FRACTURES AROUND THE

HAND
CHAUFFEUR'S
FRACTURE

 Fracture of the radial

styloid
 Seen in chauffeurs' due to
the impact of the winding
handle
 Treatment

Since they are intra-

articular fractures- they
need anatomical
reduction
If un-displaced can be
managed with a cast
ORIF with screws or
Kwires
 Anatomy of the
scaphoid

Scaphoid is a boat
shaped bone that has a
proximal and distal
pole.

The classic sign for

suspicion of scaphoid
fracture is the
tenderness in the snuff
box.
Why do scaphoid
fractures frequently
land in non union?

The more proximal. the

fracture the higher is the
risk of non union

Fractures of the proximal

pole of the scaphoid are at
maximum risk
Clinical
presentation of
fractures of DER

 The major source of blood

supply to the scaphoid is the
dorsal branch of the
radial artery which has
a retrograde flow.

 Poor vascularity is the cause

for non union.
  Head of the femur
 Scaphoid
 Talus

Other bones  Lunate

 Navicular
with precarious
blood supply Why precarious?
- Because fractures or dislocation of these bones
can cause AVN.
Management of
scaphoid
fractures

 Prolonged immobilization is
necessary
 Inadequate immobilization or
missed diagnosis contribute to non
union
 Ico established non union screw
fixation with bone grafting should
be undertaken
  Since it has the highest risk of non union it

Proximal pole requires 10 weeks of casting

 Even minimally displaced fractures need
fracture operative intervention
Rolando fracture

 intra-articular fracture
involving the first CMC
joint
 Comminuted fracture
and usually Y shaped
 Three part fracture
 Due to an axially
directed force
Management of
rolando fracture

 Since it is an intra-articular
fracture it requires anatomical
reduction and fixation to
prevent future arthritis
 Bennett fracture dislocation

 Palmar oblique ligament holds the

volar ulnar fragment in place
 While the abductor pollicis longus is
displacing the radial part of the base
and the shaft of the first MC
proximally
 Management of
bennett fracture

 Intra-articular fracture
 Needs closed anatomic
reduction F/B K wire
fixation to hold it in
place
Mallet finger

 Avulsion injury of the extensor tendon

 Due to a sudden violent palmar flexion of the DIP
joint against a taut extensor
Management of
mallet finger

 Use of a mallet finger splint

 Surgery – use of suture anchors
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