Post on 04-Dec-2015
description
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.
Handbook of Fractures 4th EditionRockwood and Green Fractures in Adults 7ed.
Proximal lnterphalangeal (PlP) Joint Dislocations
Handbook of Fractures 4th EditionRockwood 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.
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