Hand Cases and Pearls

From a lecture by Dr Karen Frye, sports medicine fellow, 2014:
Bennett’s fracture:  base of 1st metacarpal (picture below)
 – palmar portion of fracture held in place by volar oblique ligament
 – distal MC retracted by abductor pollicis
 – Tx closed reduction with percutaneous pin fixation or ORIF depending on displacement (> 3 mm)
Rolando’s fracture
– intra-articular comminution leads to T- or Y-shaped fracture
– prognosis worse than Bennett’s fracture
– Tx reduction, stabilization, surgical repair
“Pseudo-Bennett’s” fracture does not extend into the joint space.
Thumb ulnar collateral ligament injury (gamekeeper’s thumb or skiier’s thumb)
 – UCL partial or complete tear
 – X-ray to evaluate for avulsion
 – Tx:  partial tear with < 20 degrees of motion – immobilize x 4-6 wks
 – complete tear or > 20 degrees motion or >35 deg opening, need surgery lest it become unstable joint
Jersey finger:  avulsion injury of FDP
 – 75% involve the ring finger
 – exam: pain over the distal finger, finger lies in slight extension relative to others at rest, no active flexion of DIP; if pain, have them flex all fingers at once
 – tx is surgical repair ASAP
Mallet finger:
– non-operative management, STRICT splinting of DIP in extension for 6 weeks.  If pt flexes the finger at all, the clock restarts.
– exam:  resting position of DIP at 45 degrees, cannot actively extend

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