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Chapter-198 Fractures of the Hand

BOOK TITLE: Textbook of Orthopedics & Trauma (4 Volumes)

Author
1. Warrier Sudhir
ISBN
9789385891052
DOI
10.5005/jp/books/12869_199
Edition
3/e
Publishing Year
2016
Pages
10
Author Affiliations
1. 204, Silver Nest, Sardar Vallabbhai Patel Nagar, Andheri (W), Mumbai, Lilavati and Jaslok Hospitals, Mumbai, Maharashtra, India, Lilavati, Hinduja, Jaslok, Shushrusha, Sportsmed and Sunridges Hospitals, Laud Clinic, Mumbai, Maharashtra, India
Chapter keywords
Terminal phalanx, distal interphalangeal joint, phalangeal shaft fracture, intra-articular fracture, proximal interphalangeal joint, metacarpal fracture

Abstract

Identification of a fracture in the hand may be simple and at times, extremely difficult. There may be abnormal mobility and rotation and deviation in attempts at active movement. Rotational malalignment may be easily identified by inspecting the alignment of the nails of all fingers in an end-on view. Common fractures of the terminal phalanx may involve the tuft, the shaft or the distal interphalangeal joint (DIP) joint. The phalangeal shaft fractures may be transverse, oblique, spiral or comminuted. Proximal phalangeal fractures angulate volarwards. Condylar fractures of the phalanges are highly unstable injuries and need accurate reduction and stabilization to enable early mobilization. The fractures are usually of three broad types i.e. unicondylar fractures, bicondylar fractures and comminuted intra-articular injuries. Proximal interphalangeal (PIP) joint intra-articular fracture is the most common injuries of the hand. The treatment is aimed at reducing the subluxation and approximating the fragments to allow them to heal. This is achieved by blocking (neutralizing) the extension. Fractures of the shaft of the metacarpals are common injuries and could be transverse, spiral or comminuted.

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