Fractures and dislocations of the wrist and hand, then and now

Abstract

Current preoccupation with the Bone and Joint Injury Committee activities for the International Federation of Societies for Surgery of the Hand gave the senior author reason to mentally review his 35 years of experience in this field. About 20 years ago , while still serving as a military hand surgeon, the senior author surveyed 3 consecutive years of experience in the management of a series of 1621 fractures and dislocations of the wrist and hand as seen in his hand clinic . Of these, fractures were seen in 123 distal phalanges (Table I) , 174 distal interphalangeal joints (Tables I and II), 66 middle phalanges (Table II), 259 proximal interphalangeal (PIP) joints (Tables II and III), 229 proximal phalanges (Table III) , 107 metacarpophalangeal (MP) joints (Tables III and IV) , 358 metacarpals (Table IV) , 66 carpometacarpal joints (Table IV), and 213 carpal bones (Table V). There were 34 fracture/dislocations or instabilities (Table V) and 79 dislocations of hand joints other than the carpals (Table VI) . The total number of fractures and dislocations of the carpal and digital joints involved 932 articular segments . From thi s study it was interesting to note that (I) more than half of the fractures and dislocations of the hand and wrist involved the jointsl; (2) the wrist and PIP joints were most commonly involved; (3) most articular fractures healed in time , even if a fragment was displaced; (4) more than 50% of the soft tissue avulsion injuries of the finger joints involved a bony fragment; and (5) a stable although limited arc of motion was present after reduction of most articular fractures and dislocations and many nonarticular fractures and dislocations. Through the ensuing 20 years, there has been no reason to alter these observations . The greatest change in incidence results from recognition of many more carpal injuries than were known at that time. 2• 3 Therefore, a current incidence survey should show more carpal bone fractures and dislocations involving all of the carpal bones or groups of bones . For instance , fractures of the trapezoid and pisiform that were not included in Dobyns ' original survey are now well-known entities . Furthermore , both may be dislocated as can any individual carpal bone. Now recognized are dislocations involving groups of carpal bones, such as those of the scaphotrapezium-trapezoid joints and of the entire thumb axis group including the trapezium , trapezoid, and scaphoid, and similar axial dislocations involving radial, central, or ulnar