Fracture

Types of fractures

  • Fracture Distal radius.
  • Fracture dislocation PIP joint.
  • Fracture Metacarpal.
  • Barton’s Fracture.
  • Fracture wrist.
  • TFCC Injury.
  • Fracture Ulna.
  • Fracture Scaphoid.
  • Bennett Fracture.
  • Fracture Hamate.
  • Fracture Finger.
  • Instability Distal Radio Ulnar Joint.
  • Fracture Forearm.
  • Fracture Phalanx.
  • Rolando Fracture.
  • Perilunate Dislocation.
  • Open fracture hand.

*Fracture distal radius, earlier known as Colles fracture is a fracture of the distal inch of the radius bone. It is one of the commonest injuries. It may follow a trivial fall or on other occasions, it may be after a high-velocity injury.
Symptoms: There will be deformity of the wrist, pain, swelling, and movement of the wrist are painful.
Investigation: X-Rays of the wrist and the forearm are obtained. After assessing the X-Rays, the extent of the deformity is assessed.

At times, CT Scan or MRI Scan are required.

Based on the extent of the deformity, the age of the patient and other associated injuries or diseases, the treatment options can be:

  • Plaster cast.
  • Kirschner wire fixation.
  • Plating. Stainless steel and titanium plates are precontoured and low profile.

*Fracture dislocation of proximal interphalangeal joint.

In a cricket-playing country like India, fracture-dislocation is a common injury.

Diagnosis. An x-ray reveals a loss of alignment of the bones. Interpreting the x-ray properly helps to avoid missing the diagnosis. At times, the report accompanying the x-ray film may be erroneous and delays establishing the correct diagnosis. A good quality x-ray image with the appropriate position of the finger and magnification will show loss of concentric bones.

Once the loss of alignment is established, the next step, is to assess the extent of joint affection and whether the fracture has resulted in gross multiple pieces (comminution).
Treatment.Several methods of treatment are available
The common methods of treatment include:

  • *Close reduction.
  • *Close reduction and internal fixation with one or more wires.
  • *External fixation in the form of Suzuki frame or its variants.
  • *Volar plate interposition.
  • *Hemi hamate interposition arthroplasty.

A true lateral view shows fracture dislocation of PIP joint.

After surgery. A K’ wire holds the fracture pieces together. ROM started.

Fracture Dislocation after Cricket ball injury. Arrow pointing at the injury.

Hemi hamate Cartilage + Bone graft fixed with tiny titanium screws.

*Scaphoid fracture

Symptoms. Following a fall on the outstretched hand, the person will develop a swelling, though insignificant, at the base of the thumb over the wrist. Pain may often not be much. The insignificant swelling and pain may be presumed to be a sprain and but is not so and should not be neglected.

Signs. There will be tenderness in the snuff box. There may be tenderness over the front of the wrist, what is called a scaphoid tubercle.

 Investigation. X-rays with special views are needed to confirm the diagnosis.

*At times CT scan and MRI are needed.

Treatment. The fracture which are undisplaced can be treated with a plaster cast.

At times one may need open surgery and fixation with screws or wires. If the fracture is displaced, shattered, delayed diagnosis, or involves other joints, it requires surgical intervention. Proximal pole fracture is an entity which requires early intervention and surgery

Figure…Kirschner wire holding a very tiny proximal pole.

Figure…  Screw fixation of fracture scaphoid.           

Non union. The bone is notorious for not uniting. This requires bone grafting and fixation with screw or wires.

*Fracture Hamate, not a very common fracture. The bone has rotated by 180 degrees. By open reduction, the fractures were brought back into alignment and fixed with wires. The wires were removed after a few weeks.

Before Surgery

After Surgery

*Fracture Hook of Hamate is not a very common condition. The patient presents with pain in a small focal area on the palmar aspect of the hand, just distal to the wrist crease but in line with the ring finger. X-ray called carpal tunnel view may at times pick up the fracture.

If this does not help, one may require a CT scan to diagnose the fracture. The fracture may irritate the ulnar nerve(Ulnar nerve neuropathy) and cause tingling in the small finger. The fracture may require surgery.

Either fixation or excision of part of the bone (HAMATE) alleviates the symptoms. When the skin is lost due to trauma or any other reason and the bone or tendon are exposed or the wound is deep with require a skin cover which has a blood supply. An island of skin which has its own blood supply is called a flap

There is pain in the center of the wrist at the level of wrist joint. In this picture, the broken piece of bone called the Hook of the Hamate is dissected out.

*Bennett Fracture.

A fracture of the first meta carpal resulting in a single piece of bone extending into the joint is called Bennett’s fracture. They usually require a surgery to restore the alignment.

A fracture of the first meta carpal resulting in a single piece of bone extending into the joint is called Bennett’s fracture. They usually require a surgery to restore the alignment.

Before & After Surgery, the kirschner wires are holding the fracture in good alignment.

*Finger Fracture.

The child sustained fracture to his fingers. The fractures were brought back to their alignment.

Before Surgery

After Surgery.

*Perilunate Injury.

This injury occurs after a major fall, heavy fall from a height, or in a high-velocity road accident.  This results in deferoxamine of wrist bone alignment.  X-ray in the case study shows a Perilunate injury and median nerve injury. The surgery was done, the median nerve was decompressed. The architecture of the wrist bones was restored.

Before Surgery

The bony configuration is altered and the lunate bone has popped out of alignment.

During Treatment

Wire holding the bones in proper alignment. They are removed after 8 to 10 weeks.

After Treatment

Final result, after wire removal.

*Trans Scaphoid Perilunate Dislocation.

This patient had a massive fall leading to a terrible wrist injury. X-rays showed a trans scaphoid perilunate injury.

This consisted of a fracture of the scaphoid bone and tear of multiple ligaments.
He visited several hospitals and ended up loosing some precious months!
We opted to create a new joint by a salvage procedure called proximal row carpectomy, this gave him a painless mobile wrist.

Before Surgery

The delay in seeking treatment causes damage to the cartilage. Hence, a new joint is created by a procedure called Proximal Row Carpectomy, wherein a new articulation is created between capitate and radius

After Surgery

PROXIMAL ROW CARPECTOMY. A new wrist joint is reconstructed by surgically removing a set of bones. This saves wrist joint movements which are painless.

*Open Finger Fracture.

This young man sustained a open fracture of the finger. There was a large wound in the front of the finger.

We converted contaminated wound into a clean wound. Primary fixation of the fracture was done with fixation device. Our fixation method allows early finger movements with immediate wound closure, the gentleman made a full recovery.

Before Surgery

During Surgery

After Surgery

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