Hand injuries March 2018 | by EMauthor Bennett's fracture & fracture/dislocation •Oblique fracture of the base of MC1 with subluxation of 1st Carpometacarpal joint •Unstable injury •If undisplaced, then Bennett’s plaster, analgesia and fracture clinic, seek senior opinion if in doubt •If displaced, refer to orthopaedics Fracture of neck of 5th metacarpal •Most cases will not require more than neighbour strap and exercise with fracture clinic follow up •Gross deformity may require manipulation, seek senior help •Beware clenched fist injury with penetration of 5th MCP joint, they require referral Isolated metacarpal fractures •If undisplaced can be treated with support (neighbour strap or plaster support depending on pain and swelling) •Displaced or angulated fractures will need manipulation with or without internal fixation, refer to orthopaedics Multiple metacarpal fractures •May need admission for wire fixation or because of severe swelling of hand, discuss with A&E senior or orthopaedics Phalangeal fractures •Thumb oProximal phalanx ■Undisplaced , splint and fracture clinic follow up ■Displaced, refer to orthopaedics oDistal phalanx ■Manage soft tissue injuries oMallet thumb ■Refer to orthopaedics •Proximal and middle phalanges oUndisplaced fractures , neighbour strap and elevation with fracture clinic follow up oDisplaced or unstable fractures, refer to orthopaedics •Terminal phalangeal fractures oTreat for soft tissue injury, except significant intra articular fractures, refer •Salter – Harris fracture of base of proximal phalanx in children oAny displacement, especially rotation should be reduced followed by neighbour strap •Volar avulsion of base of middle phalanx, Volar plate injury oLarge or significantly displaced segment, refer to orthopaedics oSmall undisplaced segment, neighbour strap, sling and fracture clinic follow up Key point: missed volar plate injuries are a significant source of litigation in the ED |
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