Operative Treatment of Common Displaced and Unstable Fractures of the Hand

Abstract

The hand is an instrument of performance and protection. Whether at war, work, competition, or recreation, an individual’s reflexes routinely place the hand in harm’s way to protect the head and body. Accidents inevitably occur, resulting in fractures of the metacarpals and phalanges and other injuries. This Instructional Course Lecture addresses, in particular, the craft of reduction and stabilization of displaced, irreducible, and unstable fractures of the hand as an integral part of reestablishing skeletal integrity and refined digital function. The goals of treatment include returning manual laborers to their work or to the practice of their special skills, professionals to their tasks, students to their classrooms, writers to their pens, musicians to their instruments, artists to their brushes and easels, athletes to their contests, parents to their families, children to life’s enjoyments, and increasing numbers of the world’s population to a variety of digital keyboards and computers. Fracture management should be principle-driven. These principles include the attainment of anatomical (or near-anatomical) position, adequate stability to allow both fracture-healing and early active digital motion, and minimization of additional soft-tissue damage when fixation of the fracture is required1. Function follows form. Although there is some tolerance for deformity, excessive angulation or rotation of a fractured digit may obstruct the motion and function of an adjacent digit and, consequently, the hand. Bone angulation, shortening, or a combination of the two affects muscle-tendon tension, leading to digital deformity as well as to loss of motion, strength, power, and endurance. While the prevalence, rate of development, and severity of posttraumatic arthritis and pain in the joints of the hand may be less than those in larger joints, particularly weight-bearing joints, there should be no complacency in the pursuit to reestablish joint congruity when repairing an intra-articular fracture2-4. A single …