Current concepts in managing fractures of metacarpal and phalangess

Abstract

Fractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon's work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.

Operative treatment of metacarpal and phalangeal fractures with Kirschner wire fixation: A review

“…For fracture of the head of the MC bone special views like Brewerton's view and skyline view are required. 5 Computed tomography (CT) is imaging standard in diagnosis of complex bone fractures. CT scanners can show sub-millimetric bone fragments, number and location of bone fragments and the percentage of articular involvement.…”

“…K-wires are easily removed after 4 to 6 weeks depending on type of fracture, and removal doesn't require hospitalization. 5,7,9,11,12 THE FIRST MC BASE FRACTURES.…”

“…When metacarpal bones are fractured interossei muscles with their contraction affect on fragment orientation. 4,5 The metacarpal bone of the thumb is shorter and the stouter then the rest. On the radial, rough, edge of the base is the insertion of abductor pollicis longus muscle which dislocate proximal fragment when the base is fractured.…”

Ekstraartiküler Proksimal Falanks Kırıklarında Kapalı Redüksiyon ve Kirschner Teli Tespitin Klinik ve Radyolojik Sonuçları

“…Sooner frac-ture union with early mobilization and by stable fixation provides better functional outcomes (5). In surgical treatment; closed reduction and Kirschner wire fixation, screw fixation, intramedullary screw fixation, external fixation, open reduction and plate-screw fixation are defined and frequently used methods (6)(7)(8)(9)(10).…”

Managing Hand Fractures: 15 Years’ Experience-from-a Tertiary Care Hospital from Pakistan

“…Many authors have presented rationale and principles of managing hand fractures [6][7][8], with majority emphasize on surgical management in the initial phase of fractures for stabilization. Phalanges and metacarpal fractures account for most of hand fractures [9,10]. Surgical options ranges from Krischner (K-) wiring, metallic plates, external fixation or screw fixation [11,12].. Study from Pakistan showed good postoperative range of motion after K-wire placement in phalangeal and meta-carpal fractures [10].…”