CC BY-NC-ND 4.0 · Indian J Plast Surg 2011; 44(02): 203-211
DOI: 10.1055/s-0039-1699505
Review Article
Association of Plastic Surgeons of India

Current concepts in managing fractures of metacarpal and phalangess

Jagannath B. Kamath
Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal University, India
,
Harshvardhan,
Deepak M. Naik
Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal University, India
,
Ankush Bansal
Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal University, India
› Author Affiliations
Further Information

Publication History

Publication Date:
31 December 2019 (online)

ABSTRACT

Fractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon's work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.

 
  • REFERENCES

  • 1 Emmett JE, Breck LW: A review of analysis of 11,000 fractures seen in a private practice of orthopaedic surgery 1937-1956. J Bone Joint Surg Am 1958;40:1169-75.
  • 2 Lane CS. Detecting occult fractures of the metacarpal head: The Brewerton view. J Hand Surg 1977;2:131-3.
  • 3 Eyres KS, Allen TR. Skyline view of the metacarpal head in the assessment of human fight-bite injuries. J Hand Surg Br 1993;18:43-4.
  • 4 Lane CS, Kennedy JF, Kuschner SH. The reverse oblique x-ray film: Metacarpal fractures revealed. J Hand Surg Am 1992;17:504-6.
  • 5 Swanson AB. Fractures involving the digits of the hand. Orthop Clin North Am 1970;1:261-74.
  • 6 Venkataswami R. Surgery of the injured hand-towards functional restoration. 1st ed. New Delhi, India: Jaypee Publishers; 2009. p. 409.
  • 7 Freeland AE. Hand Fractures Repair, reconstruction and rehabilitation. Philadelphia: Churchill Livingstone; 2000. p. 7-8.
  • 8 Pratt DR. Exposing fractures of the proximal phalanx of the finger longitudinally through the dorsal extensor apparatus. Clin Orthop 1959;15:22-6.
  • 9 Barton NJ. Fractures of the hand. J Bone Joint Surg Br 1984;66:159-67.
  • 10 Posner MA. Injuries to the hand and wrist in athletes. Orthop Clin North Am 1977;8:593-618.
  • 11 Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicentre prospective study of 3110 consecutive cases of elective epinephrine use in the fingers and hand: The Dalhousie Project clinical phase. J Hand Surg Am. 2005;30:1061-7.
  • 12 Berkman EF, Miles GH. Internal fixation of metacarpal fractures exclusive of the thumb. J Bone Joint Surg 1943;25:816-21.
  • 13 Waugh RL, Ferrazzano GP. Fractures of the metacarpals exclusive of the thumb: A new method of treatment. Am J Surg 1943;59:186-94.
  • 14 Gould WL, Belsole RJ, Skelton Jr WH. Tension-band stabilization of transverse fractures: An experimental analysis. Plast Reconstr Surg 1984;73:111-5.
  • 15 Gropper PT, Bowen V. Cerclage wiring of metacarpal fractures. Clin Orthop 1984;188:203-7.
  • 16 Gingrass RP, Fehring B, Matloub H. Intraosseous wiring of complex hand fractures. Plast Reconstr Surg 1980;66:383-91.
  • 17 Sammut D, Evans D. The Bone tie. A new device for interfragmentary fixation. J Hand Surg Br 1999;1:64-9.
  • 18 Kamath BJ, Bhardwaj P, Harshvardhan, Binoy PS, Agarwal T. In 2010 IFSSH - Hand Surgery. Editors Chung MS, Baek GH, Gong HS. First edition. Korea: Koon Ja Publishing Inc; 2010. pp 372-3.
  • 19 Grundberg AB. Intramedullary fixation for fractures of the hand. J Hand Surg Am 1981; 6:568-73.
  • 20 Heim U, Pfeiffer KM. Small Fragment Set Manual: Internal Fixation of Small Fractures. 2nd ed. New York: Springer-Verlag; 1982.
  • 21 Lee SG, Jupiter JB. Phalangeal and metacarpal fractures of the hand. Hand Clin 2000;16:323-32.21.
  • 22 Puckett CL, Welsh CF, Croll GH, Concannon MJ. Application of maxillofacial miniplating and microplating systems to the hand. Plast Reconstr Surg 1993;92:699-707.
  • 23 Hastings II H. Open fractures and those with soft tissue damage:Treatment by external fixation. In: Barton NJ, editor. Fractures of the Hand and Wrist, Edinburgh: Churchill Livingstone; 1988. p. 145-72.
  • 24 Thurston AJ. Pivot osteotomy for the correction of malunion of metacarpal neck fractures. J Hand Surg Br 1992;17:580-2.
  • 25 Jahss SA. Fractures of the metacarpals: A new method of reduction and immobilization. J Bone Joint Surg 1938;20:178-86.
  • 26 Foucher G: "Bouquet" osteosynthesis in metacarpal neck fractures: A series of 66 patients. J Hand Surg Am 1995;20:S86-90.
  • 27 Waugh RL, Ferrazzano GP. Fractures of the metacarpals exclusive of the thumb: A new method of treatment. Am J Surg 1943;59:186-94.
  • 28 Buchler U, Fischer T. Use of a minicondylar plate for metacarpal and phalangeal periarticular injuries. Clin Orthop 1987;214:53-88.
  • 29 Wilson RL, Carter MS. Management of hand fractures. In: Hunter JM, Schneider LH, Mackin EJ, Callahan AD, editors. Rehabilitation of the Hand. St. Louis: CV Mosby; 1978. p. 180-94.
  • 30 Flatt AE. Fractures: The Care of Minor Hand Injuries. 3rd ed. St. Louis: CV Mosby; 1972.
  • 31 Simonetta C. The use of “A.O.” plates in the hand. Hand 1970;2:43-5.
  • 32 Kumar VP, Satku K. Surgical management of osteochondral fractures of the phalanges and metacarpals: A surgical technique. J Hand Surg Am 1995;20:1028-31.
  • 33 Rolando S. Fracture de la base du premier metacarpien et principalement sur une variété non encore decreite. Presse Med 1910;33:303.
  • 34 Imaeda T, An KN, Cooney WP, Linscheid RL. Anatomy of trapeziometacarpal ligaments. J Hand Surg Am 1993;18:226-31.
  • 35 Billing L, Gedda KO. Roentgen examination of Bennett’s fracture. Acta Radiol 1952;38:471-6.
  • 36 Salgeback S, Eiken O, Carsam N, Ohlsson N. A study of Bennett’s fracture. Scand J Plast Reconstr Surg 1971;5:142-8.
  • 37 van Niekerk JL, Ouwens R. Fractures of the base of the first metacarpal bone: Results of surgical treatment. Injury 1989;20:359-62.
  • 38 Chabon SJ, Siegel DB. Use of the Herbert bone screw compression jig to reduce and stabilize a Bennett fracture. Orthop Rev 1993;22:97-9.
  • 39 Moberg E. The use of traction treatment for fractures of phalanges and metacarpals. Acta Chir Scand 1949;99:341-52.
  • 40 Kilbourne BC, Paul EG. The use of small bone screws in the treatment of metacarpal, metatarsal, and phalangeal fracture. J Bone Joint Surg Am 1958;40:375-83.
  • 41 Al-Qattan MM. Phalangeal neck fractures in children: Classification and outcome in 66 cases. J Hand Surg Br 2001;26:112-21.
  • 42 London PS. Sprains and fractures involving the interphalangeal joints. Hand 1971;3:155-8.
  • 43 Weiss AP, Hastings II H. Distal unicondylar fractures of the proximal phalanx. J Hand Surg Am 1993;18:594-9.
  • 44 Freeland AE, Hand Fractures Repair, reconstruction and rehabilitation. Philadelphia: Churchill Livingstone; 2000. p. 106.
  • 45 Inanami H, Ninomiya S, Okutsu I, Tarui T. Dynamic external finger fixator for fracture dislocation of the proximal inter-phalangeal joint. J Hand Surg Am 1993;18:160-4.
  • 46 Suzuki Y, Matsunaga T, Sato S, Yokoi T. The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand. J Hand Surg Br 1994;19:98-107.
  • 47 Schneider LH. Fractures of the distal phalanx. Hand Clin 1988;4:537-47.
  • 48 Seymour N. Juxta-epiphyseal fracture of the terminal phalanx of the finger. J Bone Joint Surg Br 1966;48:347-9.