Hand Fractures Research Articles

Healthcare Providers and Parents Highlight Challenges of Pediatric Hand Fracture Care.

We conducted a qualitative descriptive study using virtual focus groups. Emergency physicians, hand therapists, plastic surgeons, and parents of children treated for hand fractures were asked to discuss their experiences with existing care for pediatric hand fractures, and perceptions surrounding the implementation of a new care pathway. Data were analyzed using directed content analysis with an inductive approach. Four focus groups included 24 participants: 18 healthcare providers and six parents. Four themes were identified: educating parents throughout the hand fracture journey, streamlining the referral process for simple hand fractures, identifying the most appropriate care provider for simple hand fractures, and maintaining strong multidisciplinary connections to facilitate care. Participants described gaps in the current care, including a need to better inform parents, and elucidated the motivations behind emergency medicine physicians' existing referral practices. Participants also generally agreed on the need for more efficient management of simple hand fractures that do not require surgical care. Healthcare providers believed the strong preexisting relationship between surgeons and hand therapists would facilitate the changes brought forward by the new care pathway. These findings highlighted shortcomings of existing care for pediatric hand fractures and will inform the co-development and implementation of a new care pathway to enable more efficient management while preserving good patient outcomes.

Comparison of Pain Catastrophic Scale and Anxiety in Patients With Boxer's Fracture and Other Types of Hand Fractures.

The Pain Catastrophic Scale (PCS) is generally associated with high and low post-recovery satisfaction and measures the pain perception of patients in the literature.This study aims to evaluate the association ofdeliberate (as in a fight or anger causing punching a wall)boxer's fractureswith catastrophic pain compared to accidental (as in a fall, accidental knocking it against a wall, etc.) fractures and evaluate the effect of anxiety about fracture union and functional recovery on clinical outcomes. A total of 62 male patients with metacarpal fractures, 31 as a result of deliberate punching (1st group) and 31 with metacarpal fractures as a result of an accident (2nd group), who applied to the emergency department or orthopedic clinic with the diagnosis of metacarpal fracture between January 2021 and October 2022, were included in the study. All patients were selected from patients who were followed up with conservative plaster/splint. The PCS scores of the patients were evaluated comparatively with the clinical results measured after at least six weeks. The mean age of the patients was 30.8 (18-50) in the 1st group and 34.8 (18-64) in the 2nd Group, and no statistically significant difference was found (p=0.274). While the median PCS score was 10.5 (interquartile range {IQR}: 12.3) for the 1st group, the median PCS score was 17.5 (IQR: 14.5) for the 2nd group, and the PCS score was statistically significantly lower in group 1 (p=0.009).While the median Visual Analogue Scale (VAS) value was 0 (IQR: 0.3) for the 1st group, the median VAS value was 1 (IQR: 2.0) for the 2nd group, and the VAS score was statistically significantly lower in the 1st group (p<0.001). While the median 'quickdisabilities of the arm, shoulder, and hand'(Q-DASH) value was 0 (IQR:2.3) for the 1st group, the median Q-DASH value was 3.4 (IQR:6.3) for the 2nd group, and the Q-DASH score was statistically significantly lower in the 1st group (p=0.001). No significant difference was observed between the 1st and2nd groups in terms of grip strength values (p=0.815). The etiology of patients presenting with a boxer's fracture should be well understood, and if necessary, these patients should be treated multidisciplinary, with psychiatric help. Better satisfaction can be achieved with lower results in patients whose PCS scoring system has lost its eigenvalue.

Developing a core outcome set for hand fractures and joint injuries in adults.

The aim of this study was to develop a core outcome set of what to measure in all future clinical research on hand fractures and joint injuries in adults. Phase 1 consisted of steps to identify potential outcome domains through systematic review of published studies, and exploration of the patient perspective through qualitative research, consisting of 25 semi-structured interviews and five focus groups. Phase 2 involved key stakeholder groups (patients, hand surgeons, and hand therapists) prioritizing the outcome domains via a three-round international Delphi survey, with a final consensus meeting to agree the final core outcome set. The systematic review of 160 studies identified 74 outcome domains based on the World Health Organization International Classification of Functioning, Disability, and Health. Overall, 35 domains were generated through thematic analysis of the patient interviews and focus groups. The domains from these elements were synthesised to develop 37 outcome domains as the basis of the Delphi survey, with a further four generated from participant suggestions in Round 1. The Delphi survey identified 20 outcome domains as 'very important' for the core outcome set. At the consensus meeting, 27 participants from key stakeholder groups selected seven outcomes for the core outcome set: pain/discomfort with activity, pain/discomfort with rest, fine hand use/dexterity, self-hygiene/personal care, return to usual work/job, range of motion, and patient satisfaction with outcome/result. This set of core outcome domains is recommended as a minimum to be reported in all clinical research on hand fractures and joint injuries in adults. While this establishes what to measure, future work will focus on determining how best to measure these outcomes. By adopting this patient-centred core outcome set, consistency and comparability of studies will be improved, aiding meta-analysis and strengthening the evidence base for management of these common and impactful injuries.

Outcome of functional treatment with a Lucerne Cast in patients with hand fractures: a retrospective case series.

The purpose of this study was to determine the clinical outcome of patients treated with a functional Lucerne Cast (LuCa) for different types of hand fractures. Static casting has traditionally been the preferred treatment for hand fractures. However, functional casting may lead to good functional outcomes, less stiffness, and earlier return to work. A retrospective case series of all consecutive patients with a metacarpal or proximal phalangeal fracture treated with a LuCa between 2018 and 2019 was conducted. A total of 90 patients were included. Clinical data were collected directly from the patient's medical records. Functional outcome was assessed with the Michigan Hand Outcomes Questionnaire (MHQ). The median MHQ score was 95 (IQR 83-100) with a median follow-up of 23months. Complications occurred in 7 of 90 patients (8%). Functional impairment occurred in two (2%) patients. Functional impairment was defined as stiffness, persisting rotational deformity, a boutonnière or swanneck deformity. Persisting pain or CRPS occurred in six (7%) patients. The LuCa shows to be effective in the functional treatment of both metacarpal and proximal phalangeal fractures with excellent patient-reported outcomes but at a relatively high rate of persisting pain.

Reliability of WhatsApp images of plain radiographs to diagnose fractures of the hand and wrist.

We assessed the reliability of plain radiographs interpreted through WhatsApp messaging system in orthopaedic hand trauma consultation in a large teaching hospital. Plain radiographs of 25 hand fractures and five normal radiographs were captured from a picture archiving and communication system using iPhone XS smartphone, anonymized and sent to 53 orthopaedic residents' and consultants' personal smartphones. The participants independently assessed the images and answered questions on fracture identification and characteristics, diagnostic confidence, further imaging and surgical inclination. The study was repeated after a 1-month washout period using the picture archiving and communication system on the hospital desktop. The results showed good (0.60 < ƙ < 0.80) intraobserver agreement on fracture identification and characteristics. The overall diagnostic accuracy for hand fractures was 95% on WhatsApp and 99% on the desktop. In conclusion, images of plain radiographs transmitted via WhatsApp were reliable for interpretation in orthopaedic hand trauma consultation.Level of evidence: IV.

ANATOMY, EPIDEMIOLOGY, DIAGNOSIS, MANAGEMENT AND TREATMENT OF THE METACARPAL FRACTURES

Introduction: The fracture of the neck of the fifth metacarpal, also known as boxers fracture, is one of the most frequent traumatic pathologies seen in the emergency department and is usually treated with conservative measures. The fifth metacarpal is the most frequently fractured, representing almost 25% of all metacarpal fractures and 10% of all fractures. Objective: to define and explore the anatomy, epidemiology, approach, diagnosis, management and treatment of metacarpal fractures. Methodology: a total of 40 articles were analyzed in this review, including review and original articles, as well as cases and clinical trials, of which 26 bibliographies were used because the information collected was not important enough to be included in this study. The sources of information were Cochrane, PubMed and Google Scholar, SciElo; the terms used to search for information in Spanish, Portuguese and English were: fractura del boxeador, fratura do metacarpo, fracture of the fifth metacarpal and boxers fractures. Results: About 30% of all hand fractures and 18% of all below-elbow fractures are metacarpal fractures. Small-finger neck fractures and ring-finger shaft fractures are among the most frequent metacarpal fractures.To diagnose the boxers fracture and evaluate the degree of angulation, plain radiographs are the gold standard. Fractures with significant angulation require closed reduction and splinting. Surgical management can result in hardware-related issues such as adhesions, infection, and tendon rupture, whereas a more conservative approach may result in malunion or stiffness due to immobilization. Conclusions: Uncomplicated fractures of the fifth metacarpal are usually treated with immobilization and splinting or neighboring strapping, with a comparable degree of functional outcome. In Metacarpal head fractures nonoperative treatment options include immobilization in the intrinsic plus position. Small finger metacarpal neck fractures are the most typical and are frequently referred to as boxers fractures. Metacarpal fractures that have no associated rotational deformity can typically be managed conservatively with immobilization and serial radiographs. The use of the Jahss maneuver can result in reduction of fractures with rotational deformity or pseudoclawing. The most common types of metacarpal shaft fractures are transverse fractures, oblique fractures, and comminuted fractures. Operative intervention should be taken into consideration if there is pseudoclawing, rotational deformity, significant metacarpal shortening, or a noticeable dorsal deformity. Despite being a rare injury, intra-articular base fractures of the index- through ring-finger metacarpals have been suggested to be an underreported and misdiagnosed condition. Complications related to these injuries are prevalent and may result from surgical or non-surgical treatment of the initial injury. KEYWORDS: fracture of the fifth metatarsal, Boxers Fracture, hand injury.

Association between Pain, Catastrophic Thinking, and Health-related Quality of Life in Patients with Hand Fractures

: Few reports have investigated the relationship between pain, catastrophic thinking, and health-related quality of life (QOL) in patients with hand fractures. We investigated the correlation between scores of the pain Numeric Rating Scale (NRS) and the Pain Catastrophizing Scale (PCS; rumination, helplessness, and magnification), and between the scores of PCS and health-related QOL based on the Short Form 8 questionnaire (SF-8).: Thirty-seven patients with hand and finger fractures were treated in a public hospital (16 men, 21 women; mean age, 56.5 years) and were treated by an occupational therapist. The relations between NRS, PCS, and SF-8 scores were examined at 4 to 6 months post-treatment. The effects of hand pain on catastrophic thinking and on mental, psychological, and daily role-based factors were analyzed by correlation and partial correlation analyses.The mean NRS score was 2.13. The mean PCS subitem scores were: rumination, 6.00; helplessness, 1.97; and magnification, 2.18. There were significant positive correlations between the NRS and all PCS scores. Relations between the PCS scores and SF-8 subitem scores, excluding items that were not correlated with NRS in partial correlation analysis, indicated significant negative correlations between multiple PCS subitems and SF-8 subitem scores for role physical, bodily pain, vitality, mental health, and physical component summary.Pain and catastrophic thinking were correlated with health-related QOL in patients with hand fractures. In addition to assessing hand pain, therapists should monitor the effects of mental and psychological factors and daily activities in this group of patients.

The epidemiology and distribution of hand fractures in Singapore.

The aim of this study was to elucidate the epidemiology and distribution of hand fractures in Singapore. A total of 701 hand fractures in 596 patients aged 21 years and above from a single centre were reviewed from 2010 to 2011. Details regarding the patient demographics, occupation, mechanism of injury, associated injuries and treatment were obtained. Hand fractures were particularly significant in patients between the ages of 21 and 40 years 58.9% of the total cases. The relative risk of hand fractures in males was 5.5 times greater than that in females. The majority of hand fractures occurred at the workplace (47.7%), with crush injury being the main mechanism of injury (33.6%). The most common locations of hand fracture were the little finger ray (31.2%) and distal phalanges (37.7%). There were 170 cases that underwent surgical fixation, which accounted for 24.3% of all fractures. Fixation rate was similar for both closed and open fractures but was significantly higher in the proximal and middle phalanges compared to the distal phalanx and metacarpal (P < 0.001). With regards to surgical fixation methods, wires were commonly used in either tuft fractures (100.0%) or intra-articular fractures (69.9%), whereas plates and screws were commonly used in shaft fractures (65.5%). The most significant population that sustained hand fractures in Singapore are young to middle-aged males who are skilled manual workers. The most commonly involved ray and location of hand fractures are the little finger ray and the distal phalanges, respectively, as they are in a relatively more exposed location.

Joshi's external stabilization system and K-wire fixation in the management of hand fractures – A prospective comparative study

Background: Hand fractures can be treated conservatively or surgically, depending on the severity, location, and type of fracture, as in conservative management chance of nonunion, malunion, and stiffness is more if it is displaced or angulated fracture. Various modes of treatment have been used which include K-wire fixation, mini plates, and external fixator application. A modified form of mini-external fixator devised in India is Joshi's External Stabilization System (JESS). Aim: This prospective study was conducted to compare the functional and radiological outcomes following metacarpal/phalangeal fracture fixed with either K-wire or JESS. Materials and Methods: Forty patients with hand fractures (58 fractures – 18 metacarpal and 40 phalanges) were prospectively studied. Twenty patients underwent K-wire fixation and 20 were fixed with JESS, functional and radiological outcomes were assessed, grip strength using dynamometer, visual analog scale (VAS) score, disabilities of the arm, shoulder, and hand (DASH) score, range of motion (ROM) using the American Society for Surgery of the hand scale, tip pinch strength. Student's t-test, Wilcoxon test, Fisher's exact test, and Chi-squared test were used. Results: At 6 months' follow-up, patients fixed with either of the fixation modality showed statistically significant improvement in different outcome variables such as ROM (P < 0.001), quick DASH score (P < 0.001), VAS score (P < 0.001), tip pinch strength (P < 0.001), and hand grip (P < 0.001). All the fractures united at an average 6 weeks. Functional outcomes were excellent in closed fracture fixed with either JESS or K-wire and good to moderate in open injuries. However, overall comparison between K-wire and JESS, no significant difference in these outcome measures was found. Conclusions: K-wires as well as JESS both provide adequate stability and satisfactory results in fractures of the metacarpal and phalanges. This study could not find the superiority of JESS over traditional K-wire fixation.

Joshi's external stabilization system fixator – A mini solution to avert major disabilities in hand injuries

Background: Fractures of hand bones are often considered minor injuries and treatment is either delayed or neglected. These fractures are usually treated conservatively that leaves behind a residual functional deficit. Surgical intervention should be considered for open, unstable, multiple, comminuted, or intra-articular fractures. Standard surgical treatment includes the use of K-wire, plate, or mini-screws which are associated with unsatisfactory results and high complication rates. Joint stiffness is a commonly reported complication with most of the existing devices used for hand bone fractures. There is a deficit of data pertaining to the effectiveness of Joshi's External Stabilization System (JESS) in avoiding joint stiffness. Joshi's external fixator is a reliable treatment of phalangeal and metacarpal fractures of the hand. It is an economical, simple, lightweight, and stable contract. Patients and Methods: We report a prospective cohort study of 30 patients of hand bone fracture, 10–60-year age range, treated by JESS. Functional evaluation was made using the Duncan et al. scoring. Results: The results recorded were excellent in 31.58% of cases, good in 42.11% of cases, fair in 21.05%, and poor in 5.26% of patients. Conclusion: JESS ex-fix for hand is a useful construct that allows early mobilization of nearby joints. It can be considered a suitable choice for the management of phalangeal and metacarpal fractures of hand to deliver good functional outcome.

Comparison of injury profiles between elite Australian male and female cricket players.

This study presents seven seasons of injury surveillance data for both elite Australian male and female cricket players, revealing injury statistics and allowing for comparison between sexes. Retrospective cohort. Participants were elite Australian male and female cricket players who were contracted to play for a national and/or state/territory team and/or T20 franchise between 2015-16 and 2021-22 (7 seasons). Injury data was recorded in Cricket Australia's Athlete Management System database and combined with match data. The STROBE-SIIS statement was used as the relevant guideline for this study. Data for 1345 male player seasons and 959 female player seasons revealed sex-related differences in the injury incidence rates and prevalence. Males had higher incidence (average 136 vs 101 injuries per 1000 match days) and prevalence of match time-loss injuries (average 10.4% vs 6.5% players unavailable). However, the overall incidence of all medical attention injuries were similar between sexes (Incidence Rate Ratio (IRR) 0.9, 95%CI 0.8-1.0). The most frequent match time-loss injuries for males were hamstring strains (7.4 new injuries per 100 players per season), side and abdominal strains (5.5), concussion (5.0), lumbar stress fractures (4.3), and wrist and hand fractures (3.9). The most frequent match time-loss injuries for females over the 7 seasons were hamstring strains (3.1), concussion (2.3), quadriceps strains (2.4) and shin/foot/ankle stress fractures (2.0). The IRR of medical attention injuries for males compared to females was higher for lumbosacral stress fractures (IRR 2.3), elbow and forearm injuries (1.5), and concussion (1.4), and lower for lower leg, foot, and ankle stress fractures (0.6), shoulder and upper arm injuries (0.7), and quadriceps strains (0.6). Robust long-term injury surveillance enabled the injury profiles of elite Australian male and female cricket players to be understood and compared. Males had a higher incidence and prevalence of match time-loss injuries, likely reflecting a higher match exposure.

Extra Periosteal Sliding Plate, a New Surgical Technique for the Treatment of Fractures of the First Metacarpal and Proximal Phalanx

Background: One of the most important objectives when performing an open reduction of a fracture is to achieve a stable internal fixation with minimal damage of the periosteum to preserve irrigation in the fracture site and thus promote adequate healing. Minimally Invasive plate osteosynthesis (MIPO) follow this key technical point with great effectiveness and efficiency, however, a reduction technique with these characteristics for the management of hand fractures has not yet been widely described for the management of hand fractures. Methods: The authors technique proposes a new surgical technique “extra-periosteal sliding plate” fixation for first metacarpal and proximal phalanx fractures. Data are obtained from 9 patients from June 2022 to January 2023 and a threemonth postoperative follow-up is performed where functionality and rehabilitation results are evaluated. Results: In total nine patients underwent to the described technique achieving adequate fracture stability and total bone healing with favorable functional outcomes without sequelae. Conclusion: Extra-periosteal sliding plate fixation is considered a great surgical option for the management of hand fractures, specially in those patients with severe trauma in whom vascular and soft tissue integrity must be preserved, providing suitable functional outcomes.

Outcomes of mini-open retrograde intramedullary headless screw fixation of metacarpal fractures

Abstract Background Metacarpal fractures accounting around one-third of hand fractures, which account for ten percent of all fractures and happen predominantly between the ages of 30 and 40. This research objected to examine the radiological, functional, and complication-reduction effects of closed reduction and internal fixation utilizing headless compression screws in metacarpal fractures cases. Patients and methods This prospective one-arm research involved 24 subjects with a total of 25 unstable metacarpal neck and shaft fractures surgically treated at Menoufia university hospital and Sheikh-Zayed Specialized, Egypt. They were controlled with intramedullary headless compression screws (IMHS). Results Complications were reported in 5 (20.8%) patients, Union of fracture was reported in 23 (95.8%) patients. The mean TAM score was 250.63 ± 19.58 ranging between 180 and 260 with a median of 260. The mean dash score was 1.75 ± 2.91 ranging between 0 and 11.36 with a median of 0.00. Conclusion The metacarpal fractures IMHS fixation is an effective, safe, and complication-free treatment and looked to need less imposing and restore function more quickly.

Metacarpal Fractures

Hand-related trauma is a common injury accounting for nearly a million emergency department visits annually. Fractures involving the metacarpals comprise approximately 40% of all hand injuries. Sports-related injuries are seen most often in children and young adults; middle-aged workers suffer more motor vehicle accident or work-related/industrial injuries; and the elderly seems to injure their hands from ground-level falls. The most commonly reported hand fracture involves the fifth metacarpal neck. Metacarpal fractures are described by their bone location in which they occur (head-neck-shaft-base). Fracture patterns are referred to as transverse, oblique (short/long), or comminuted based on fracture line configuration. The predominance of metacarpal fractures is closed injuries. However, open metacarpal fractures can result from severe bone and soft-tissue trauma caused by bone fragment(s) lacerating the skin. Small finger metacarpal neck fractures have the highest probability of being associated with an open fracture because of their injury mechanism. The primary goals of metacarpal fracture treatment are to achieve acceptable alignment, stable reductions, bony union, and full motion. Bone fracture location, fragment(s) size, and fracture pattern will influence treatment decisions. Most metacarpal fractures can be treated nonoperatively with closed reduction maneuvers and splinting. Metacarpal fractures associated with open injuries can be treated effectively with early detection, copious irrigation, antibiotic therapy, appropriate wound coverage, and fracture immobilization. Surgical considerations of metacarpal fractures include malunion, failure to maintain fracture reduction, polytrauma, and open fractures resulting in severe soft-tissue trauma.

Surgeons Receiving Information About Patient Language Reflecting Unhelpful Thoughts or Distress About Their Symptoms Identify Such Language More Often Than Those Who Do Not Receive This Information.

Unhelpful thoughts and feelings of distress regarding symptoms account for a large proportion of variation in a patient's symptom intensity and magnitude of capability. Clinicians vary in their awareness of this association, their ability to identify unhelpful thoughts or feelings of distress regarding symptoms, and the skills to help address them. These nontechnical skills are important because they can improve treatment outcomes, increase patient agency, and foster self-efficacy without diminishing patient experience. In this survey-based study, we asked: (1) Are there any factors, including exposure of surgeons to information about language reflecting unhelpful thoughts about symptoms, associated with the total number of identified instances of language rated as reflecting unhelpful thoughts or feelings of distress regarding symptoms in transcripts of patient encounters? (2) Are there any factors, including exposure of surgeons to information about language reflecting unhelpful thoughts about symptoms, associated with the interobserver reliability of a surgeon's identification of language rated as reflecting unhelpful thoughts or feelings of distress regarding symptoms in transcripts of patient encounters? Surgeons from an international collaborative consisting of mostly academic surgeons (Science of Variation Group) were invited to participate in a survey-based experiment. Among approximately 200 surgeons who participate in at least one experiment per year, 127 surgeons reviewed portions of transcripts of actual new musculoskeletal specialty encounters with English-speaking patients (who reported pain and paresthesia as primary symptoms) and were asked to identify language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms. The included transcripts were selected based on the rated presence of language reflecting unhelpful thinking as assessed by four independent researchers and confirmed by the senior author. We did not study accuracy because there is no reference standard for language reflecting unhelpful thoughts or feelings of distress regarding symptoms. Observers were randomized 1:1 to receive supportive information or not regarding definitions and examples of unhelpful thoughts or feelings of distress regarding symptoms (referred to herein as "priming") once at the beginning of the survey, and were not aware that this randomization was occurring. By priming, we mean the paragraph was intended to increase awareness of and attunement to these aspects of human illness behavior immediately before participation in the experiment. Most of the participants practiced in the United States (primed: 48% [29 of 60] versus not primed: 46% [31 of 67]) or Europe (33% [20 of 60] versus 36% [24 of 67]) and specialized in hand and wrist surgery (40% [24 of 60] versus 37% [25 of 67]) or fracture surgery (35% [21 of 60] versus 28% [19 of 67]). A multivariable negative binomial regression model was constructed to seek factors associated with the total number of identified instances of language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms. To determine the interobserver agreement, Fleiss kappa was calculated with bootstrapped 95% confidence intervals (resamples = 1000) and standard errors. After controlling for potential confounding factors such as location of practice, years of experience, and subspecialty, we found surgeons who were primed with supportive information and surgeons who had 11 to 20 years of experience (compared with 0 to 5 years) identified slightly more instances of language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms (regression coefficient 0.15 [95% CI 0.020 to 0.28]; p = 0.02 and regression coefficient 0.19 [95% CI 0.017 to 0.37]; p = 0.03). Fracture surgeons identified slightly fewer instances than hand and wrist surgeons did (regression coefficient -0.19 [95% CI -0.35 to -0.017]; p = 0.03). There was limited agreement among surgeons in their ratings of language as indicating unhelpful thoughts or feelings of distress regarding symptoms, and priming surgeons with supportive information had no influence on reliability (kappa primed: 0.25 versus not primed: 0.22; categorically fair agreement). The observation that surgeons with brief exposure to supportive information about language associated with unhelpful thoughts and feelings of distress regarding symptoms identified slightly more instances of such language demonstrates the potential of training and practice to increase attunement to these important aspects of musculoskeletal health. The finding that supportive information did not improve reliability underlines the complexity, relative subjectivity, and imprecision of these mental health concepts. Level I, therapeutic study.

Fixation of Hand Fractures with Intramedullary Headless Compression Screws.

Metacarpal and phalangeal fractures remain among the most frequently encountered orthopedic injuries, accounting for 10% of all fractures. For operative fractures, there is an array of treatment options with percutaneous kirschner wire stabilization and screw and plate fixation strategies predominating. Recently, a new fixation method was introduced, intramedullary (IM) fixation with headless screws, which has advantages of a percutaneous technique and buried hardware. The purpose of this review is to highlight the indications and surgical techniques of IM screw fixation of metacarpal and phalangeal fractures. Although more research is needed, IM fixation represents a potentially reliable alternative to Kirschner-wire and plate fixation.

K-wire Fixation of Closed Hand Fractures Outside the Main Operating Room Does Not Increase Infections

A multicenter prospective analysis of patients undergoing CRIF of metacarpal or phalangeal fractures inside or outside the OR was performed. Demographic data, injury characteristics, surgery information and postoperative infectious complications were recorded, including cellulitis, frank pus, and osteomyelitis. The study involved 1042 patients with a total of 2265 Kirschner-wires (K-wires). Infection rates were not statistically higher in the 719 patients who had CRIF outside of the OR (cellulitis 2.5%, frank pus 1.4%) compared with the 323 patients with CRIF in the OR group (cellulitis 3.4%, frank pus 2.5%). The OR group had a longer time to operation and a longer procedure time, but a shorter time with the K-wires in place. K-wire fixation of closed hand fractures outside of the OR under field sterility is safe because it does not increase infectious complications compared to CRIF in the main OR under full sterility.

Principles of management of hand fractures.

The optimal management of hand fractures requires a multidisciplinary approach. Initial assessment should include a thorough medical history and clinical examination, followed by appropriate radiological imaging. These are crucial in determining the appropriate management. Following joint stabilisation to allow fractures to unite, early mobilisation is needed to maximise the functional restoration of the hand. In this review, the principles of operative and non-operative management of these injuries are discussed.

Proximal phalanx fracture treated with extension block Splint: An observational study at a tertiary care centre

Proximal phalangeal fractures are common fractures of the hand. The fracture are difficult to treat because of vicinity of 2 important joints and presence of tight osseofascious tunnel. The purpose of this study was to evaluate the efficacy of extension block splint in the management of selective proximal phalangeal fracture of hand. 21 Patients with proximal phalangeal fractures were treated by extension block splint and evaluated prospectively. Patient were followed up after 1 week, 3 weeks, and thereafter on monthly basis. Average follow up period was 9.8 months and outcomes were assessed by Belsky’s criteria. In our study, 76.19% patients had excellent outcomes, 19.04% had good, 4.76% had poor outcomes. 2 patients had extensor lag which subsided at further follow up at 1 year. The results of this prospective study shows that with careful selection of patients extension block splint is a simple, safe and effective technique for managing proximal phalanx fracture of hand.

Principles of Metacarpal Fracture (Management &amp; Treatment)

The hand is essential in humans for physical manipulation of their surrounding environment. Allowing the ability to grasp, and differentiated from other animals by an opposing thumb, the main functions include both fine and gross motor skills as well as being a key tool for sensing and understanding the immediate surroundings of their owner.&#x0D; Hand fractures are the most common fractures presenting at both accident and emergency and within orthopedic clinics. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. These decisions are dependent on a wide range of factors including age, hand dominance, occupation, and co-morbidities.&#x0D; A fracture is best described as a soft tissue injury with an associated bony injury. Despite this being the case, this paper intends to deal mainly with the bone injury and aims to discuss both the timing, as well as the methods available, of hand fracture management.&#x0D; Fractures of the metacarpal are the most common of hand fractures accounting for up to 40% [1, 2] and are usually the injury described as ‘a broken hand’ by the general public. For discussion purposes fractures of the metacarpals are best described anatomically and the digits can be grouped together, although the fifth metacarpal is often expressed on its own as the ‘boxer fracture’ and accounts for a quarter of all metacarpal fractures [2]. Likewise, due to anatomical and functional variance the first metacarpal is generally classified as a separate entity which is not included in this Article.