TEXTBOOK READING

FINGER INJURY
Presented by:
Fareez/Giva/Ruzana/Aida/Ummu/Faizah/Yarianti/Rafika
Advisor:
dr. Wendlin
dr. NurJalal
dr. Zwunda

Supervisor:
dr Petrus Johan, Sp. OT
Orthopaedic and Traumatology Department
Medical Faculty of Hasanuddin University
Makassar, 2015

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

Triquetrum
Fisiform
Lunatum

Trapezoid
Trapezeum
Hamatum
Capitatum
Scapoid

Mechanism Of Injury
A high
degree of
variation
Frequently sustained during ball-handling sports
'jamming"
injuries

Axial loading
along the upper
extremity

Sudden reaches made during everyday

activities such as to catch a falling object

caught in clothing,
furniture, or workplace
equipment

also make one suspicious of associated injuries to

the carpus, forearm, elbow and shoulder girdle
Industrial settings or other
environments with heavy
objects and high forces lead

CLINICAL
EVALUATION
Age

Hand dominance
Occupation
Systemic illnesses
Mechanism of injury
Crush
direct trauma
Twist
Tear
laceration,
Time of injury

Exposure to contamination
Treatment
Financial issues:

Physical examination
CRT
Neurologic

status
Rotational and angulatory deformity.
ROM (by goniometer).
Malrotation at one bone segment is best represented by
the alignment of the next more distal segment.

R
AE
DV
I A
OL
GU
RA
AT
P I
HO
I N
C

CLASSIFICATION

Open Fractures
Swanson, 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 Kwires are buried.

Open

treatments

morbidity
the

of surgical tissue trauma

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 fractures
Collateral ligament avulsion fractures
Oblique, vertical, and horizontal head
fractures

 Most

require anatomic reduction to re-establish joint

congruity

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).

DISTAL PHALANX
FRACTURE
K-WIRES
CRIF
SPLINTING
PROXIMAL PHALANX
FRACTURE

SPLINTING
CRIF

MIDDLE PHALANX
FRACTURE
K-WIRES
CRIF
SPLINTING
CMP JOINT
REDUCTION

METACARPAL NECK
FRACTURE

METACARPAL
SHAFT FRACTURE

CRIF

METACARPAL BASE
FRACTURE

THUMB
CMC JOINT
REDUCTION

CMC JOINT
CRIF

ORIF
CRIF

PIP
CRIF
ORIF

FIGURE 3. The most recognized patterns of thumb

metacarpal base intra-articular fractures are (A) the
partial articular Bennett fracture and (B) the
(From Bucholz RW, Heckman JD, Court-Brown C, et al., eds. Rockwood and Green's Fractures in Adults 6th ed Philadelphia: Lippincott
complete
Williams
& Wilklns; 2006.) articular Rolando fracture.

Thumb MCP Dislocation

Skiers

thumb-acute
condition

Gamekeepers

thumbchronic condition

Stress

Handbook of Fractures 4th Edition

Rockwood and Green Fractures in Adults 7ed.

view examination

Handbook of Fractures 4th Edition

Rockwood and Green Fractures in Adults 7ed.

Proximal lnterphalangeal (PlP)

Joint Dislocations

Handbook of Fractures 4th Edition

Rockwood and Green Fractures in Adults 7ed.

Careful
palpation for
localized
tenderness

Rockwood and Green Fractures in Adults 7ed.

Rockwood and Green Fractures in Adults 7ed.

Proximal lnterphalangeal (PlP)

Joint Dislocations

Rockwood and Green Fractures in Adults 7ed.

Distal lnterphalangeal (DlP) and

Thumb lnterphalangeal (lP) Joint
Dislocations
Nonoperative Treatment
Stable

: 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 Treatment
Delayed presentation ( > 3 weeks)
Open dislocations

C0MPLICATIONS

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