Hand Fractures

Posted by e-Medical PPT
Boxer’s Fracture
A break in one or more metacarpal bones, usually the fourth or the fifth, caused by punching a hard object. Such a fracture is often distal, angulated, and impacted
Finger shorten posteriorly

Scaphoid Fracture
Epidemiology
 common in young men; not common in children or in patients beyond middle age
Mechanism
 FOOSH resulting most commonly in a transverse fracture through the waist (middle) of the scaphoid
Clinical Features:
pain on wrist movement
tenderness in scaphoid region (anatomical "snuff box")
usually undisplaced
Investigations:
 x-ray (AP/lat/scaphoid views with wrist exended and ulnar deviation)
+/- bone scan and CT scan
Note: a fracture may not be radiologically evident up to 2 weeks after acute injury, so if a patient complains of wrist pain and has anatomical snuff box tenderness but a negative x-ray, treat them as if they have a scaphoid fracture and repeat x-ray 2 weeks later to rule out a fracture
Treatment:
Undisplaced: cast
Displaced = open (or percutaneous) screw fixation

Colles’ and Smith Fracture
Colles’ Fracture:
Due to FOOSH
> 40 yrs, female (esp. osteoperosis)
Fx fragment: upward-dorsal angulation (fork-like appearance)

Smith Fracture:
Aka: reverse Colles’ fracture
Falling on the back of a flexed hand
Fx fragment: volar (palmar) displacment

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