More Related Content Similar to Common Hand Fractures & Dislocations (20) More from Nattakul Yamprasert (16) Common Hand Fractures & Dislocations 1. Common Hand
Fractures & Dislocations
นายแพทย์ณัฐกุล แย้มประเสริฐ
กลุ่มงานออร์โธปิดิกส์ โรงพยาบาลมหาราชนครราชสีมา
1
“Common Things Happen Commonly!”
2. Outline
• Fracture of distal end radius
• Metacarpal neck fracture (Boxer’s fracture)
• Proximal phalangeal fracture
• PIP joint dislocation
• Mallet injury
• Central slip injury
16. Acceptable Reduction
• <15° dorsal and <20° palmar tilt
• >15° radial inclination
• <5° radial shortening
• Ulnar variance negative or neutral
• Articular step <1 mm
• Articular gap <2 mm
17. Modified Lafontaine’s Criteria
• Dorsal angulation >20°
• Dorsal comminution >50%, Palmar comminution, Articular comminution
• Initial displacement >1cm
• Initial shortening >5mm
• Associated ulnar fracture
• Severe osteoporosis
3+
Suggested Unstable!
19. Guideline for Management
• Closed reduction
• Immobilization with short arm AP slab/short arm cast
• ROME of shoulder, elbow and hand as soon as possible
• F/U q 1-2 weeks
• Immobilization 6-8 weeks
23. Guideline for Management
Refer to specialist in case of…
• Unacceptable alignment after reduction (esp. young active pt.)
• Any type of fracture with open wound around the wrist
• Displaced intra-articular fracture
• Fracture with neurovascular injury
• Multiple fracture/multiple trauma
34. Metacarpal Neck Fracture
(Boxer’s Fracture)
Image source: http://photo.cultjer.com/img/cache/width/1000/ug_photo/2014_08/the_leftovers_wallpaper_1920x120140820011822.jpg
38. Guideline for Management
• Closed reduction “Jahss maneuver”
• Immobilization with radial gutter/ulnar gutter slab
• AROME
• F/U q 1 week
• Immobilization 2 weeks + protected load 6 weeks
49. Guideline for Management
• Closed reduction
• Immobilization with radial gutter/ulnar gutter slab
• AROME
• F/U q 1 week
• Immobilization 2-3 weeks + protected load until 8 weeks
50. Guideline for Management
Refer to specialist in case of…
• Intra-articular fracture
• Multiple digital fracture
• Open fracture
• Neurovascular injury
60. Guideline for Management
Soft tissue mallet/nondisplaced fracture:
• Closed reduction and splinting DIP joint in slightly
hyperextension
• AROME of PIP, MCP joint
• F/U q 1-2 weeks to recheck splint position
• Full-time immobilization 6 weeks + night splint 6 weeks
74. Guideline for Management
• Reduction PIP joint to full extension
• Dynamic PIP joint extension splint 6 weeks or
• Static PIP joint extension splint 3 weeks + AROME
• F/U q 1-2 weeks to recheck splint position