Trauma: Hand Injury

Hand Injury

Scaphoid Fracture

  • Most Common Carpal Bone Fracture
  • Complications:
    • High Rate of Nonunion (15%)
    • Avascular Necrosis (5-10%)
  • Presentation: “Snuffbox” Tenderness
    • Immediate XR May Be Negative
  • Tx: Thumb Spica Cast

Scaphoid Fracture 1

Thumb Spica Cast 2

Finger Tendons

  • Tendons:
    • Extensor Tendon
      • Central Slip: To PIP
      • Lateral Bands: To DIP
    • Flexion
      • Flexor Digitorum Superficialis: To PIP
      • Flexor Digitorum Profundus (FDP): To DIP
  • Injuries:
    • Jersey Finger: Avulsion of FDP
      • Finger Sits in Slight Extension
    • Mallet Finger: Avulsion of Terminal Extensor Tendon Over DIP
      • Characterized by DIP Flexion
    • Boutonniere Deformity: Rupture of Central Slip Over PIP
      • Characterized by PIP Flexion & DIP Extension
  • Repair Tendon Lacerations > 50-60% Width

Finger Flexor Tendons 3

Finger Extensor Tendons 4

Mallet Finger 4

Boutonniere Deformity 4

Digit Replantation Indications

  • All Thumb Injuries
  • Multiple Digits
  • Zone I (DIP & Distal)
    • Zone 2 (MCP & PIP) Have Poor Outcomes
  • Pediatrics

References

  1. Nakamoto JC, Saito M, Medina G, Schor B. Scaphoid stress fracture in high-level gymnast: a case report. Case Rep Orthop. 2011;2011:492407. (License: CC BY-3.0)
  2. Sasi PK, Mahapatra S, Raj Pallapati SC, Thomas BP. Acute Traumatic Musculotendinous Avulsion of the Flexor Pollicis Longus Tendon Treated with Primary Flexor Digitorum Superficialis Transfer: A Novel Technique of Management. Case Rep Orthop. 2016;2016:2106203. (License: CC BY-4.0)
  3. Gray H. Anatomy of the Human Body (1918). Public Domain.
  4. Lee SA, Kim BH, Kim SJ, Kim JN, Park SY, Choi K. Current status of ultrasonography of the finger. Ultrasonography. 2016 Apr;35(2):110-23. (License: CC BY-NC-3.0)