Finger Fractures Research Articles

Evaluation of Fractures in Children and Adolescents in a Level I Trauma Center in Austria

Injury represents a major concern for children and adolescents worldwide. It is estimated that 10% to 25% of all pediatric injuries will result in fractures. This study aimed to analyze the epidemiology, gender distribution, age, and circumstances of fractures in childhood in a Level I Trauma Center in Austria. Children managed with fractures between December 2004 and October 2006 were prospectively evaluated. Patients were divided into four age groups: infants (<1 year), preschool children (1-6 years), school-aged children (6-14 years), and adolescents (>14 years). The study included 3,339 patients younger than 19 years, who presented with 3,421 fractures. There was a male predominance (61.3%, n = 2,096). Girls (38.7%, n = 1,325) had a lower mean age at presentation of 8.2 years (boys, 9.8 years). An increase in the incidences of fractures was observed until a peak of 11 years in girls and 12 years in boys. A majority of fractures occurred in sports facilities (34.7%), followed by those at home (17.6%) and outdoors (16.7%). The most frequent mechanisms were falls on level surface (41.9%), falls from a height <3 m (23.2%), and involuntary contact with persons or objects (18.2%). The most common fractures were those of the distal radius (15.3%), followed by those of the finger (14%) and distal forearm fractures (8%). As the Department of Pediatric Surgery in Graz serves as the referral center at least for nearly all major pediatric fractures in the Austrian state of Styria, mechanisms and patterns of major fractures in this study can serve as the basis for state-wide pediatric injury prevention efforts. These prevention strategies should not aim to reduce the level of exposure but should increase the risk awareness and encourage children and their parents to use necessary precautions.

Predictors of the Postoperative Range of Finger Motion for Comminuted Hand and Finger Fractures Treated with a Titanium Plate: Level 2 Evidence

Predictors of the Postoperative Range of Finger Motion for Comminuted Hand and Finger Fractures Treated with a Titanium Plate: Level 2 Evidence

Assessing Rotational Deformity of the Little Finger

Excessive scissoring or overlap of fingers can cause discomfort, weaken grip strength, and affect cosmesis. The treatment of little finger fractures is guided by the degree of scissoring or rotational deformity perceived in the digit. The purpose of this study is to assess the variation of little finger scissoring or overlap in the normal population using standard clinical examination. We evaluated 80 uninjured little fingers in 40 normal patients. The digital images of photographed hands, taken in both extension and flexion, were used to evaluate the overlap percentage of the adjacent fingernail as a proxy for rotation of the digits. Paired t tests were used for statistical analysis. The average fingernail overlap was 25% ± 20%, ranging from 0% to 71%. The average overlap on the left hand was significantly less at 21% ± 18% as compared to 30% ± 21% on the right (P < .01). The average variation between hands in individuals was 16% ± 13%.This study confirms that overlap or scissoring of the little finger varies between the hands of a given individual. Our results question the usefulness of assessing rotational deformity of the little finger by checking for overlap and comparing with the contralateral side. This has implications not only in assessing patients for possible surgery, but also in planning and performing surgical reductions of acute fractures and for correction of malunions.

The Epidemiology of Pediatric Basketball Injuries Presenting to US Emergency Departments: 2000-2006

Background:There is limited published research on the epidemiology of basketball injuries treated in US emergency departments (EDs).Hypothesis:Age and sex patterns exist for the most common pediatric basketball injuries treated in EDs.Study Design:Descriptive epidemiology study.Methods:Data from the National Electronic Injury Surveillance System and the National Sporting Goods Association were used to calculate national injury incidence rates and 95% confidence intervals of pediatric basketball injuries.Results:An estimated 325 465 annual visits were made to US EDs for pediatric basketball-related injuries from 2000 to 2006. The 5 most common injuries were ankle sprains (21.7%), finger sprains (8.0%), finger fractures (7.8%), knee sprains (3.9%), and facial lacerations (3.9%). Among persons aged 12 to 17 years, girls had a higher rate of knee sprains than boys (P < 0.001), but this association did not exist among those aged 7 to 11 years (P = 0.27). Boys had a higher rate of facial lacerations than girls (P < 0.01). Among persons aged 12 to 17 years, girls had a higher rate of finger sprains (P < 0.01). For both boys and girls, the rate of the 5 most common basketball injuries was higher among those aged 12 to 17 years compared with those aged 7 to 11 years (P < 0.01).Conclusions:The annual number of basketball-related pediatric ED visits approaches a third of a million and demonstrates the extent of the public health problem that injuries in this sport pose. Distinct sex and age patterns were observed.Clinical Relevance:The study findings provide important information on basketball injury rates that may be used for targeting prevention interventions by sex and age group.

Contributors to Secondary Osteoporosis and Metabolic Bone Diseases in Patients Presenting with a Clinical Fracture

Previously undetected contributors to secondary osteoporosis and metabolic bone diseases (SECOB) are frequently found in patients with osteoporosis, but the prevalence in patients at the time they present with a clinical fracture is unknown. All consecutive patients with a recent clinical vertebral or nonvertebral fracture, who were able and willing to be investigated (n = 626: 482 women, 144 men, age range 50-97 yr) had bone mineral density and laboratory investigations (serum calcium, inorganic phosphate, 25-hydroxyvitamin D, creatinine, intact PTH, TSH, free T(4), serum and urine protein electrophoresis, and in men also serum testosterone). Known SECOB contributors were present in 23.0% of patients and newly diagnosed SECOB contributors in 26.5%: monoclonal proteinemia (14 of 626), renal insufficiency grade III or greater (54 of 626), primary (17 of 626) and secondary (64 of 626) hyperparathyroidism, hyperthyroidism (39 of 626), and hypogonadism in men (12 of 144). Newly diagnosed SECOBs, serum 25-hydroxyvitamin D less than 50 nmol/liter (in 63.9%), and dietary calcium intake less than 1200 mg/d (in 90.6%) were found at any age, in both sexes, after any fracture (except SECOB in men with finger and toe fractures) and at any level of bone mineral density. At presentation with a fracture, 26.5% of patients have previously unknown contributors to SECOB, which are treatable or need follow-up, and more than 90% of patients have an inadequate vitamin D status and/or calcium intake. Systematic screening of patients with a recent fracture identifies those in whom potentially reversible contributors to SECOB and calcium and vitamin D deficiency are present.

Behandlungsfehler in der Handchirurgie.

Hand surgery is an interdisciplinary specialty in which the contents of further training in the individual fields differ widely. We have first investigated general quality criteria and then the further training programmes of the specialties general surgery, orthopaedic and trauma surgery as well as plastic and aesthetic surgery. On the basis of the treatment error statistics of the Chamber of Medicine of North Rhine-Westphalia from the years 2004-2008, the treatment error quotas for a period of 5 years were evaluated according to specialty and the presence of additional training in hand surgery. This revealed that treatment errors in hand surgery with 41.7% were markedly more frequent than the general average value of 31.1%. On individual evaluations, the error quota for qualified surgeons without additional training was 44% whereas that for surgeons with additional training was 26%. Most frequently treatment errors were reported for distal radius fractures, followed by soft-tissue and cut injuries, carpal tunnel syndrome and finger fractures. The largest difference in the error quotas for the groups with and without further training in hand surgery was found for soft-tissue injuries including tendon injuries, 13.3% as compared with 53.7%.

Pull-Out Wire Fixation for Acute Mallet Finger Fractures With K-Wire Stabilization of the Distal Interphalangeal Joint

The aim of this study was to describe and assess a surgical technique for the treatment of mallet finger fractures using a pull-out wire with K-wire stabilization of the distal interphalangeal (DIP) joint in extension. From May 2003 to January 2008, we performed pull-out wire fixation of the fracture fragment with stabilization of the DIP joint using a K-wire in 65 closed mallet finger fractures in 65 patients with a mean age of 32 years (range, 18-48). The mean time between the injury and surgery was 8 days (range, 0-19 d). In this cohort, the mean joint surface involvement was 39% (range, 30% to 49%) and all injuries were associated with DIP joint subluxation. Fifteen days after surgery, the digits were assessed for skin necrosis, skin breakdown, and wound and wire track infection. Patient follow-up lasted 24 to 27 months, with a mean period of 25.5 months. The fingers were assessed for loss of extension and flexion of the DIP joints. We graded the results using Crawford's criteria. Fracture reduction was maintained and all fractures united. We found no skin necrosis, skin breakdown, infection, or nail deformities. At the final follow-up, the mean extensor loss of the DIP joints was 7° (range, 0° to 37°). The mean flexion loss of the DIP joints was 1° (range, 0° to 15°). We noted extensor loss of the joint less than 10° in 57 digits and 10° to 15° (mean, 13°) in 8 digits. Based on Crawford's criteria, 52 digits were excellent, 8 were good, 4 were fair, and one was poor. Pull-out wire fixation of the reduced fracture fragment and K-wire stabilization of the DIP joint is a useful technique for the treatment of mallet finger fractures. Therapeutic IV.

Pertes de substance osseuse à la main et au poignet traitées en urgence par technique de la membrane induite (technique de Masquelet)

A prospective study is reported concerning 11 cases of bone defect of the hand and wrist treated by the induced membrane technique. Ten men and one woman with an average age of 49 yrs (17–72) sustained a high-energy trauma with severe mutilation of digit and hand but with intact pulp. Eight cases of open finger fractures with composite loss of substance and three cases of bone and joint infection (thumb, wrist, fifth finger) were included. All cases were treated by the induced membrane technique which consists in stable fixation, flap if necessary, and in filling the bone defect by a cement methyl methacrylate polymere (PMMA) spacer. A secondary procedure at two months is needed where the cement is removed and the void is filled by cancellous bone. The key point of this induced membrane technique is to respect the foreign body membrane which formed around the cement spacer creating a biologic chamber. Bone union was evaluated prospectively by X-ray and CT scan by a surgeon not involved in the treatment. Failure was defined as non-union at one year, or uncontrolled sepsis at one month. Two cases failed to achieve bone union. No septic complications occurred and all septic cases were controlled. In nine cases, bone union was achieved within four months (three to 12). Evidence of osteoid formation was determined by a bone biopsy in one case. Masquelet first reported 35 cases of large tibial non-union defects treated by the induced membrane technique. The cement spacer promotes foreign body membrane induction constituting a biological chamber. Works on animal models reported by Pellissier and Viateau demonstrated membrane properties: secretion of growths factors (VEGF, TGF beta1, BMP2) and osteoinductive cellular activity. The induced membrane seems to mimic a neoperiosteum. This technique is useful in emergency or septic conditions where bone defects cannot be treated by shortening. It avoids microsurgery and is limited by availability of cancellous bone.

Nonunion and Avascular Necrosis Following Phalangeal Neck Fractures in Children

To investigate the characteristics of nonunion and avascular necrosis following phalangeal neck fracture in children. A cohort of all pediatric phalangeal neck fractures complicated by nonunion, with or without avascular necrosis of the phalangeal head, over the last 10 years was reviewed retrospectively. The following data were documented: age, gender, fracture site, mechanism of injury, fracture type, presence of digital ischemia, initial management, and outcome. Our database of phalangeal neck fractures in children over the last 10 years included 215 fractured digits. Of these, 4 developed nonunion (group A) and 8 developed nonunion with avascular necrosis (group B). All patients in group A were young children (mean age, 2.5 y) with fractured thumbs, initially managed by closed reduction and splinting. The fractures redisplaced and failed to unite, resulting in instability that was later treated by bone grafting and stabilization with a K-wire. Patients in group B were older children (mean age, 5.6 y) and 7 of 8 had finger fractures. All 8 patients presented with stiffness of the affected joint, and no further surgery was performed. When nonunion occurs following pediatric phalangeal neck fractures, it usually affects the thumb and presents with thumb instability, and bone grafting is often required to achieve union. In contrast, avascular necrosis following phalangeal neck fractures usually affects the little finger and presents with stiffness, and hence, further surgery is not often required short term, although the long-term result after skeletal maturity is unknown. Therapeutic IV.

Finger fractures imaging: accuracy of cone-beam computed tomography and multislice computed tomography

To compare the diagnostic accuracy and radiation exposure of cone beam computed tomography (CBCT) and multislice computed tomography (MSCT) in the evaluation of finger fractures. In a 3-year period, 57 consecutive patients with post-traumatic fractures of the metacarpal-phalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints with involvement of the articular surface were studied by means of CBCT and MSCT. Student's t test was used to compare CBCT and MSCT accuracy in evaluating the percentage of joint surface involvement and in detecting bone fragments. The average tissue-absorbed doses of CBCT and MSCT were also compared. A value of p < 0.05 was considered statistically significant. Inter-observer agreement was calculated. In all cases, CBCT allowed the percentage of articular involvement to be correctly depicted compared with MSCT, showing 100% sensitivity and specificity (p < 0.001). A total of 103 bone fragments were depicted on MSCT (mean 3.8 per patient, range 1-23). CBCT indicated 92 out of 103 fragments (89.3%) compared with MSCT (mean diameter of missed fragments 0.9mm, range 0.6-1.3mm), with no statistically significant difference between CBCT and MSCT (p < 0.025). Multislice CT radiation exposure was significantly higher than that of CBCT (0.18mSv vs 0.06mSv, p < 0.0025). Inter-observer agreement was good (overall κ = 0.89-0.96). Cone beam CT may be considered a valuable imaging tool in the preoperative assessment of finger fractures, when MSCT is not available.

The Hand Arc—A Hand-based Splint Design for Intraarticular Fractures

When a fracture of the finger is intraarticular in nature, it adds another dimension to the rehabilitation program, as the joint space is affected and subsequently gaining motion can be a challenge. Traction splinting has been reported in the literature as one way to manage intraarticular finger fractures in an attempt to provide stability while allowing motion. These authors have modified some of the original traction splints to create a hand-based version to use for the patients with an intraarticular, proximal interphalangeal joint fracture.

Two extension block Kirschner wire technique for mallet finger fractures

We treated 32 displaced mallet finger fractures by a two extension block Kirschner-wire technique. The clinical and radiological outcomes were evaluated at a mean follow-up of 49 months (25 to 84). The mean joint surface involvement was 38.4% (33% to 50%) and 18 patients (56%) had accompanying joint subluxation. All 32 fractures united with a mean time to union of 6.2 weeks (5.1 to 8.2). Congruent joint surfaces and anatomical reduction were seen in all cases. The mean flexion of the distal interphalangeal joints was 83.1 degrees (75 degrees to 90 degrees ) and the mean extension loss was 0.9 degrees (0 degrees to 7 degrees ). No digit had a prominent dorsal bump or a recurrent mallet deformity. We believe that this technique, when properly applied, produces satisfactory results both clinically and radiologically.

Is the Use of Biodegradable Devices in the Operative Treatment of Avulsion Fractures of Fingers, the So-Called Mallet Finger Advantageous? A Feasibility Study with Meniscus Arrows®

Purpose:Treatment of Mallet fingers or fractures remains a controversial topic. No evident preference can be distilled from the reports of the clinical results obtained by conservative treatment with splints and internal fixation. If operative treatment is indicated, several techniques can be used. However, each technique has disadvantages like the risk of comminution of the fragment, the risk of infection and necrosis, a demanding operative technique and-or the necessity of removing the metallic devices. This can be avoided by the use of biodegradable devices. The purpose of this feasibility study was to evaluate the outcome of internal fixation of a Mallet fracture with a biodegradable device, the Meniscus Arrow®.Methods:We treated nine consecutive patients with a Mallet fracture by fixation of the fragment with a biodegradable Meniscus Arrow®, at this moment the smallest device available, with an average operation time of 14 minutes.Results:Postoperatively, no complications were found. All patients were satisfied by the results after surgery, with a restored range of motion in the distal interphalangeal joint as previously and good alignment with full consolidation of all fractures at radiological evaluation.Conclusions:The operative treatment of bony mallet fingers with the Meniscus Arrow® is a fast procedure without complications in our prospective series of nine patients and without the need of a second operation to remove the implant.

River Tree Rope Swing Injuries

To review injuries associated with falls from river tree rope swings (RTRS) and identify points of action for prevention. This study was a retrospective analysis of injury reports directly related to falls from RTRS. Case reports for 2002-06 were extracted from the National Electronic Injury Surveillance System (NEISS), US legal literature, and news reports. Direct observation of river tree rope swings was performed with kayak and camera to identify potential hazards. A laboratory study was performed on samples of rope used in RTRS to assess entanglement risk. NEISS detailed 73 injuries directly related to falls from RTRS in ages 5-25 years. Finger fractures were the most commonly reported injury. Based on NEISS data, an estimated 700 injuries may occur related to RTRS each year. RTRS share risk of severe injuries with traditional rope swings such as lower extremity fractures, concussions, and spinal cord injuries. Drowning, finger avulsion and genital lacerations appear more common with river tree rope swings. RTRS are dangerous and are associated with a variety of serious injuries from falls and entanglement. The most hazardous risk factors of RTRS are use by a non-swimmer, shallow water, extreme fall distance, and presence of a small diameter retrieval line. RTRS injuries occurring in remote locations are challenges to rural physicians and EMS providers. Prevention of recreational injuries, including injuries sustained from RTRS, remains a daunting task.

Konservative Behandlung von großen ossären Malletläsionen: 10 Fälle

Operative stabilisation of mallet finger fractures is generally recommended in cases with more than one-third of the articular surface involved. Results of surgical stabilisation are often unsatisfying regarding anatomic reconstruction of the joint surface and mobility of the DIP joint. In a retrospective study we present the results of conservative treatment of 10 consecutive patients with mallet finger fractures involving one-third to two-thirds of the joint surface. Treatment consisted in splinting with a dorsal aluminium splint for 4 to 6 weeks, nightsplinting continued for a total of 8 weeks. Functional results at 9 months follow-up are very good with an extensor lag of maximally 5 degrees in 5 cases, a reduced flexion of maximally 10 degrees in 2 cases. All patients are pain-free. Radiological results show a very good remodelling of the DIP joint surface with anatomic joint congruency even in cases with initially up to 3 mm fragment displacement and 1 mm fragment rotation. There was no secondary palmar subluxation. Our findings support the conclusion of Wehbé and Schneider and Tuttle et al. that most mallet finger fractures can be treated conservatively, regardless the size and amount of displacement of the bone fragment. In conclusion, we consider that operative stabilisation has to be discussed only in the presence of palmar subluxation.

Non-operative treatment of common finger injuries

Finger fractures are common injuries with a wide spectrum of presentation. Although a vast majority of these injuries may be treated non-operatively with gentle reduction, appropriate splinting, and careful follow-up, health care providers must recognize injury patterns that require more specialized care. Injuries involving unstable fracture patterns, intra-articular extension, or tendon function tend to have suboptimal outcomes with non-operative treatment. Other injuries including terminal extensor tendon injuries (mallet finger), stable non-articular fractures, and distal phalanx tuft fractures are readily treated by conservative means, and in general do quite well. Appropriate understanding of finger fracture patterns, treatment modalities, and injuries requiring referral is critical for optimal patient outcomes.

Treatment of intra-articular fractures of the fingers

目的 探讨手指关节内骨折脱位的内固定方法及其疗效.方法 1994年6月-2007年1月,对25例28处手部关节内骨折的患者,分别采用张力带钢丝、微型螺钉和克氏针夹扣法固定的方法进行治疗.并比较三种固定方法在近节指骨基底撕脱性骨折、近侧指间关节各型骨折的应用选择及效果.结果 术后随访3个月～11.5年,平均6.4年.术后28处骨折均愈合.根据主观和客观征象进行评定:优25处,良3处.X线片征象显示:优23处,良5处(为陈旧骨折).手指关节活动度为55°～110°,平均70°.结论 对手指关节内骨折,应重视骨折的精确复位和关节周围韧带的保护、修复,指间关节侧方骨折脱位采用张力带钢丝固定或微型螺丝钉固定,指间关节背侧和掌侧撕脱性骨折采用克氏针夹扣法固定可获得较满意的疗效。

Emergency finger fractures – An easy fix

Many finger fractures can be treated with low-technology open or closed pinning. With our ability to provide effective local anesthesia and hemostasis (1,2), the only reason to transfer the patient from the emergency department to the main operating room is to utilize power equipment to drive K-wires and C-wires to obtain the desired reduction and fixation. Many surgeons were quite comfortable using the Riordan pin, which has been taken off the market. Many surgeons have also used simple hypodermic needles, bending the tip slightly forward into the long axis of the needle so that it can be driven straight. Unfortunately, due to the hard bones of young male patients and the somewhat insecure attachment of the plastic needle to the plastic syringe, it can sometimes be difficult to efficiently pin some fractures. K-wires have an unsuitable tip configuration and need to be driven at high rotation and pressure into bone (with accompanying undesirable heat) (3). C-wires are a great mechanical improvement. They can be driven more slowly with higher torque. They cut efficiently and less traumatically into bone, and are reminiscent of the chairmaker’s bits of the 19th century. I have devised a simple, modified vise grip as an effective pin driver, which I have used on hundreds of occasions in the emergency department (Figure 1). Using this tool, I have been able to fix virtually any fracture suitable for pinning without the significant inconvenience of obtaining time in the operating room. Figure 1) Needle driver created from a modified vise grip Initially, the vise grip was used successfully without any modification. The grip was somewhat less precise and secure, so a slight modification (the creation of a slot) was devised. The slot was created with the use of a Dremel tool (Dremel, USA) and a fine cutting disk. A slot could be made equally simply with a fine triangular file, although likely with less accuracy and precision. As seen in Figure 1, a simple longitudinal slot is cut into one jaw of the vise grip, angled very slightly off centre so that the C-wire rests without tension along the handle. The vise grip holds the pin absolutely securely, which can then be driven manually under controlled rotation and pressure into the bone and across the fracture. The vise grip even has a built-in wire cutter, further minimizing the equipment required. I have never had a complication using this simple device as described. It can be autoclaved numerous times before some slight rusting is noted. It can then, of course, be retired back to the workshop, where there are no cosmetic concerns, to continue its useful existence.

Traumatologie et hockey sur glace

To examine finger, thumb, hand, wrist, and forearm fractures in the National Hockey League (NHL) and determine: (1) basic demographic data, (2) return to sport (RTS) rates, (3) performance after RTS, and (4) the difference in RTS between players treated operatively versus conservatively.NHL players with finger, thumb, hand, wrist, and forearm fractures between the 1995-1996 and 2014-2015 seasons were identified through team injury reports and archives on public record. Player demographics, RTS rate, games played per season, and performance score for each player were recorded and compared between the preinjury season and one season following injury.A total of 247 total NHL players with hand, wrist, and forearm fractures were identified, consisting of 30.8% finger, 38.5% hand, 13.8% thumb, 14.6% wrist, and 2.4% forearm fractures. Defenseman comprised the majority of players (40.1%). The overall RTS rate was 98.0%, with no significant difference between players with surgery or between injury location groups. In total, 52 players (21.1%) underwent surgery with no significant correlation of surgery rates based on fracture location. The mean number of missed games was 13.8 ± 9.9, with players sustaining wrist and forearm fractures missing the largest number of games (21.6 ± 17.7and 22.8 ± 7.5 games missed, respectively). There was no significant change in games played or performance scores 1 year after injury for players with any of the fracture types compared with baseline preoperative games played and performance.NHL players have a high RTS rate following hand, wrist, and forearm fractures. Players were able to return to preinjury performance within 1 year, regardless of treatment or type of fracture.Level IV, case series.

Conservative treatment for closed fifth metacarpal (small finger) fractures

Conservative treatment for closed fifth metacarpal (small finger) fractures