Arch Hand Microsurg.  2023 Jun;28(2):75-86. 10.12790/ahm.23.0005.

Management of metacarpal and phalangeal fractures

• Chae S
• Park IJ

• KMID: 2542557
• DOI: http://doi.org/10.12790/ahm.23.0005

Abstract

Hand fractures are the most common fractures in orthopedic surgery. In most cases, conservative treatment is sufficient for stable fractures, but surgical treatment is required for unstable fractures, fractures that cannot be maintained after reduction, and fractures with severe soft tissue injuries. In the management of hand fractures, the focus should be on restoring the function of the hand after fracture healing. Rapid rehabilitation exercises are an important factor in restoring the function of the hand by reducing swelling at the fracture site, preventing joint stiffness, and reducing soft tissue adhesion. Therefore, conservative treatment that can minimize soft tissue damage is usually prioritized, and in specific situations, if surgical intervention can help facilitate early rehabilitation exercises, then it could be a desirable choice. This review article aims to help readers decide on a treatment method by presenting various treatment methods for hand fractures and the academic basis for those options.

Keyword

수지; 중수골; 골절; 고정; 손; Phalangeal; Metacarpal; Fracture; Fixation; Hand

Figure

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  Fig. 1. (A) Right fifth finger overlapping deformity. (B) Right fourth finger scissoring deformity. (C) Example of normal nail arrangement. (D) Normal variation of both fifth fingers overlapping. Written informed consent was obtained from the patient for the the publication of the clinical images.

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  Fig. 2. A true lateral view of the hand. Written informed consent was obtained from the patient for the the publication of the clinical images.

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  Fig. 3. (A) Diagram and simple radiograph showing the Ishiguro technique in a bony mallet finger. (B) Modified Ishiguro technique with two blocking pins. Written informed consent was obtained from the patient for the the publication of the clinical images.

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  Fig. 4. The Leddy and Packer classification of flexor digitorum profundus avulsion fractures.

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  Fig. 5. (A) Deforming force direction of a middle phalangeal fracture. (B) Deforming force direction of a proximal phalangeal fracture.

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  Fig. 6. (A) Picture and simple radiograph showing middle phalangeal volar base fracture. (B) Intraoperative photograph after debridement of the comminuted bony fragments. (C) Autologous bone graft of the hemi-hamate bone. Written informed consent was obtained from the patient for the the publication of the clinical images.

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  Fig. 7. A dynamic external fixator could be used for a middle phalangeal base fracture.

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  Fig. 8. In a metacarpal bone fracture, a hand splint should be performed, as shown in this figure. (A) A longitudinal middle split was made on the plaster bandage from the metacarpal shaft to the tip of the finger. (B-D) By using the split plaster bandages, the empty space at the fractured area was minimized and the contact surface was maximized to enable three-point fixation. Reprinted from Gil et al. [13] with permission of Archives of Hand and Microsurgery.

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  Fig. 9. Fracture fixation is possible using anterograde nailing with two pins. Written informed consent was obtained from the patient for the the publication of the clinical images.

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  Fig. 10. (A) The direction of the deforming force of Bennett’s fracture. (B) The direction of the reduction force for Bennett’s fracture.

Reference

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