A fracture of the hand is an open or closed injury in which the bony elements are completely or partially damaged. It is usually caused by an external mechanical impact on the hand. This could be a fall from weight, an injury from a heavy object, a fall on the hand, or pressing the hand between hard surfaces.
- construction of the hand
- Anatomy of the hand skeleton:
- The effects of the treatment are:
- Metacarpal fractures
- Conservative treatment of metacarpal fractures
- Other animals
- Story
- etymology
- Postnatal skeletal ossification in dogs
- Articulation of the lower limbs
- Joints of the lower limbs of the free leg
- types of injuries
- Symptoms of a fracture
- treatment methods
- When is surgery necessary for a hand fracture?
- Diagnosis
- Treatment of metatarsal fractures
construction of the hand
The bones of the wrist, metacarpals and phalanges make up the skeleton of the hand. These bony structures are connected to each other by various types of joints. The long and short (intrinsic) muscles of the hand are connected to the bony structures of the hand via tendons and enable the unique movements of the fingers and the hand as a whole. In addition to these three main bone groups, the hand skeleton also contains sesamoid bones.
The hand mediates human interactions with the outside world. She can signal the presence of common illnesses and bad habits in a person. Examination of the hand not only provides information about local changes, but also about the condition of the entire body.
Anatomy of the hand skeleton:
- wrist
- scaphoid
- triquetrum
- sicklebone
- pea leg
- Big polygon leg (trapezium leg)
- Small polygonal leg (trapezoidal leg)
- skull bones
- hook bone
- metacarpals
- finger bones
The skin of the hands is often considered an indicator of age. Studies show that a person's age can be determined by the appearance of their hands with an accuracy of up to five years.
Fullness on the hands leads to an accelerated development of deep wrinkles. Due to external factors such as (UV radiation, chemical influences on the skin, temperature fluctuations, etc.), the first age-related changes in the skin on the hands appear long before the 'crow's feet' and nasolabial folds that many people fear.
This process can be slowed down with timely cosmetic treatments.
biorevitalization – An injection treatment in which hyaluronic acid is injected into the middle layer of the skin, which forms the breeding ground for the upper layer of skin.
The effects of the treatment are:
- The skin is visibly smoother and firmer;
- The visibility of veins is reduced;
- pigmentation is smoothed;
- the turgor of the skin is improved (lifting effect),
- the feeling of dryness disappears.
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Metacarpal fractures
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Conservative treatment of metacarpal fractures
Fractures without displacement are treated in plaster for 4-6 weeks. Follow-up radiographs are then taken to assess the treatment results and to rule out secondary displacement of the fracture. After the plaster cast is removed, the movement of the metatarsophalangeal joints may be somewhat restricted, which requires movement training with special exercises and therapeutic drills. In the case of displaced fractures, conservative treatment with appropriate repositioning (juxtaposition) of the fragments is also possible.
If there is a length, width or angular misalignment of the broken bone, osteosynthesis, ie fixing the fracture with a plate, screws or spokes, is indicated; Diaphyseal fractures of the metacarpal bone can be fixed in the bone with a plate and/or screws or a pin. If the plate causes discomfort to the patient, it can be removed, but not before a year has passed. However, in most cases the metal brackets cannot be removed. The insert is placed intraperiosteally (within the core canal) for approximately 4-6 weeks. This brace will be removed at the check-up when the bone has healed.
It is also possible to immobilize the bone fragments through a small skin puncture if sufficient closed reduction (juxtaposition) of the fracture can be achieved. The ends of the pins usually protrude above the skin, but can also be inserted under the skin. These metal fixators are removed after the fracture has healed, which is approximately six weeks after insertion. The main advantage of this method is that no skin incisions are required during the operation. Regardless of the osteosynthesis method chosen, the patient usually begins practicing finger joint movements a few days after the operation.
The final choice of the osteosynthesis method is left to the doctor and depends on the medical indications, the type of osteosynthesis and the functional requirements of the hand.
Other animals
The principle of homology is illustrated by the adaptive radiation of mammalian metacarpals. They all correspond to the basic pattern of the pentadactyl, but are modified for different purposes. The third metacarpal is shaded along its length; the shoulder blade is shaded.
In quadrupedal animals, the metacarpals are part of the forelimbs and are often reduced in proportion to the number of fingers. In digrade and unguligrade animals, the metacarpals are greatly enlarged and reinforced, forming an additional limb that typically increases the animal's speed. In both birds and bats, the metacarpals form part of the wing.
Story
etymology
The Greek physician Galen called the heel μετακάρπιον. The Latin form metacarpium is more similar to its ancient Greek predecessor μετακάρπιον than to metacarpus. Meta- means 'forbidden' in Greek and carpal comes from the ancient Greek καρπός (carpós, 'wrist'). In anatomical Latin, adjectives such as metacarpius, metacarpicus, metacarpiaeus, metacarpeus, metacarpianus and metacarpalis can be found. The form metacarpiaeus corresponds most closely to the later Greek form μετακάρπιος. Metacarpalis, like ossa metacarpalia in the modern official Latin nomenclature of Terminologia Anatomica, is a composite of Latin and Greek parts. Some object to the use of such hybrids in anatomical Latinum.
Postnatal skeletal ossification in dogs
skull – Complete ossification of the cranial arch by the age of three months; in dwarf and brachycephalic dog breeds the fontanelles can be preserved; Skull base until the age of two.
spine – Ossification at 7-9 months of age; first sternum segment at 11-14 months of age, sacrum at two years of age.
Completion of the growth zones of the thoracic limb bones in dogs:
shoulder blade Humerus Humerus Elle Carpal bones metacarpals finger bones Age of ossification 5-6 months 4-5 months Proximal (upper) growth area Up to 24 months Up to 12 months 6-9 months (elbow bulb) 6 months 6 months Distal (lower) growth area 6 months up to 12 months up to 12 months 6 months 6 months. Articulation of the lower limbs
In this part of the human body there are 2 symmetrically located sacroiliac joints and 1 semi-movable joint - the pubic symphysis, which is often also called the pubic symphysis.
The pubic symphysis is a semi-movable joint of the upper branches of the pubic bones of the pelvis, which is a disk of fibrocartilage. Their front surface is 3-5 mm wider than the back surface.
Some people have a slit in the pubic conjunctiva that is filled with avascular fluid. The bone tissue is covered by hyaline cartilage at the contact surfaces with the intervertebral disc.
As a reminder. In men, the longissimus joint is the attachment point of the ligament from which the penis is suspended. In women, a special hormone called elastin is produced during pregnancy, which makes the pubic symphysis more mobile and allows labor to proceed.
As the name suggests, the sacroiliac joint is where the sacrum connects to the hip bone in the pelvis. At their connection points, the articular surfaces, the bone tissue is covered with fibrocartilage.
These two joints have a flat shape and are not movable.
Joints of the lower limbs of the free leg
The human leg consists of 3 parts - the hip, the lower leg and the foot. Your mobility is ensured by the hip, knee and ankle joints.
It is also worth mentioning that the joints of the lower limbs are particularly strong and heavily stressed. The knee is the joint that is most commonly damaged.
This is due to its 'imperfect' geometry, which nature has equipped with ligaments, tendons and meniscus for stabilization. Your injuries make the knee the 'problem leader' among all parts of the leg.
types of injuries
The universal orthopedic classification AO/ASIF can be used for metacarpal fractures. The metacarpal region has an anatomical region index of 7 and is indexed according to the numbering of the fingers of the same name:
The relationship between the fracture line and the articular surface (proximal or distal diaphysis) is also given:
The location of the fracture line is indicated by a numerical index:
The fracture type indicates the peculiarities of the fracture line and the resulting fragments:
A simplified classification of metacarpal fractures includes the following features:
- Open or closed.
- Location – intra-articular fracture of the head or base, extra-articular fracture of the neck, diaphyseal fracture.
- Transverse, oblique, spiral, detachment.
- With and without displacement.
In diaphyseal fractures of the fourth and fifth metacarpal bones, there is often a rotational displacement of the fragments with shortening of the bone and separation of the same fingers.
Symptoms of a fracture
All indicate trauma: blow, fall, etc. Typical symptoms are the following:
- Swelling and pain in the metacarpal area at the site of injury;
- Increased pain at the fracture site when the finger is impacted axially;
- Angular misalignment of the metacarpal bone with the apex of the angle directed toward the dorsal side;
- asymmetry of the finger compared to the contralateral finger;
- Painful or impossible clenching of the fist;
- Occurrence or worsening of pain when moving the wrist in the area of the carpal joint.
The presence of at least one of these symptoms in conjunction with evidence of a traumatic event raises suspicion of a disruption in the integrity of the metacarpal bone.
With fractures of the first metacarpal, general symptoms occur: swelling, pain, deformation, impairment of the function of the first finger. If such an injury is suspected, it is necessary to look for intra-articular fractures of the base of the first metacarpal:
- Bennett fracture – dislocation of the joint head Os inetacarpi primum combined with a dislocation of the trapezoid bone joint.
- The Roland fracture is a T- or Y-shaped fragmentary lesion of the proximal bone head involving the articular surface.
Bennett's fragment fracture (1st metacarpal).
To clarify the diagnosis, an X-ray examination of the injured hand in straight, lateral and oblique projections is necessary. At the same time, it is necessary to exclude damage to the bony structures of the wrist.
treatment methods
If the carpal bones are fractured, the function of the injured limb must be completely restored. For this purpose, the bone fragments are reduced, a plaster cast is applied and rehabilitation is initiated. The repositioning of the bones is carried out under local anesthesia, less often under general anesthesia.
A cast is applied from the head of the metacarpal bone to the upper third of the forearm. The thumb is fixed on the cast. After two to three weeks, the patient is examined with a second x-ray.
Applying the cast incorrectly can lead to long-term consequences. If the bandage is too tight, it compresses the tissue and squeezes the blood vessels. Within a few weeks of immobilization, articulation disappears due to poor blood circulation and an ischemic contracture develops.
If the cast or splint is weak, the patient moves the hand involuntarily. This causes displacement and abnormal bone fusion, and the anatomy of the wrist is disrupted.
A complication of an open hand fracture can be osteitis. It occurs when bacteria invade the bone from outside and form a cavity filled with pus. Symptoms include severe and persistent pain, fever, and signs of severe intoxication. Bone density is reduced, often leading to a second fracture at the site of the first.
To relieve pain, non-steroidal anti-inflammatory drugs are prescribed, and if these do not help, glucocorticosteroids are used. Chondroprotectants and calcium supplements should be taken to accelerate bone regeneration.
When is surgery necessary for a hand fracture?
If complications are detected, surgery is required. There are several types of interventions:
- osteosynthesis. During the surgery, the edges of the broken bone are held together with staples or metal pins. A plaster cast is then applied for immobilization.
- Bone grafting. Whole bone from the patient, a donor, or an artificial implant is inserted into the damaged area. This speeds up the repair of the damaged bone.
- Arthrodesis. This operation is performed for multiple fragment fractures of the hand. The bones are held in position by artificial immobilization and the joint is not displaced.
- Endoprosthetics – damaged bone structures are replaced with artificial implants.
The doctor selects the surgical method individually for each patient. The age and general condition of the patient, the type of injury and possible contraindications are taken into account.
Diagnosis
To get an accurate picture of what happened to the bones of the foot, x-rays in 2-3 projections (frontal, lateral and oblique) are required. Some metatarsal fractures are not visible on the baseline radiograph and do not become apparent until 10-15 days later when a layer of callus begins to form. This applies to stress fractures without dislocation.
In cases of doubt, a CT or MRI scan of the foot is recommended. After a comprehensive examination, the doctor can choose the most appropriate treatment method.
Treatment of metatarsal fractures
Fractures of the diaphyses or neck of the metatarsal bone without displacement are treated as follows:
- an elastic bandage that is wrapped around the foot;
- a posterior plaster splint;
- a short movable splint in a plaster or cast;
- a short plastic shoe.
In the event of a fracture, it is not desirable to lean on the broken foot. Children with a fracture are always provided with a cast because they are unable to comply with the doctor's order and step on the foot. In some cases, the doctor may approve occasional heel support, but most often crutches are used to allow movement of the healthy leg. Depending on the severity of the case, the number of broken bones, and other causes, immobilization of the leg takes 3 to 5 weeks.
If the bone fragments are displaced by more than 4 mm, reduction is performed. During an open reduction, the surgeon makes an incision in the foot and pulls out the vessels, nerves and tendons. The broken bone is repositioned and a special metal plate is inserted and secured with screws. Immobilization with a plaster cast is not necessary, as the metal structure itself holds the broken bone well. The patient can walk with the heel bone as support for a month.
Based on the X-ray findings, the doctor can decide that a closed repositioning of the bone fragments, which are fixed percutaneously (without incision) with Kirschner pins, is sufficient. The doctor manually removes the displacement of the bone fragments, and then drills the pins, taking into account the peculiarities of the fracture. The outer end of the wire remains in place. Once the bone has healed, the needle is removed.
The advantage of this technique is that it is minimally traumatic, there is no incision or scar, and the procedure is quick and easy. The disadvantages are the inconvenience of leaving the needle for a month, the risk of wound infection and prolonged immobilization in a plaster cast (at least 1 month).
- Bones of the tarsal bone of the hand.
- Cracked metatarsal.
- Fracture of the lateral condyle.
- The tarsal and metatarsal bones.
- metatarsal bones.
- tibia and fibula.
- Shoe prophylaxis - what is it?.
- Inflammation of the tibial cortex.
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