finale textbook

FINGER INJURYPresented by:

Fareez/Giva/Ruzana/Aida/Ummu/Faizah/Yarianti/Rafika

Advisor:dr. Wendlindr. NurJalaldr. Zwunda

Orthopaedic and Traumatology DepartmentMedical Faculty of Hasanuddin University

Makassar, 2015

TEXTBOOK READING

Supervisor:dr Petrus Johan, Sp. OT

Finger Injury

Epidemiology

Metacarpal and phalangeal fractures are common, comprising l0% of all fractures; >50% of these are work related.

The 1998 , Incident phalangeal and metacarpal fractures to be the second and third most common hand and forearm fractures following radius fractures

Anatomy

Lunatum ScapoidCapitatum

Trapezoid

HamatumFisiform

TrapezeumTriquetrum

Mechanism Of Injury

A high degree of variation

A high degree of variation

'jamming" injuries

Frequently sustained during ball-handling sports

Sudden reaches made during everyday activities such as to catch a falling object

Axial loading along the upper

extremity also make one suspicious of associated injuries to the carpus, forearm, elbow and shoulder girdle

caught in clothing, furniture, or workplace

equipment

caught in clothing, furniture, or workplace

equipment

Industrial settings or other environments with heavy

objects and high forces lead

CLINICAL EVALUATION

Exposure to contaminationTreatmentFinancial issues:

AgeHand dominanceOccupationSystemic illnessesMechanism of injury

Crushdirect traumaTwistTear laceration,

Time of injury

AgeHand dominanceOccupationSystemic illnessesMechanism of injury

Crushdirect traumaTwistTear laceration,

Time of injury

Physical examination

CRTNeurologic statusRotational and angulatory deformity.ROM (by goniometer).Malrotation at one bone segment is best represented by

the alignment of the next more distal segment.

RADIOGRAPHIC

EVALUATION

CLASSIFICATION

Open FracturesSwanson, Szabo, and Anderson

TREATMENT GENERAL PRINCIPLES

• "Fight-bite" injuries: Curved laceration overlying a joint in the hand, must be suspected caused by a tooth.

• This must be assumed to be contaminated with oral flora and should be addressed with broad-spectrum antibiotics, irrigation and debridement.

• Animal bites: Antibiotic coverage is needed for Pasterella and Eikenella.

• There are essentially five major treatment alternatives:

• Immediate motion

• Temporary splinting

• Closed reduction and internal fixation (CRIF)

• Open reduction and internal fixation (ORIF)

• Immediate reconstruction

• Non operative treatment:

• Advantage• lower cost

• avoidance of the risks and complications associated with surgery and anesthesia.

• Disadvantage • stability is less assured.

CRIF prevent overt deformity Pin tract infection is the prime complication, unless K-

wires are buried.Open treatments

morbidity of surgical tissue traumathe most anatomic and stable reduction.

Critical elements in selecting between non-operative and operative treatment are the assessments of rotational malalignment and stability.

General indications for surgery

TREATMENT

Treatment of stable fracture :

Unstable fractures that are irreducible by closed means or exhibit continued instability despite closed treatment require CRIF or ORIF, of unstable fractures.

Fractures with segmental bone loss:

The primary treatment ,should be directed to the soft tissues, maintaining length with Kirschner wires or external fixation.

MANAGEMENT OF SPECIFIC FRACTURE PATTERNS

Metacarpal Head Fractures include Epiphyseal fracturesCollateral ligament avulsion fracturesOblique, vertical, and horizontal head fractures

Most require anatomic reduction to re-establish jointcongruity and to minimize post traumatic arthrosis. Stable reductions of fractures may be splinted in the "protected

position' consisting of metacarpal-phalangeal flexion >70 degrees to minimize joint stiffness (Fig.2a.l).

METACARPAL SHAFT FRACTURE

PIPCRIFORIFORIF

CRIF

K-WIRESCRIF

SPLINTING

SPLINTINGCRIF

CMC JOINT

CRIF

CMP JOINT

REDUCTION

THUMB CMC JOINT

REDUCTION

DISTAL PHALANX FRACTURE

CRIF

K-WIRESCRIF

SPLINTING

PROXIMAL PHALANX FRACTURE

METACARPAL NECKFRACTURE

METACARPAL BASEFRACTURE

MIDDLE PHALANX FRACTURE

FIGURE 3. The most recognized patterns of thumb metacarpal base intra-articular fractures are (A) the partial articular Bennett fracture and (B) the complete articular Rolando fracture.

(From Bucholz RW, Heckman JD, Court-Brown C, et al., eds. Rockwood and Green's Fractures in Adults 6th ed Philadelphia: Lippincott Williams & Wilklns; 2006.)

Thumb MCP Dislocation

Skier’s thumb-acute condition

Gamekeeper’s thumb-chronic condition

Stress view examination

Handbook of Fractures 4th EditionRockwood and Green Fractures in Adults 7ed.

Proximal lnterphalangeal (PlP) Joint Dislocations


Careful palpation for

localized tenderness

Rockwood and Green Fractures in Adults 7ed.


Proximal lnterphalangeal (PlP) Joint Dislocations

Distal lnterphalangeal (DlP) and Thumb lnterphalangeal (lP) Joint DislocationsNonoperative TreatmentStable : reduced dislocations with immediate active

range of motion.Unstable : immobilized in 20 degrees of flexion for up to

3 weeks before instituting active range of motion.

Operative TreatmentDelayed presentation ( > 3 weeks)Open dislocations

C0MPLICATIONS

Malunion Nonunion Infection Metacarpophalangeal joint extension contracture Loss of motion Posttraumatic osteoarthritis

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