Phalangeal Fractures: Anatomy, Injuries and Treatment-Hand Fractures: Indications, the Tried and True and New Innovations

Hand Fractures: Indications, the Tried and True and New Innovations

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Hand fractures are the second most common fracture of the upper extremity, and management of patients with these injuries is common for most hand surgery practices. Some recent innovations in the treatment of hand fractures include minimally invasive surgery with immediate postoperative mobilization, the use of wide-awake anesthesia, and sustained investigation and innovation in the biomechanics and treatment of proximal interphalangeal joint fracture dislocations. The principles of management for hand fractures include restoring prehension and avoiding complications such as stiffness and deformity. Preventing stiffness requires early finger motion to limit tendon adhesions and joint contractures, while avoiding deformity requires adequate reduction and immobilization of the fracture. If patients with unstable proximal interphalangeal joint dorsal fracture dislocations desire a single-stage procedure, surgical options include open reduction and internal fixation, extension block pinning, volar plate arthroplasty, or dynamic external fixation. For the treatment of metacarpal and phalangeal fractures, intramedullary headless compression screws have shown promise in allowing immediate mobilization. Other treatment options include using the MetaHUS fixation system, which allows immediate mobilization, or using Kirschner wires as deﬁnitive ﬁxation. The choice of implant depends on factors such as fracture stability, bone loss, and comminution. Wide-awake local anesthesia-no tourniquet techniques have been used with success in many types of hand surgery, including operative ﬁxation of fractures. Complications such as stiffness, malunion, nonunion, and nail deformity after surgery for bone mallet fractures can be prevented through optimal fracture care, good bone reduction, stable fixation, prevention of wound infections, smoking cessation, and early mobilization. In cases of symptomatic malunion or nonunion, corrective osteotomies and revision ﬁxation with bone grafting may be considered.

Keywords

hand fractures

management

minimally invasive surgery

wide-awake anesthesia

treatment

complications

stiffness

deformity

implant choice

early mobilization