be treated nonoperatively

Displacement of more than 5 mm, unacceptable angulation, or clinical malrotation are indications for intervention.


Transverse Metacarpal Fractures


Fixation of Transverse Metacarpal Fractures


Spiral Metacarpal Fractures


Dislocation of Metacarpal bases

Get true laterals Reduce K wire

Specific Injuries

Thumb

75


Bennett’s fracture


Rolando fracture


Stener Lesion


Take Home

82

Early Mobilisation

Least invasive intervention that will achieve

aims

Anticipate compliance and complications

www.wrightington.com97

Never


Never


Dubert Procedure

Hand Fractures and Dislocations

Health & Medicine

Transcript of Hand Fractures and Dislocations