AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Metacarpal and Phalangeal Fractures
Michael S. Bednar, MD
Chief, Section of Hand Surgery
Associate Professor
Dept. of Orthopaedic Surgery and Rehabilitation
Loyola University – Chicago
Introduction
Incidence – metacarpal and phalangeal fractures – 10% of all fractures
Location
Distal phalanx (45-50%)
Metacarpal (30-35%)
Proximal phalanx (15-20%)
Middle phalanx (8-12%)
“Phalangeal fracture of the hand. An analysis of gender and age-related incidence and aetiology.” De Jonge. JHS 19B,
1994.
10-29 y.o. – sports
40-60 y.o. – industrial injures, highest incidence
>70 y.o. – accidental falls
Classification of phalangeal fractures – modified from Belsky, Jupiter, Axelrod
Location Pattern Skeleton Deformity Soft tissue Assoc Injury Reaction to Motion
base transverse simple angulation closed skin stable
shaft oblique impacted dorsal/palmar open tendon unstable
neck spiral comminuted lateral avulsion ligament
head avulsion bone loss malrotation burnnerve
physis shortening crush blood vessel
X-rays
AP and true lateral of individual digit
Oblique helpful when fracture close to joint
Pre-and post-reduction views
Management
Considerations
Associated soft tissue injury
Age of:
Patient
Injury
Associated diseases
Patient motivation
Socioeconomic factors
Principles of treatment
Accurate fracture reduction
Movement of uninvolved fingers to prevent stiffness
Elevation of extremity to limit edema
Immobilization in intrinsic positive position
Early remobilization of injured finger
Fracture consolidation
Closed non-displaced fracture – protected motion can start within the first 21 days depending on stability
Fractures of diaphyseal phalanges have prolonged healing times
Middle phalanx – 10-14 weeks
Proximal phalanx – 5-7 weeks
Comminuted fractures and those requiring ORIF take longer to consolidate
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