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