Hand and Wrist Fractures

Abstract

Hand and wrist fractures are common in athletes and the general population and are frequently associated with falls and contact sports. Many of these fractures can be managed nonoperatively, so it is important for sports medicine providers to understand diagnosis and treatment of hand and wrist fractures.Distal phalanx fractures are common in sports. Jersey finger occurs from forced hyperextension with injury to the flexor digitorum profundus at the volar plate of the distal interphalangeal joint (DIP). Radiographs are recommended as an avulsion fracture may be present. Treatment is surgical with an expected 8 to 12 wk out of sport (1). A mallet finger occurs with forced flexion of the DIP with the finger extended, injuring the extensor tendon distal to the DIP with a possible avulsion injury (2). Treatment for mallet finger consists of extension splinting of the DIP joint for 6 to 8 wk. Surgical indications include volar subluxation, >30% involvement of the articular surface, DIP arthrodesis, or chronic injury (1).Metacarpal fractures are caused by punching a rigid object, direct hand trauma, or a fall in an older patient. Radiographs are used for evaluation though computed tomography (CT) scans may be needed for surgical planning. Fractures of the metacarpal heads are treated surgically especially if there is an intra-articular step off (3). Metacarpal neck fractures are the most common and are referred to as boxer fractures in the fifth metacarpal. From the second to the fifth metacarpal, the accepted angulations for nonsurgical management are 10, 20, 30, and 40 degrees. Surgery is recommended for severe angulation, unstable fractures, and rotational deformity (4). Fractures of the metacarpal shafts can be transverse, oblique, spiral, or comminuted. Oblique fractures are inherently unstable, and transverse fractures can result in angulation deformities. Similar angulations are accepted for fractures of the metacarpal heads and shafts.