Hand clinics
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This article addresses the types of metacarpal and phalangeal fractures seen in a variety of sports. Treatment options are discussed in depth based on the location, configuration, and associated soft-tissue injuries. This article provides a greater understanding of the treatment algorithm to minimize the possibility of long-term functional consequences for the athlete.
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Distal radioulnar joint injuries can occur in isolation or in association with distal radius fractures, Galeazzi fractures, Essex-Lopresti injuries, and both-bone forearm fractures. The authors have classified DRUJ/TFCC injuries into stable, partially unstable (subluxation), and unstable (dislocation) patterns based on the injured structures and clinical findings. Clinical findings and plain radiographs are usually sufficient to diagnose the lesion, but axial CT scans are pathognomonic. ⋯ In complex dislocation, reduction is not possible because there is soft tissue interposition or a significant tear. After the associated injury is dealt with, treatment for complex injuries requires exploration of the DRUJ, extraction of the interposed tissue, repair of the soft tissues, and open reduction and internal fixation of the ulnar styloid fracture (if present and displaced). The early recognition and appropriate treatment of an acute DRUJ injury are critical to avoid progression to a chronic DRUJ disorder, the treatment of which is much more difficult and much less satisfying.
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The unique function of the boxer's hand requires persistent, forceful punching in a constantly clenched fist posture, therefore, the metacarpophalangeal joints are continually exposed to blunt trauma and highly vulnerable to injury. This injury is traditionally termed boxer's knuckle. Although a myriad of metacarpophalangeal joint derangement is apt to result from isolated or repetitive blows inflicted and absorbed by the hand, the most serious and disabling type of boxer's knuckle is extensor hood disruption. Based on experience with 27 surgical cases, this article describes characteristic extensor hood pathology and operative techniques that have afforded a consistently favorable outcome.
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Proximal interphalangeal joint fracture dislocations are complex, potentially disabling injuries for any patient, especially the competitive athlete. Dorsal fracture dislocations are fairly common and volar fracture dislocations are rare. ⋯ Volar fracture dislocations are usually amenable to closed or open reduction and internal fixation. The results of treatment of both volar and dorsal fracture dislocations can be unpredictable.
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Hamate hook fractures, although uncommon, are now recognized with increasing frequency because of the increase in popularity of racket sports and golf. Careful clinical evaluation and adjunctive radiologic investigation help establish the diagnosis. Acute nondisplaced fractures can heal with immobilization, while displaced fractures and nonunions typically require open reduction and internal fixation (acute fractures) or hook excision.