Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.
FRACTURES OF
METACARPALS AND
PHALANGES
Dr Sumer Yadav
Mch plastic and reconstructive
surgery
dr sumer yadav, mch plastic
s...
INTRODUCTION
 Most common fractures of the upper limb
 Most common cause of functional
disability in labor population
 ...
Wrist/ hand Anatomy - bones
 Carpals
 (proximal row)
 (distal row)
 Metacarpals
 Phalanges
dr sumer yadav, mch plasti...
SKELETAL ANATOMY OF HAND
 5 metacarpal bone
Head
Shaft
base
 14 phalanges 3 for each finger 2 for
thumb
Head
Shaft base
...
Hand Anatomy
• Bony Anatomy
• Carpals
• Scaphoid
• Lunate
• Triquetral
• Trapezium
• Trapezoid
• Hamate
• Pisiform
dr sume...
ANATOMY CONT…….
 Key skeletal element
 Has 3 arches,2 transverse arches &
1longitudinal arch
dr sumer yadav, mch plastic...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
Splinting Position
Position of FunctionPosition of Safety
YES NOdr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail....
Thumb spica
Basic Splinting
Position of “safety”
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
Hand Functions
 Grasping patterns
 Hook, spheres, cylinders
 Pinches
 Key, tripod, inferior/superior
 Fine motor mani...
INDICATIONS FOR FIXATION OF
METACARPAL& PHALANGEAL#
 Irreducible fractures
 Malrotation
 Intra articular fractures
 Op...
METACARPAL#
 Metacarpal head fractures
 Rare, intraarticular
 As a result of axial loading or direct
trauma, complex do...
Classification of fractures of
metacarpal head
 1)epiphysael
 Ligamentous avulsion
 Osteochondral slices
 Two part fra...
TREATMENT OF METACARPAL
HEAD #
 1)displaced ligamentous avulsion &
osteochondral #-open reduction &
internal fixation wit...
complications
 Most common- stiffness-it is due to
extensor tendon
adhesions,collateralligament or
dorsal capsule contrac...
METACARPAL NECK FRACTURES
 Boxers fracture
 Commonly involves-ring & small
fingers
 Occur when clenched MCP strikes
sol...
Boxer’s Fracture
• Mechanism:
impaction force
exerted through the
distal end of the
metacarpal in
closed fist potion
• Pat...
TREATMENT
 For closed # with no pseudo clawing-cock
–up splint
 Pseudo clawing-closed reduction with
JAHSS maneuver then...
Cont…..
 Immobilisation-12-14days & then
AROM exercises
 After 6 weeks –join duty
 If closed reduction fails---ORIF wit...
METACARPAL SHAFT FRACTURES
 CLASSIFICATION—transverse,
oblique
comminuted
dr sumer yadav, mch plastic
surgery.
sumeryadav...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
transverse metacarpal shaft fracture
 AXIAL LOADING
 Indications for intervention-any
angulation for index & mid
finger,...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
OBLIQUE OR SPIRAL FRACTURES
 IF ROTATION >10* GO FOR
INTERVENTION
 Treatment-CRIF by k-wire
ORIF by k-wire
inter fragmen...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
RIGID FIXATION
 Indications-multiple #,isolated
transverse#,malunion,pseudo
arthrosis,bone loss
 Types –interfragmentary...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
EXTERNAL FIXATION
 Indications-severe comminuted
compound contaminated fractures
in which anatomic reconstruction is
not ...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
COMPLICATIONS OF INTERNAL
FIXATION
 Pin tract infection
 Osteomyelitis
 Fracture through pin holes
 Neuro vascular inj...
OPEN REDUCTION & INTERNAL
FIXATION FOR METACARPAL
SHAFT #
 Indications-displacement>10*--
second & third metacarpal
 >20...
BI ABSORBABLE FIXATION
 Polyglycolic acid,poly lactic acid,poly
Para dioxanone
 Disadvantage->non infectious
inflammator...
METACARPAL BASE # &
CARPOMETACARPAL #
DISLOCATION
 Treatment-for second & third –ORIF
—k-wire
 For fourth & fifth—for si...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
COMPLICATIONS OF METACARPAL
FRACTURES
 1)mal union
 2)dorsal angulation
 3)malrotation
 4)osteomyelitis
 5)nonunion
d...
PHALANGEAL FRACTURES
 FRACTURES OF DISTAL PHALANX
 Classificatuion:1)tuft #
 simple #
 comminuted#
 Shaft #---transve...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
TREATMENT OF DISTAL
PHALANGEAL #
 TUFT #-drain subungual hematoma
 finger splint
 Shaft #-- CRIF—k-wire
 Epiphyseal #-...
FRACTURES OF MID & PROXIMAL
PHALANX
 ARTICULAR #(london)--1)condylar
#
 Type1-stable #without
displacement
 Type2-unico...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
UNICONDYLAR FRACTURES
 Classification-Weiss &Hastings
 Class1-oblique volar
 Class2-longsaggital
 Class3-dorsal corona...
TREATMENT OF BYCONDYLAR
FRACTURES
 ORIF WITH PLATES & SCREWS
 Dynamic splint
 External fixation
 Interfragmentary scre...
PSEUDOBOUTTONOUIRE
DEFORMITY
 IN FRACTURES OF HEAD OF
PHALANX WHEN THERE IS
DISPLACED collateral ligamentous
injury & hea...
Other fractures of head of phalanx
 1)avulsion # of dorsal base of mid
phalanx->detachment of central
tendon insertions a...
CONT….
 #lateral base of proximal or mid
phalanx—it represents collat
ligament avulsion
 Treatment-a) uncomplicated—spli...
Cont…
 SHAFT # INVOLVING JOINT-
 Treatment ORIF
 Proximal traction phalanx splint-
noninvasive, minimal stiffness,
comm...
NECK FRACTURES
 Common in toddlers
 Classification->type1-nondisplaced
 type2-displaced with some bone
contact
 Type3-...
SHAFT FRACTURES
 They can be transverse, oblique,
spiral, comminuted
 Treatment
 1)nondisplaced & stable-cock-up
positi...
CONT
 Transverse#-ORIF with kwire& intra
osseous wire
 Displaced unstable & comminuted-
external fixation,miniplate & sc...
COMPLICATIONS OF PHALANGEAL
FRACTURES
 MALUNION-classified-a)
malrotation,volar angulation,lateral
angulation,
 It is us...
CONT…
 Intrarticular malunion
 Nonunion
 Loss of motion
 Pip joint extensor lag
 infection
dr sumer yadav, mch plasti...
Fractures of the thumb bones
 Fractures of phalanx-a) extra
articular
B) Intra articular
EXTRA ARTICULAR-1)distalp-
longi...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
FRACTURES OF PROXIMAL
PHALANX
 Head & neck#-CRIF WITH K WIRE
 ORIF WITH K WIRE
 Angulation of 20-30* is
unacceptable
dr...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
Intraarticular # & avulsion
 1)dorsal base of distal phalanx-
mallet thumb
 Treatment-external splint
 2)ulnar base of ...
FRACTURES OF THUMB
METACARPAL
 Metacarpal head fractures-displaced
 Treatment-ORIF OR CRIFwith k
wire& repair of radial ...
BENNET FRACTURE
 #OF base of thumb metacarpal
 True lateral view
 It is # subluxation
 Injury due to axial loading of
...
Bennett’s Fracture
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
TREATMENT
 WHEN fragment is <15-20% of
articular surface-CRIF with k wire
 if > 25%-ORIF
 COMPLICATIONS-mal union
dr su...
ROLANDO FRACTURE
 # base of metacarpal with Y or T
shape
 Any comminuted intraarticular # of
base of metacarpal
 Treatm...
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com
Nächste SlideShare
Wird geladen in …5
×
Nächste SlideShare
Metacarpal fractures
Weiter
Herunterladen, um offline zu lesen und im Vollbildmodus anzuzeigen.

Teilen

fractures of hand bones

Herunterladen, um offline zu lesen

fractures of hand bones

Ähnliche Bücher

Kostenlos mit einer 30-tägigen Testversion von Scribd

Alle anzeigen

Ähnliche Hörbücher

Kostenlos mit einer 30-tägigen Testversion von Scribd

Alle anzeigen

fractures of hand bones

  1. 1. FRACTURES OF METACARPALS AND PHALANGES Dr Sumer Yadav Mch plastic and reconstructive surgery dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  2. 2. INTRODUCTION  Most common fractures of the upper limb  Most common cause of functional disability in labor population  Most common in males in the age of 1o- 40yrs  Most fractures are functionally stable  Outer rays of hand are most frequently injured  Goal is rapid & full restoration of hand function dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  3. 3. Wrist/ hand Anatomy - bones  Carpals  (proximal row)  (distal row)  Metacarpals  Phalanges dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  4. 4. SKELETAL ANATOMY OF HAND  5 metacarpal bone Head Shaft base  14 phalanges 3 for each finger 2 for thumb Head Shaft base dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  5. 5. Hand Anatomy • Bony Anatomy • Carpals • Scaphoid • Lunate • Triquetral • Trapezium • Trapezoid • Hamate • Pisiform dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  6. 6. ANATOMY CONT…….  Key skeletal element  Has 3 arches,2 transverse arches & 1longitudinal arch dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  7. 7. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  8. 8. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  9. 9. Splinting Position Position of FunctionPosition of Safety YES NOdr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  10. 10. Thumb spica Basic Splinting Position of “safety” dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  11. 11. Hand Functions  Grasping patterns  Hook, spheres, cylinders  Pinches  Key, tripod, inferior/superior  Fine motor manipulation  Sensation  Pain, touch, discrimination, object identification, vibration dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  12. 12. INDICATIONS FOR FIXATION OF METACARPAL& PHALANGEAL#  Irreducible fractures  Malrotation  Intra articular fractures  Open fractures  Sub capital fractures  Segmental bone loss  Polytrauma with hand fractures  Multiple hand or wrist fractures  fractures With soft tissue injury  osteotomy dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  13. 13. METACARPAL#  Metacarpal head fractures  Rare, intraarticular  As a result of axial loading or direct trauma, complex dorsal MCP dislocations  IVX-x-ray-3 views— PA,LATERAL,OBLIQUE,brewerton skyline metacarpal  Ct scan dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  14. 14. Classification of fractures of metacarpal head  1)epiphysael  Ligamentous avulsion  Osteochondral slices  Two part fractures in different planes  Comminuted Bone loss  Occult compression # dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  15. 15. TREATMENT OF METACARPAL HEAD #  1)displaced ligamentous avulsion & osteochondral #-open reduction & internal fixation with k-wire or interfragmentary screws  2)for partial loss of bone->auto grafts taken from toe  3)comminuted intra articular #-> open reduction & internal fixation or skeletal traction or silicone arthro plasty  4)open fractures->clean & open reduction & internal fixation dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  16. 16. complications  Most common- stiffness-it is due to extensor tendon adhesions,collateralligament or dorsal capsule contractures  Epiphyseal growth arrest  Avascular necrosis dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  17. 17. METACARPAL NECK FRACTURES  Boxers fracture  Commonly involves-ring & small fingers  Occur when clenched MCP strikes solid objects & angulates with apex dorsal dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  18. 18. Boxer’s Fracture • Mechanism: impaction force exerted through the distal end of the metacarpal in closed fist potion • Pathology: Fracture through the neck of the fifth metacarpal/volar displacement dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  19. 19. TREATMENT  For closed # with no pseudo clawing-cock –up splint  Pseudo clawing-closed reduction with JAHSS maneuver then buddy & give cock up splint-check x-ray  For index & mid metacarpal neck #-- angulation >15* is unacceptable  For ring angulation of 30-40*is acceptable  For little finger-angulation of 50-60* is acceptable dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  20. 20. Cont…..  Immobilisation-12-14days & then AROM exercises  After 6 weeks –join duty  If closed reduction fails---ORIF with k-wire dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  21. 21. METACARPAL SHAFT FRACTURES  CLASSIFICATION—transverse, oblique comminuted dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  22. 22. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  23. 23. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  24. 24. transverse metacarpal shaft fracture  AXIAL LOADING  Indications for intervention-any angulation for index & mid finger,>20* ring finger,>30* for little finger  Treatment-closed reduction & internal fixation by k-wire,open reduction & internal fixation by k- wire,intramedullary fixation k-wire dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  25. 25. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  26. 26. OBLIQUE OR SPIRAL FRACTURES  IF ROTATION >10* GO FOR INTERVENTION  Treatment-CRIF by k-wire ORIF by k-wire inter fragmentary screw fixation Tran osseous wire+-k-wires intra medullary fixation k-wire dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  27. 27. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  28. 28. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  29. 29. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  30. 30. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  31. 31. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  32. 32. RIGID FIXATION  Indications-multiple #,isolated transverse#,malunion,pseudo arthrosis,bone loss  Types –interfragmentary compression screws, plates & screws dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  33. 33. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  34. 34. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  35. 35. EXTERNAL FIXATION  Indications-severe comminuted compound contaminated fractures in which anatomic reconstruction is not possible  Septic nonunion  Advantages-no osteo penia,secondary reduction can be carried ,provides ready access to wounds dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  36. 36. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  37. 37. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  38. 38. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  39. 39. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  40. 40. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  41. 41. COMPLICATIONS OF INTERNAL FIXATION  Pin tract infection  Osteomyelitis  Fracture through pin holes  Neuro vascular injury  Over distraction  Loss of reduction  Impair tendon excursion dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  42. 42. OPEN REDUCTION & INTERNAL FIXATION FOR METACARPAL SHAFT #  Indications-displacement>10*-- second & third metacarpal  >20*--fourth metacarpal  >30*--fifth metacarpal  Most spiral & oblique #  Multiple meta carpal #  Soft tissue injury  Bone loss dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  43. 43. BI ABSORBABLE FIXATION  Polyglycolic acid,poly lactic acid,poly Para dioxanone  Disadvantage->non infectious inflammatory response dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  44. 44. METACARPAL BASE # & CARPOMETACARPAL # DISLOCATION  Treatment-for second & third –ORIF —k-wire  For fourth & fifth—for simple # dis— CRIF k-wire  For multiple # dis—ORIF-k-wire dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  45. 45. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  46. 46. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  47. 47. COMPLICATIONS OF METACARPAL FRACTURES  1)mal union  2)dorsal angulation  3)malrotation  4)osteomyelitis  5)nonunion dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  48. 48. PHALANGEAL FRACTURES  FRACTURES OF DISTAL PHALANX  Classificatuion:1)tuft #  simple #  comminuted#  Shaft #---transverse—stable or unstable  ----longitudinal  Articular#---volar, epiphyseal,dorsal dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  49. 49. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  50. 50. TREATMENT OF DISTAL PHALANGEAL #  TUFT #-drain subungual hematoma  finger splint  Shaft #-- CRIF—k-wire  Epiphyseal #--ORIF  Complications– nonunion  -malunion dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  51. 51. FRACTURES OF MID & PROXIMAL PHALANX  ARTICULAR #(london)--1)condylar #  Type1-stable #without displacement  Type2-unicondyle,unstable  Type3-bicondyle,comminuted dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  52. 52. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  53. 53. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  54. 54. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  55. 55. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  56. 56. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  57. 57. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  58. 58. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  59. 59. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  60. 60. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  61. 61. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  62. 62. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  63. 63. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  64. 64. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  65. 65. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  66. 66. UNICONDYLAR FRACTURES  Classification-Weiss &Hastings  Class1-oblique volar  Class2-longsaggital  Class3-dorsal coronal  Class4-volarcoronal  Treatment-CRIF OR ORIF with k-wire or screws  AT 5-7DAys—arom, splint PIP in full extension  Remove k wires 3-4 weeks dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  67. 67. TREATMENT OF BYCONDYLAR FRACTURES  ORIF WITH PLATES & SCREWS  Dynamic splint  External fixation  Interfragmentary screws dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  68. 68. PSEUDOBOUTTONOUIRE DEFORMITY  IN FRACTURES OF HEAD OF PHALANX WHEN THERE IS DISPLACED collateral ligamentous injury & healing occurs ,when there is adhesions between the adjacent lateral band,& oblique retinacular ligament& volar plate dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  69. 69. Other fractures of head of phalanx  1)avulsion # of dorsal base of mid phalanx->detachment of central tendon insertions a result of ant pip jt dislocation  Treatment- ORIF dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  70. 70. CONT….  #lateral base of proximal or mid phalanx—it represents collat ligament avulsion  Treatment-a) uncomplicated—splint for 10-14 days  B) complicated—ORIF with k-wire  # BASE OF PROXIMAL PHALANX-  Treatment-ORIF dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  71. 71. Cont…  SHAFT # INVOLVING JOINT-  Treatment ORIF  Proximal traction phalanx splint- noninvasive, minimal stiffness, comminuted# dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  72. 72. NECK FRACTURES  Common in toddlers  Classification->type1-nondisplaced  type2-displaced with some bone contact  Type3-completely displaced  Treatment-ORIF with k-wire or dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  73. 73. SHAFT FRACTURES  They can be transverse, oblique, spiral, comminuted  Treatment  1)nondisplaced & stable-cock-up position  2)displaced-stable after CR-cock-up position slab  Displaced unstable after reduction-  A) spiral &oblique-CR& IF with kwire dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  74. 74. CONT  Transverse#-ORIF with kwire& intra osseous wire  Displaced unstable & comminuted- external fixation,miniplate & screws dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  75. 75. COMPLICATIONS OF PHALANGEAL FRACTURES  MALUNION-classified-a) malrotation,volar angulation,lateral angulation,  It is usually seen after oblique or spiral #  Treatment-osteotomy with plate fixation,lateralwedge osteotomy,corrective osteotomy dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  76. 76. CONT…  Intrarticular malunion  Nonunion  Loss of motion  Pip joint extensor lag  infection dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  77. 77. Fractures of the thumb bones  Fractures of phalanx-a) extra articular B) Intra articular EXTRA ARTICULAR-1)distalp- longitudnal,transervse,tuft Treatment-repair of dermal nail matrix, application of splint,CRIF WITH k wire, ORIF with k wire dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  78. 78. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  79. 79. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  80. 80. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  81. 81. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  82. 82. FRACTURES OF PROXIMAL PHALANX  Head & neck#-CRIF WITH K WIRE  ORIF WITH K WIRE  Angulation of 20-30* is unacceptable dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  83. 83. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  84. 84. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  85. 85. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  86. 86. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  87. 87. Intraarticular # & avulsion  1)dorsal base of distal phalanx- mallet thumb  Treatment-external splint  2)ulnar base of proximal phalanx- game keeper thumb  Treatment-reinsertion of collateral ligament or CRIF with k wire dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  88. 88. FRACTURES OF THUMB METACARPAL  Metacarpal head fractures-displaced  Treatment-ORIF OR CRIFwith k wire& repair of radial collateral ligament  Shaft #-1)epibasal#-may extend into trapezio-metacarpal joint  Treatment-CRIF with k wire dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  89. 89. BENNET FRACTURE  #OF base of thumb metacarpal  True lateral view  It is # subluxation  Injury due to axial loading of partially flexed thumb  Fragment- variable size, pyramidal  Goals of treatment-a) restore stability of cmc joint dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  90. 90. Bennett’s Fracture dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  91. 91. TREATMENT  WHEN fragment is <15-20% of articular surface-CRIF with k wire  if > 25%-ORIF  COMPLICATIONS-mal union dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  92. 92. ROLANDO FRACTURE  # base of metacarpal with Y or T shape  Any comminuted intraarticular # of base of metacarpal  Treatment-ORIF with k wire or plate & screws, bone graft dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  93. 93. dr sumer yadav, mch plastic surgery. sumeryadav2004@gmail.com
  • sarrphilly

    Oct. 15, 2021
  • TipsyJane

    Aug. 29, 2021
  • TanuMudgil

    Jul. 19, 2021
  • trinadhPhanikumarvas

    May. 26, 2021
  • Harinibs1

    May. 10, 2021
  • EidiIdham

    May. 4, 2021
  • PrajaktaPalghadmal

    Mar. 26, 2021
  • christopherarisi

    Mar. 13, 2021
  • aminuphilo

    Dec. 25, 2020
  • DrKanika1609

    Sep. 28, 2020
  • DrKanika1609

    Sep. 28, 2020
  • SharadParmar4

    Aug. 30, 2020
  • chandraveersidhant

    Aug. 23, 2020
  • MataraEliya

    Aug. 13, 2020
  • MilimoEmmanuel

    Jul. 27, 2020
  • harshiniprakash1

    Jul. 21, 2020
  • IbnAhmedAbalhareth

    Jul. 17, 2020
  • FayasRasheed

    Jul. 10, 2020
  • nafisah98

    Jun. 27, 2020
  • SriTata1

    May. 10, 2020

fractures of hand bones

Aufrufe

Aufrufe insgesamt

7.762

Auf Slideshare

0

Aus Einbettungen

0

Anzahl der Einbettungen

16

Befehle

Downloads

808

Geteilt

0

Kommentare

0

Likes

40

×