J Korean Fract Soc.  2018 Apr;31(2):61-70. 10.12671/jkfs.2018.31.2.61.

Hand Fractures

Affiliations
  • 1Department of Orthopaedic Surgery, Dankook University Medical College, Cheonan, Korea. kimjp@dankook.ac.kr

Abstract

Hand fractures are the second most common fracture in the upper extremities after the distal radius, and patients with these injuries may be experienced in hand surgery clinics. On the other hand, during the treatment of hand fractures, complications can occur due to complex functions of the hand and small-sized injuries to the bone and soft tissues. This review focused on the principles of management of these fractures, including injury mechanism, evaluations and recent treatment options. Minimally invasive surgery in various types of hand fractures, including the phalanx and metacarpal bone, is preferred because early mobilization after surgery has been emphasized to reduce complications, such as stiffness.

Keyword

Hand fractures; Finger phalanges; Metacarpal bones; Complications

MeSH Terms

Early Ambulation
Finger Phalanges
Hand*
Humans
Metacarpal Bones
Minimally Invasive Surgical Procedures
Radius
Upper Extremity

Figure

  • Fig. 1 Examinations showing rotational deformity of the hand. (A) Examining the digital pulps and the planar alignment of the nails with respect to the adjacent digits. (B) Affected finger deviates from its normal rotational direction to the scaphoid. The arrows indicates the fingers affected by a rotational deformity.

  • Fig. 2 Fan lateral view of the right hand.

  • Fig. 3 Radiographs showing a transverse fracture in the proximal phalanx treated with plate and screw fixation. (A) Posterolateral view. (B) Lateral view.

  • Fig. 4 Radiographs showing multiple fractures in a hand treated with intramedullary pinning of the metacarpal bones and plate and screw fixation of the proximal phalanx. (A) Preoperative radiograph. (B) Postoperative radiograph.

  • Fig. 5 Radiographs showing a ring finger metacarpal spiral fracture treated with a lag screw fixation. (A) Preoperative radiograph. (B) Postoperative radiograph.

  • Fig. 6 (A) Preoperative radiograph showing a bony mallet finger injury. (B) C-arm images performing extension block pinning.

  • Fig. 7 Radiographs and intraoperative photographs after the suture-over-button technique in a Jersey finger injury.

  • Fig. 8 Volar plate reconstruction in proximal interphalangeal joint fracture dislocation. (A) Preoperative radiographs. (B) Illustration showing the surgical procedures of a volar plate reconstruction. (C) Intraoperative radiograph and photograph.

  • Fig. 9 Radiographs showing a proximal phalanx condylar fracture of the little finger treated with headless cannulated screws. (A) Preoperative radiograph. (B) Postoperative radiograph.

  • Fig. 10 Radiographs and arthroscopic images after arthroscopic-assisted reduction and pinning in the thumb proximal phalanx base fracture. (A) Preoperative radiograph. (B) Articular surface reduction with arthroscope. (C) Postoperative radiograph.

  • Fig. 11 Radiographs showing thumb metacarpophalangeal joint arthrodesis due to post-traumatic osteoarthritis. (A) Preoperative radiograph. (B) Postoperative radiograph.

  • Fig. 12 (A) Photographs of a patient who had post-traumatic stiffness in his ring finger after surgery for a proximal phalangeal fracture. (B) Tenolysis of the flexor tendon was performed. (C) Tenotomy of the lumbrical tendon was done to resolve the lumbrical plus finger.

  • Fig. 13 (A) Radiographs and photographs of a 54-year-old male who had malunion of his right little finger. (B) He could make a full fist after a corrective osteotomy had been performed.


Cited by  1 articles

A novel finger brace for preventing finger stiffness after trauma or surgery: a preliminary report with a case series
Dae-Geun Kim, Hyo Jun Park
Arch Hand Microsurg. 2023;28(4):239-249.    doi: 10.12790/ahm.23.0033.


Reference

1. Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma. 2015; 29:e242–e244.
Article
2. Day CS, Stern PJ. Fractures of metacarpals and phalanges. In : Green DP, Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green's operative hand surgery. 6th ed. Philadelphia: Elsevier/Churchill Livingston;2011. p. 239. p. 241.
3. Henry M. Hand fractures and dislocations. In : Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD, editors. Rockwood and Green's fractures in adults. 8th ed. Philadelphia: Wolters Kluwer Health;2015. p. 710.
4. Stanton JS, Dias JJ, Burke FD. Fractures of the tubular bones of the hand. J Hand Surg Eur Vol. 2007; 32:626–636.
Article
5. Ben-Amotz O, Sammer DM. Practical management of metacarpal fractures. Plast Reconstr Surg. 2015; 136:370e–379e.
Article
6. Gaheer RS, Ferdinand RD. Fracture dislocation of carpometacarpal joints: a missed injury. Orthopedics. 2011; 34:399.
Article
7. Tuncer S, Aksu N, Dilek H, Ozkan T, Hamzaoglu A. Fractures of the fingers missed or misdiagnosed on poorly positioned or poorly taken radiographs: a retrospective study. J Trauma. 2011; 71:649–655.
Article
8. Cheah AE, Yao J. Hand fractures: indications, the tried and true and new inovations. J Hand Surg Am. 2016; 41:712–722.
9. Marjoua Y, Eberlin KR, Mudgal CS. Multiple displaced metacarpal fractures. J Hand Surg Am. 2015; 40:1869–1870.
Article
10. Gonzalez RM, Hammert WC. Dorsal fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am. 2015; 40:2453–2455.
Article
11. Paksima N, Johnson J, Brown A, Cohn M. Percutaneous pinning of middle phalangeal neck fractures: surgical technique. J Hand Surg Am. 2012; 37:1913–1916.
Article
12. Biz C, Iacobellis C. Comparison of percutaneous intramedullary Kirschner wire and interfragmentary screw fixation of displaced extra-articular metacarpal fractures. Acta Biomed. 2014; 85:252–264.
13. Hiatt SV, Begonia MT, Thiagarajan G, Hutchison RL. Biomechanical comparison of 2 methods of intramedullary K-wire fixation of transverse metacarpal shaft fractures. J Hand Surg Am. 2015; 40:1586–1590.
Article
14. del Piñal F, Moraleda E, Rúas JS, de Piero GH, Cerezal L. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am. 2015; 40:692–700.
Article
15. Nuland K, Charette R, Rodner CM. Operative treatment of unstable long oblique proximal phalanx fractures. J Hand Surg Am. 2016; 41:120–121.
Article
16. Zelken JA, Hayes AG, Parks BG, Al Muhit A, Means KR Jr. Two versus 3 lag screws for fixation of long oblique proximal phalanx fractures of the fingers: a cadaver study. J Hand Surg Am. 2015; 40:1124–1129.
Article
17. Nicklin S, Ingram S, Gianoutsos MP, Walsh WR. In vitro comparison of lagged and nonlagged screw fixation of metacarpal fractures in cadavers. J Hand Surg Am. 2008; 33:1732–1736.
Article
18. Wada T, Oda T. Mallet fingers with bone avulsion and DIP joint subluxation. J Hand Surg Eur Vol. 2015; 40:8–15.
Article
19. Tuttle HG, Olvey SP, Stern PJ. Tendon avulsion injuries of the distal phalanx. Clin Orthop Relat Res. 2006; 445:157–168.
Article
20. Tyser AR, Tsai MA, Parks BG, Means KR Jr. Stability of acute dorsal fracture dislocations of the proximal interphalangeal joint: a biomechanical study. J Hand Surg Am. 2014; 39:13–18.
Article
21. Janssen SJ, Molleman J, Guitton TG, Ring D. What middle phalanx base fracture characteristics are most reliable and useful for surgical decision-making? Clin Orthop Relat Res. 2015; 473:3943–3950.
Article
22. Frueh FS, Calcagni M, Lindenblatt N. The hemi-hamate autograft arthroplasty in proximal interphalangeal joint reconstruction: a systematic review. J Hand Surg Eur Vol. 2015; 40:24–32.
Article
23. Kiral A, Erken HY, Akmaz I, Yildirim C, Erler K. Pins and rubber band traction for treatment of comminuted intra-articular fractures in the hand. J Hand Surg Am. 2014; 39:696–705.
Article
24. Sirota MA, Parks BG, Higgins JP, Means KR Jr. Stability of fixation of proximal phalanx unicondylar fractures of the hand: a biomechanical cadaver study. J Hand Surg Am. 2013; 38:77–81.
Article
25. Livesley PJ. The conservative management of Bennett's fracture-dislocation: a 26-year follow-up. J Hand Surg Br. 1990; 15:291–294.
Article
26. Zhang X, Shao X, Zhang Z, Wen S, Sun J, Wang B. Treatment of a Bennett fracture using tension band wiring. J Hand Surg Am. 2012; 37:427–433.
Article
27. Culp RW, Johnson JW. Arthroscopically assisted percutaneous fixation of Bennett fractures. J Hand Surg Am. 2010; 35:137–140.
Article
28. Marsland D, Sanghrajka AP, Goldie B. Static monolateral external fixation for the Rolando fracture: a simple solution for a complex fracture. Ann R Coll Surg Engl. 2012; 94:112–115.
Article
29. Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am. 2013; 38:1021–1031. quiz 1031.
Article
Full Text Links
  • JKFS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr