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MANUS

FRACTURES
RP Joe Puspo : 201520401011160
Almira Yulianingrum : 201520401011121
Idza Fariha Afri : 201520401011149

BACKGROUND

Fractures of the hand is one of the fractures that often


occur, both in the case of emergencies such as accidents.
A good evaluation at the initial examination, as well as
proper management can significantly prevent the
occurrence of morbidity and disability in patients.
Evaluation and management is influenced also by age,
dominant hand, job, comorbidities. The occurrence of
fractures of the hand, it also includes fractures of the
metacarpal and phalang.

ANATOMY
The Carpal Bones

The proximal Carpal Bones

Scaphoid, lunate,triquetrum, pisiform

The Distal Carpal Bones

Trapezium, trapezoid, capitate, hamate

(Human Anatomy, 2006)


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ANATOMI MANUS
The Metacarpal Bones and Phalanges

(Human Anatomy, 2006)


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Tendon and Ligament At Regio Manus

FRAKTUR DAN DISLOKASI


FRACTURES OF THE SCAPHOID

FRACTURES OF THE SCAPHOID

UNDISPLACED FRACTURES

DISPLACED FRACTURES

The cast is applied from the upper


forearm to just short of the metacarpophalangeal joints of the fingers, but
incorporating the proximal phalanx of
the thumb. The wrist is held dorsiflexed
and the thumb forwards in the glassholding position
For 8 weeks
can also be treated in plaster, but the
outcome is less predictable. It is
better to reduce the fracture openly
and to fix it with a compression
screw.
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FRACTURES OF THE SCAPHOID

COMPLICATIONS

Avascular necrosis
Nonunion
Osteoarthritis
Delayed union

FRACTURES OF OTHER CARPAL BONES

Triquetrum
Avulsion of the dorsal ligaments is not uncommon; analgesics and splintage for a few
days are all that is required.; Occasionally the body is fracture; it usually heals after
46 weeks in plaster.

Hamate
They are also difficult to define on plain x-rays, carpal tunnel views and CT scan is
needed. If shows a fracture, fixation may occasionally be needed.

Trapezium
The body fracture may need open reduction and internal fixation if displaced; the
ridge
fracture usually settles with splintage for a week or two.

Capitate
The capitate is relatively protected within the carpus. However, in severe trauma the
wrist can be fractured; the distal fragment can rotate, in which case open reduction
and internal fixation is required.

Lunate
Fractures of the lunate are rare and follow a hyperextension injury to the wrist. There
is a real risk of nonunion; undisplaced fractures should be immobilized in a cast for 6
weeks; displaced fractures should be reduced and fixed with a screw.

CARPAL DISLOCATIONS, SUBLUXATIONS AND INSTABILITY

LUNATE AND PERILUNATE DISLOCATIONS


A fall with the hand forced into dorsiflexion may tear the tough ligaments
that normally bind the carpal bones. The lunate usually remains attached to
the radius and the rest of the carpus is displaced backwards (perilunate
dislocation). Usually the hand immediately snaps forwards again but, as it
does so, the lunate may be levered out of position to be displaced
anteriorly (lunate dislocation).

painfull
swollen
parasthesia

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LUNATE AND PERILUNATE DISLOCATIONS

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METACARPAL FRACTURES

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METACARPAL FRACTURES

Baseball finger (Mallet Finger)


Boxer Fracture
Bennet Fracture

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METACARPAL FRACTURES

Baseball finger (Mallet Finger)

Fracture of the base


phalanx distal

Therapy MALLET
SPLINT
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METACARPAL FRACTURES

Boxer Fracture

Close reduction GIPS

Fracture the metacarpal neck

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METACARPAL FRACTURES

Bennet Fracture

Therapy :
wire (percutaneus pinning)

Fracture thumb metacarpal-dislocation of the carpo metacarpal


(CMC) joint

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REVERSE BENNETTS
FRACTURE
Metacarpal base fracture IV and V

Therapy :
Reduction used K - wire and then do with a cast or splint

FRACTURES OF THE PHALANGES

Transverse fracture of the shaft


Spiral fracture of the shaft.
Comminuted fracture, usually due to a crush injury
Avulsion of a small fragment of bone.
Metaphyseal fracture at the base of the proximal
Phalanx. This is most commonly seen in children.
Intra-articular fractures

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FRAKTUR PROXIMAL PHALANX


Proximal phalanx shaft
(mid-part of the bone) :

Proximal phalanx base (into


the joint) :

Ligament Pull Off


Breaks in the middle
of the base of the
bone

Transverse (straight
across the bone)
Crush injury
Short oblique (short
diagonal) breaks
Long oblique (long
diagonal) break
Spiral break

FRAKTUR MIDDLE PHALANX


Middle Phalanx Base
(outside the joint)

Phalang central part


simply by fixation
with a plaster for
three weeks, after 3
weeks of moving the
affected finger will be
do

Middle
PillonPhalanx
fractureBase
(Intra-articular)
Dorsal fracture

subluxation/dislocation
Volar fracture
dislocations

MIDDLE PHALANX - MID-PART OF THE BONE

Transverse (straight across the bone)


Crush injury
Short oblique (short diagonal) breaks
Long oblique (long diagonal) break
Spiral break

FRACTURES OF THE DISTAL


PHALANX

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THERAPY

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