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.

Degree and location of metacarpal angulations

“…Since plate fixation involves the dorsal surface, the knowledge of its anatomy is imperative for successful plating. It has been traditionally considered that the dorsal surface is convex [6] . However, our results suggest that it is more angular than it is curved.…”

Angular stable lateral plating is a valid alternative to conventional plate fixation in the proximal phalanx. A biomechanical study

“…Although a lot of phalangeal fractures can be managed non-operatively, operative treatment may be indicated in the presence of shortening, excessive deformity, involvement of multiple rays, open fractures or failure to achieve acceptable reduction (Adams et al, 2013;Wong et al, 2008;Kamath et al, 2011;Nunley and Kloen, 1991;Ouellette et al, 2004). Following hand fractures, early physiotherapy is important to regain a good functional outcome (Hardy, 2004;Lu et al, 1996;Nunley and Kloen, 1991;Page and Stern, 1998).…”

“…Phalangeal fractures are among the commonest hand fractures constituting about 10% of all hand injuries (Kamath et al, 2011;Ouellette et al, 2004). Although a lot of phalangeal fractures can be managed non-operatively, operative treatment may be indicated in the presence of shortening, excessive deformity, involvement of multiple rays, open fractures or failure to achieve acceptable reduction (Adams et al, 2013;Wong et al, 2008;Kamath et al, 2011;Nunley and Kloen, 1991;Ouellette et al, 2004).…”

Ensaio experimental para tratamento cirúrgico das fraturas transversas da falange proximal – Técnica com parafuso intramedular cônico de compressão versus placa de compressão lateral

“…1,2 A falange proximal é fraturada com maior frequência em relação às falanges médias ou distais. 3,4 A indicação de tratamento cirúrgico dessas fraturas deve levar em consideração o tipo do traço fraturário, o desvio entre os fragmentos e a dificuldade de manter a redução incruenta da fratura. 3 Tem como objetivo a restauração da anatomia e da função do dedo acometido.…”

“…3 Tem como objetivo a restauração da anatomia e da função do dedo acometido. 4,5 As técnicas descritas variam de uma estabilidade relativa ao princípio de estabilidade absoluta. Por vezes, uma combinação de métodos é necessária 6 e isso depende da natureza do traço fraturário, da disponibilidade de implantes e da preferência do cirurgião.…”