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Adam C Watts Consultant Hand and Upper Limb Surgeon, Wrightington Hospital Visiting Professor, Manchester University Hand Fractures and Dislocations Edinburgh Hand Course

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  • Adam C Watts Consultant Hand and Upper Limb Surgeon, Wrightington Hospital

    Visiting Professor, Manchester University

    Hand Fractures and Dislocations

    Edinburgh Hand Course

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  • Principles

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    History

    Age Sex Hand Dominance Occupation

    Mechanism of injury Low energy / high energy Crush Penetrating

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    Hand Fractures Diagnosis

    Neurovascular

    Soft tissue envelope

    X-rays

    CT (rarely)

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    Considerations

    Open/closed Intra-articular/extra-articular Site Undisplaced/displaced Rotation Stable/unstable Compliant patient

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    Associated Injuries

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    Emergency Management

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    General Principles

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    Early mobilisation

    Minimum soft tissue disruption

    if stable = mobilise

    if unstable = splint / fixation

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    Hand Splintage

    Buddy Zimmer Dynamic finger Mallet

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    Edinburgh position of immobilisation

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    Complications

    Malunion

    Finger stiffness

    Post traumatic OA

    Non-union

  • Specific Injuries

    Distal Interphalangeal Joint

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    Mallet Injury

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    Paediatric Distal Phalanx fracture - Seymour Lesion

    Beware Subluxation Epiphyseal injury Nail bed injury

  • Specific Injuries

    Phalangeal and PIPJ

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    Phalangeal Shaft Fractures

    Transverse fractures usually stable and are immobilized for 3 weeks

    Spiral fractures unstable and should be stabilized.

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    Normal alignment and rotational deformity

    Beware Malrotation

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    Phalangeal Fractures -extraarticular CRIF

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    Phalangeal Fractures -extraarticular ORIF

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    Phalangeal Intra-Articular

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    Basal phalangeal fractures intra-articular

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    ORIF Basal Phalangeal fractures Pilon Fractures

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    Dislocation PIPJ

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    Extensor Tendon Injuries - Zone 3

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    Extensor Tendon Injuries - Zone 3

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    Extensor Tendon Injuries - Zone 3

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    ORIF Basal Phalangeal fractures intra-articular

    Screws and wires

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  • Specific Injuries

    Metacarpal

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    Boxers fracture

    Jahss Manoeuvre

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    Metacarpal Fractures

    Minimally displaced or angulated fractures can be treated nonoperatively

    Displacement of more than 5 mm, unacceptable angulation, or clinical malrotation are indications for intervention.

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    Transverse Metacarpal Fractures

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    Fixation of Transverse Metacarpal Fractures

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    Spiral Metacarpal Fractures

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    Dislocation of Metacarpal bases

    Get true laterals Reduce K wire

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  • Specific Injuries

    Thumb

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    Bennetts fracture

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    Rolando fracture

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    Stener Lesion

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    Take Home

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    Early Mobilisation

    Least invasive intervention that will achieve

    aims

    Anticipate compliance and complications

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    Never

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    Never

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    Dubert Procedure

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