mano a mano mi zucker, md. a dr z lecture on… injuries and some other stuff of the hand
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MANO a MANO
MI Zucker, MD
A dr Z Lecture
On…
• Injuries and some other stuff of the HAND.
BENNETT’s Fracture
• Base of the 1st MC• A fracture-subluxation• Unstable• Rx: Surgery
ROLANDO’s Fracture
• Comminuted fracture base of 1st MC
• Guarded prognosis• Rx: Surgery or
molded cast
METACARPAL SPIRAL Fracture
• Axial loading• Closed reduction if
significant rotation• Rx: Cast
BOXER’s Fracture
• or MACHO Fracture: “Men Angrily Cuffing Hard Objects”
(C. Blackmore)• Rx: Closed reduction,
cast
GAMEKEEPER’s or SKIER’s THUMB
• Forced abduction• Rx: Cast if
incomplete or nondisplaced tear of medial collateral ligament, surgery if complete and displaced MCL tear (Stener lesion)
SPIRAL Fracture of Phalanx
• Axial loading• Rx: Closed reduction,
cast
SALTER-HARRIS Lesion
• Type II• Rx: Closed reduction,
cast
VOLAR PLATE Fracture
• Forced hyperextension• Rx: Splint
DISLOCATION PIP Joint
• Even more forced hyperextension
• Rx: Closed reduction and splint. If tendon entrapment, may required open reduction
MALLET or BASEBALL Finger
• Forced flexion• Rx: Splint; if large
fragment, surgery
TUFT Fracture
• Crush• Often, open• Rx: Splint
ENCHONDROMA
• Pathologic fracture• Most common true
neoplasm of fingers, usually benign
• Rx: Curettage and pack lesion
METASTASIS
• Renal Cell Carcinoma• Metastases to the
fingers are uncommon
INFECTION
• Pyogenic bacterial osteomyelitis and septic arthritis
• Note that this destructive lesion crosses the joint, a common occurrence in infection
NECROTIZING FASCIITIS
• Life threatening infection of subcutaneous tissues, often from trivial open injury
• Rx: Emergency extensive surgical debridement and I.V. antibiotics. May have to amputate.
Foreign Body: GLASS
• Usually, glass is visible, but negative films do not exclude it
WE’RE ALMOST DONE!
Two obvious ones: Injury by nail gun and amputation by power saw
GOODBYE
• Copyright 2004
MI Zucker, MD
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