Fractures of Hand
Fractures of the hand means fracture of the different areas of the fingers.
Fractures of the hand means fracture of the different areas of the fingers and thumb known as phalanges and fractures of the metacarpal bones of the palm.Each finger has 3 joints- DIP joint corresponding to the distal finger crease, PIP joint corresponding to the mid finger crease and MP joint which corresponds to the proximal finger crease. These joints are very frequently involved in the fractures and are most difficult to treatand to regain former normal function ofthe finger.Many of the hand fractures can be managed non operatively, appropriate follow up is crucial for a good outcome.
Goal of treatmentof hand fracturesis minimum deformity and maximum function, to reduce and stabilize the fracture, maintain the reduction and begin rehabilitation to restore function.
- Salter and Harris classification
- Type1= fracture confined to physis
- Type2= fracture starts in the physis and extends through the shaft
- Type3= fracture starts in physis and extends into joint
- Type4= fracture starts in the shaft and extends through the physis and into the joint
- Type5= physis is crushed
PREOPERATIVE MANAGEMENT
- Patient is usually attended at emergency
- After assessing the condition of the hand and vascularity is assessed
- Digital Xray of hand is done to assess the fracture
- If fracture is associated with the lacerated wound or skin or soft tissue loss over the finger then it is called compound fracture. Compound fracture if present, is irrigated thoroughly and immobilized with a splint or slab
- Patient is admitted and all pre op investigations are done
- Injury to tendons and neurovascular structures is assessed
Management of hand fractures
Appropriate management of hand fractures depend on multiple factors-the type of work of the patient, involvement of joint in the fracture, association of fractures with tendon, nerve or soft tissue loss
Undisplaced or minimally displaced fractures can be managed by close reduction or manipulation of the finger and splinting with plaster cast or Kwire insertion.
Displaced fractures should initially be managed with closed reduction but if it fails or if the displacement is too wide or is associated with compounding injury with tendon, nerve involvement then exploration and repair and fracture fixation with K-wire or plate and screws should be done
Distal Phalynx
- Fracture of distal phalynx isreduced and fixed with k wire insertion
- If fracture is present with avulsion of FDP tendon, then fixation of FDP tendon with bone is done with suture over the button
Dip Joint
- Goal of treatment should allow healing of a congruent joint without any lag in extending the finger
- Rule out any dislocation of the joint
- Fractureis reduced&fixation is done with k wires or screws
- Alignment is maintained and range of motion is started around 3 weeks and continued for an additional 3 weeks or until radiographic healing is present
Middle Phalynx Shaft Fracture
- Fracture is reduced and Fixation is done with k wire
- Immobilization is done for 3 weeks and rehabilitation is done for next 3 weeks
Pip Joint Injuries
- Injuries around PIP joint are challenging to treat
- Rule out any joint dislocation
- Stiffness is common after joint injuries
- Initial trial of closed reduction is done, if it is successful, then dorsal blocking splint and early active flexion can produce good results
- When reduction is not successful withclosed reduction,surgical open reduction with screw fixation is done
- Early active flexion physical therapyis recommended
Proximal Phalynx Fracture
- Usually presents with extensor tendon injury.
- Fragments are reduced under vision and stabilized with mini plates and k wire fixation
- Rehabilitation begins around 5th postoperative day with edema control and a figure of 8 splint allowing flexion and blocking with 10 degrees of extension
Metacarpal Fractures
- If metacarpal fractures are left untreated, then it could lead to weak hand grip, ineffective hand closure and scissoring of fingers.
- Undisplaced and minimum displaced fractures need plaster cast only. Displaced fractures are reduced under vision and stabilised with mini plates or k-wire fixation
Post operative management
- Rehabilitation is most important aspect of management of hand fractures
- Immobilization of hand orfinger is done for 3 weeks
- Hand elevation is continued for 3 weeks
- Suturesare removed after 2 weeks
- K- wire is removed after 3 weeks
- Gradually active and passive range of motion exercisesare started
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Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.
MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)
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If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
Yes, you have to wear it round the clock unless we suggest you to remove it.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
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