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Hand Injuries

Hand Injuries. Dr. Wahby Ghalib CABMS, FJMC, MRCS. The most common cx after hand injury is stiffness Results from swelling & immobilization Usually #s heal in 4w clinical evaluation : more important than XR evidence of healing. Safe immobilization.

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Hand Injuries

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  1. Hand Injuries Dr. Wahby Ghalib CABMS, FJMC, MRCS

  2. The most common cx after hand injury is stiffness • Results from swelling & immobilization • Usually #s heal in 4w • clinical evaluation : more important than XR evidence of healing.

  3. Safe immobilization • Wrist extended • MPJs flexed • IPJs straight • Thumb abducted

  4. Metacarpal fractures

  5. Angular deformity :usually no interference with function • Rotational deformity : interferes

  6. Shaft # • Direct force • Punching • Twisting force  spiral #

  7. Rx • CR + volar or dorsal slab • Spiral # may need ORIF

  8. Neck # • Usually 5th MCB • Usually due to punching  Boxer`s # • May be open # (teeth)

  9. Boxer`s # • Unstable • Palmar angulation : well tolerated • Needs reduction & K. wire to avoid malunion & 2ndary flexion of IPJ

  10. Fractures of base of 1st MCB • Epibasal # • Bennett`s # • Rolando`s #

  11. Epibasal # • Rx : reduction ± K. wire

  12. Bennett`s # • Punching • Triangular piece remains attached to the trapezium while the rest of the thumb subluxates • CR + K. wire

  13. Rolando`s # • Comminuted intraarticular # of the base of the 1st MCB • Rx : CR + K. wires or ORIF

  14. Phalangeal fractures

  15. Rx • Undisplaced # : buddy strapping 2-3 w

  16. Rx • Displaced # : reduction by traction  stable : buddy strapping  unstable : IF

  17. Intrinsic muscles  angulation with apex volar  counteract by MPJ flexion

  18. Distal phalanx # • Tuft # : bone is shattered focus on swelling & nail injury • Shaft # : if displaced : CR + needle • Physeal # : Salter – Harris 2

  19. Mallet finger : avulsion of the extensor tendon ± bone fragment  mallet finger splint • Avulsion of the flexor tendon

  20. CMJ dislocation • Usually the thumb • Reduction by traction & hyper-pronation ± K. wire

  21. MPJ dislocation • Usually the thumb • Simple : CR • Complex : palmar plate lodged in the joint & MC head clasped between flexor tendon & the lumrical  CR or OR

  22. IPJ dislocation • Rx : traction & buddy strapping

  23. Injury to the ulnar collateral ligament of 1st MPJ • = gamekeeper or skier injury • Partial : thumb stable in extension  immobilize 4w • Complete : thumb unstable in flexion & extension  repair

  24. Zones of tendon injury • I : beyond insertion of FDS • II : between distal palmar crease & insertion of FDS ( flexor sheath) • III : between end of carpal tunnel & distal palmar crease • IV : within carpal tunnel • Proximal to carpal tunnel

  25. Zone 2 = no - man`s land : adhesions are very likely

  26. thanx

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