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Polyfractures in the Hand

  • Alan E. Freeland
  • Michael E. Jabaley
  • James L. Hughes

Abstract

When there are more than one fracture in the hand that are either unstable, displaced, or both, the hand is in particular jeopardy of becoming stiff, deformed, and dysfunctional. Occasionally, this can occur with closed injuries, and, in such instances, it is more common with crush and blast type injuries. We showed examples of multiple metacarpal fractures in Chapter 20, and in Chapter 28 we showed an example of a bicondylar phalangeal fracture along with another proximal phalanx fracture of an adjacent finger. Polyfractures in the hand and wrist are more common in open injuries, which are demonstrated in Chapter 39. Anatomic restoration and stabilization of bony architecture in these instances are important not only in securing bony union but also as an adjunct in soft tissues healing and healing of other deep structures that require repair or reconstruction. In this chapter, we show examples of both a metacarpal and a phalanx being fractured in the same hand in a closed injury. Stable fixation leading to good stability and pain control is certainly an advantage for implementation of early and aggressive active range of motion and institution of measures against swelling, such as the Jobst pump, isotoner glove, and Coban wrapping (Fig. 37-1 A Fig. 37-1 B Fig. 37-1 C Fig. 37-1 D and 37-2 A-D).>

Fig. 37-1 A

This patient sustained blunt trauma with a crush injury. There was swelling in the hand but the fractures were closed.

Fig. 37-1 B

This patient sustained blunt trauma with a crush injury. There was swelling in the hand but the fractures were closed.

Fig. 37-1 C

Open reduction and internal fixation restored anatomy and stability and controlled pain so that early intensive active range of motion exercises could be instituted. Note here that the split metaphysis of the proximal phalanx of the ring finger was restored to excellent congruity without reconstructing the metaphysis first by incorporating these fragments into the T-buttress plate.

Fig. 37-1 D

Open reduction and internal fixation restored anatomy and stability and controlled pain so that early intensive active range of motion exercises could be instituted. Note here that the split metaphysis of the proximal phalanx of the ring finger was restored to excellent congruity without reconstructing the metaphysis first by incorporating these fragments into the T-buttress plate.

Copyright information

© Springer-Verlag New York Inc. 1986

Authors and Affiliations

  • Alan E. Freeland
    • 1
    • 2
  • Michael E. Jabaley
    • 3
    • 4
  • James L. Hughes
    • 5
    • 6
  1. 1.Section of Hand SurgeryUniversity of Mississippi Medical CenterJacksonUSA
  2. 2.Jackson Veteran’s Administration Hospital, Mississippi Methodist Rehabilitation Center, Blake Clinic for Crippled Children and Mississippi Children’s Rehabilitation CenterJacksonUSA
  3. 3.Division of Plastic SurgeryUniversity of Mississippi Medical CenterJacksonUSA
  4. 4.St. Dominic’s-Jackson Health Services Center, Mississippi Baptist Medical Center, River Oaks Hospital, Mississippi Methodist Rehabilitation CenterJacksonUSA
  5. 5.Division of Orthopaedic SurgeryUniversity of Mississippi Medical CenterJacksonUSA
  6. 6.Jackson Veteran’s Administration Hospital, Mississippi Methodist Rehabilitation Center, Blake Clinic for Crippled Children and Mississippi Children’s Rehabilitation CenterJacksonUSA

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