fractures of hand bones

FRACTURES OF
METACARPALS AND
PHALANGES
Dr Sumer Yadav
Mch plastic and reconstructive
surgery
dr sumer yadav, mch plastic
surgery.
sumeryadav2004@gmail.com

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
surgery.

Wrist/ hand Anatomy - bones
 Carpals
 (proximal row)
 (distal row)
 Metacarpals
 Phalanges
surgery.

SKELETAL ANATOMY OF HAND
 5 metacarpal bone
Head
Shaft
base
 14 phalanges 3 for each finger 2 for
thumb
Head
Shaft base
surgery.

Hand Anatomy
• Bony Anatomy
• Carpals
• Scaphoid
• Lunate
• Triquetral
• Trapezium
• Trapezoid
• Hamate
• Pisiform
surgery.

ANATOMY CONT…….
 Key skeletal element
 Has 3 arches,2 transverse arches &
1longitudinal arch
surgery.

surgery.

Splinting Position
Position of FunctionPosition of Safety
YES NOdr sumer yadav, mch plastic
surgery.

Thumb spica
Basic Splinting
Position of “safety”
surgery.

Hand Functions
 Grasping patterns
 Hook, spheres, cylinders
 Pinches
 Key, tripod, inferior/superior
 Fine motor manipulation
 Sensation
 Pain, touch, discrimination, object
identification, vibration
surgery.

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
surgery.

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
surgery.

Classification of fractures of
metacarpal head
 1)epiphysael
 Ligamentous avulsion
 Osteochondral slices
 Two part fractures in different
planes
 Comminuted
Bone loss
 Occult compression #
surgery.

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
surgery.

complications
 Most common- stiffness-it is due to
extensor tendon
adhesions,collateralligament or
dorsal capsule contractures
 Epiphyseal growth arrest
 Avascular necrosis
surgery.

METACARPAL NECK FRACTURES
 Boxers fracture
 Commonly involves-ring & small
fingers
 Occur when clenched MCP strikes
solid objects & angulates with apex
dorsal
surgery.

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
surgery.

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
surgery.

Cont…..
 Immobilisation-12-14days & then
AROM exercises
 After 6 weeks –join duty
 If closed reduction fails---ORIF with
k-wire
surgery.

METACARPAL SHAFT FRACTURES
 CLASSIFICATION—transverse,
oblique
comminuted
surgery.

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
surgery.

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
surgery.

RIGID FIXATION
 Indications-multiple #,isolated
transverse#,malunion,pseudo
arthrosis,bone loss
 Types –interfragmentary
compression screws, plates &
screws
surgery.

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
surgery.

COMPLICATIONS OF INTERNAL
FIXATION
 Pin tract infection
 Osteomyelitis
 Fracture through pin holes
 Neuro vascular injury
 Over distraction
 Loss of reduction
 Impair tendon excursion
surgery.

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
surgery.

BI ABSORBABLE FIXATION
 Polyglycolic acid,poly lactic acid,poly
Para dioxanone
 Disadvantage->non infectious
inflammatory response
surgery.

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
surgery.

COMPLICATIONS OF METACARPAL
FRACTURES
 1)mal union
 2)dorsal angulation
 3)malrotation
 4)osteomyelitis
 5)nonunion
surgery.

PHALANGEAL FRACTURES
 FRACTURES OF DISTAL PHALANX
 Classificatuion:1)tuft #
 simple #
 comminuted#
 Shaft #---transverse—stable or
unstable
 ----longitudinal
 Articular#---volar, epiphyseal,dorsal
surgery.

TREATMENT OF DISTAL
PHALANGEAL #
 TUFT #-drain subungual hematoma
 finger splint
 Shaft #-- CRIF—k-wire
 Epiphyseal #--ORIF
 Complications– nonunion
 -malunion
surgery.

FRACTURES OF MID & PROXIMAL
PHALANX
 ARTICULAR #(london)--1)condylar
#
 Type1-stable #without
displacement
 Type2-unicondyle,unstable
 Type3-bicondyle,comminuted
surgery.

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
surgery.

TREATMENT OF BYCONDYLAR
FRACTURES
 ORIF WITH PLATES & SCREWS
 Dynamic splint
 External fixation
 Interfragmentary screws
surgery.

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
surgery.

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
surgery.

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
surgery.

Cont…
 SHAFT # INVOLVING JOINT-
 Treatment ORIF
 Proximal traction phalanx splint-
noninvasive, minimal stiffness,
comminuted#
surgery.

NECK FRACTURES
 Common in toddlers
 Classification->type1-nondisplaced
 type2-displaced with some bone
contact
 Type3-completely displaced
 Treatment-ORIF with k-wire or
surgery.

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
surgery.

CONT
 Transverse#-ORIF with kwire& intra
osseous wire
 Displaced unstable & comminuted-
external fixation,miniplate & screws
surgery.

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
surgery.

CONT…
 Intrarticular malunion
 Nonunion
 Loss of motion
 Pip joint extensor lag
 infection
surgery.

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
surgery.

FRACTURES OF PROXIMAL
PHALANX
 Head & neck#-CRIF WITH K WIRE
 ORIF WITH K WIRE
 Angulation of 20-30* is
unacceptable
surgery.

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
surgery.

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
surgery.

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
surgery.

Bennett’s Fracture
surgery.

TREATMENT
 WHEN fragment is <15-20% of
articular surface-CRIF with k wire
 if > 25%-ORIF
 COMPLICATIONS-mal union
surgery.

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
surgery.

fractures of hand bones

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