Current conceptsHand Fractures: A Review of Current Treatment Strategies
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History
Rudimentary care of hand fractures (eg, rest and elevation) is presumably as old as humans themselves. Upright posture may have contributed to an increase in these injuries, and today, falls from standing height remain a major source of hand injuries. The ancient Egyptian Imhotep described reduction and immobilization of fractures in 3000 bc. Hippocrates in 200 bc and Galen in ad 160 recommended prolonged immobilization of broken bones and frequent dressing changes. More durable, plaster-based
Epidemiology
Hand fractures are among the most common skeletal injuries. As is the case with many orthopedic injuries, young men and elderly women are most susceptible. Modes of injury in different age groups are predictable: children and young adults are frequently injured in sports-related activities, middle-age manual laborers are prone to work-related injuries, and older patients may experience hand trauma as the result of a fall or motor vehicle collision. The distal phalanx is the most commonly
Diagnosis
Diagnosis of hand fractures begins with a thorough patient interview. The patient should describe the mechanism of injury because this may suggest certain reduction maneuvers, assist in identifying secondary injuries, and reveal pathological fractures. A very low-impact injury leading to fracture, for instance, should raise the suspicion of osteoporosis or enchondroma. In addition to a history of the injury, it is important to note the patient's handedness, their functional status, occupation,
General principles
Most hand fractures are well managed without surgery. This was known to ancient physicians; however, today we better appreciate the dangers of prolonged immobilization.7 Stiffness, pressure sores, and, rarely, compartment syndrome may result from mismanaged casting or splinting, and in this sense, “conservative” treatment may be particularly risky. Surgery is indicated when early mobilization of soft tissues is critical, when the fracture is otherwise unreducible, in instances of polytrauma or
Complications
Stiffness is a far more common and difficult to treat complication of metacarpal and phalangeal fractures than are malunion, nonunion, and arthrosis combined. Each of these complications may occur with or without an operation, and each is more easily prevented than treated. Strictly surgical complications—hardware prominence, hardware infection, and wound breakdown—are often primarily related to technique. Management of complications lies on a broad spectrum from the simple to the complex. A
References (54)
- et al.
Fractures of the tubular bones of the hand
J Hand Surg Eur Vol
(2007) - et al.
Unstable mallet fractures: a comparison between three different techniques in a multicenter study
Chin J Traumatol
(2010) - et al.
Articularly placed interfragmentary screw fixation of difficult condylar fractures of the hand
J Hand Surg Am
(2011) - et al.
A percutaneous technique to treat unstable dorsal fracture-dislocations of the proximal interphalangeal joint
J Hand Surg Am
(2011) Dorsal fracture dislocation of the proximal interphalangeal joint
J Hand Surg Am
(2008)- et al.
Volar plating for unstable proximal interphalangeal joint dorsal fracture-dislocations
J Hand Surg Am
(2012) - et al.
Percutaneous, intramedullary fracture reduction and extension block pinning for dorsal proximal interphalangeal fracture-dislocations
J Hand Surg Am
(2010) - et al.
Treatment of complex proximal interphalangeal joint fractures using a new dynamic external fixator: 15 cases
Chir Main
(2009) - et al.
Use of dynamic distraction external fixation for unstable fracture-dislocations of the proximal interphalangeal joint
J Hand Surg Am
(2008) - et al.
Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation: a pins and rubber band system
J Hand Surg Am
(2007)
Staged external fixation for chronic fracture-dislocation of the proximal interphalangeal joint: outcomes of patients with a minimum 2-year follow-up
J Hand Surg Am
Small finger metacarpal neck fractures
J Hand Surg Am
Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study
J Hand Surg Am
Comparison of intramedullary nailing versus plate-screw fixation of extra-articular metacarpal fractures
J Hand Surg Am
The conservative management of Bennetts fracture subluxation: a 26-year follow-up
J Hand Surg Br
Treatment of a Bennett fracture using tension band wiring
J Hand Surg Am
Arthroscopically assisted percutaneous fixation of Bennett fractures
J Hand Surg Am
Symptomatic nonunion of a distal phalanx fracture: treatment with a percutaneous compression screw
J Hand Surg Am
Complications of K-wire fixation in procedures involving the hand and wrist
J Hand Surg Am
Rewarming patterns in hand fracture patients with and without cold intolerance
J Hand Surg Am
Fractures of the metacarpals and phalanges
Fractures, dislocations, and ligamentous injuries
Hand fractures and dislocations
Fractures and dislocations of the hand
Les debuts de l'osteosynthese en Belgique
Chirurgie: operatoire des fractures
History of fracture fixation of the hand and wrist
Clin Orthop Relat Res
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