Journal of Musculoskeletal Trauma

Avulsion Fractures of around the Hand: Dong Whan Kim, Jung Il Lee; J Korean Fract Soc 2024;37(3):158-168. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.158

Abstract PDF: An avulsion fracture occurs when soft tissues, including the tendons and ligaments, are forcibly detached from the main bone by an external force. The hand contains numerous anatomical structures, such as ligaments, tendons, and volar plates, which are essential for maintaining multidirectional motion and joint stability. Excessive force applied in a specific direction can damage these structures, leading to avulsion fractures around the joint. These fractures can result in severe complications if left untreated or improperly managed, including joint deformity, contracture, nonunion or malunion of the fracture, secondary osteoarthritis, and limited range of motion. Therefore, an accurate examination, diagnosis, and appropriate treatment are crucial for preventing these adverse outcomes. An avulsion fracture can be managed conservatively when the avulsed fragment does not compromise joint stability or motion. Nevertheless, surgical intervention is required to stabilize the fragment if it affects joint stability or motion. The use of internal fixation has become more prevalent because of recent advances in small implants for fixation.

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Complications of Hand Fractures and Its Prevention: Jong Woo Kang; J Korean Fract Soc 2024;37(1):46-51. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.46

Abstract PDF: Complications of hand fractures occur regardless of the methods used for their treatment. The treatment is also challenging. The most common and troublesome complications of hand fractures are malunion, finger stiffness, and consequent functional impairment. Early recognition and meticulous treatment of these complications is essential for improvement in hand function and satisfaction. Most of all, surgeons should clearly understand that prevention of complications is the easiest way to ensure a satisfactory outcome in hand fractures.

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Current Concepts in Management of Phalangeal Fractures: Yohan Lee, Sunghun Park, Jun-Ku Lee; J Korean Fract Soc 2022;35(4):169-181. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.169

Abstract PDF: This review focused on the research published to date on the treatment of phalangeal fractures according to the anatomical location of the finger bones, excluding the thumb. In many finger fracture cases, conservative treatment should be prioritized over surgical treatment. The three determinants of surgical treatment are the presence of an intra-articular fracture, the stability of the fracture itself, and the degree of damage to the surrounding soft tissues. Surgical treatment is recommended when bone fragments of 3 mm or more and distal phalanx subluxation are present in the bony mallet finger, and the main surgical treatment is closed reduction and extension block pin fixation. It is essential to pay attention to rotational deformation asf ractures occur proximally. Since intra-articular fractures can cause stiffness and arthritis in the future, a computed tomography scan is recommended to confirm the fracture pattern. These fractures require anatomical reduction of the bone fragments within the joint, and the instability of the joint itself must be corrected. There are no superior surgical treatment methods. It is therefore advantageous for the surgeon to select a surgical method that he is familiar with and confident of performing, considering the fracture itself and various patient-related clinical factors. Nonunion is rare as a complication of a finger fracture, and finger stiffness is the most common complication. Ensuring rapid joint movement as soon as possible can reduce finger stiffness.

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Hand Fractures: Seokwon Yang, Jong Pil Kim; J Korean Fract Soc 2018;31(2):61-70. Published online April 30, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.2.61

Abstract PDF

Hand fractures are the second most common fracture in the upper extremities after the distal radius, and patients with these injuries may be experienced in hand surgery clinics. On the other hand, during the treatment of hand fractures, complications can occur due to complex functions of the hand and small-sized injuries to the bone and soft tissues. This review focused on the principles of management of these fractures, including injury mechanism, evaluations and recent treatment options. Minimally invasive surgery in various types of hand fractures, including the phalanx and metacarpal bone, is preferred because early mobilization after surgery has been emphasized to reduce complications, such as stiffness.

Citations

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A novel finger brace for preventing finger stiffness after trauma or surgery: a preliminary report with a case series
Dae-Geun Kim, Hyo Jun Park
Archives of Hand and Microsurgery.2023; 28(4): 239. CrossRef

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Autogenous Iliac Bone Grafting for the Treatment of Nonunion in the Hand Fracture: Joo Yong Kim, Young Keun Lee, Ki Chan An, Tae Woo Sung; J Korean Fract Soc 2011;24(2):163-168. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.163

Abstract PDF: PURPOSE
To evaluate autogenous iliac bone graft for nonunion after hand fracture.
MATERIALS AND METHODS
From October 2006 through September 2008, we analyzed 35 patients, 37 cases of autogenous iliac bone graft for nonunion after hand fracture that have followed up for more than 12 months. We analyzed about etiology, fracture site, initial treatment, time to bone graft, grafted bone size, grafted bone fixation method, radiologic time of bony healing and bone union rate retrospectively. Also we evaluated VAS and range of motion of each joints (MCP, PIP, DIP) at final follow-up assessment.
RESULTS
Etiology was open fracture 23 cases (62.2%), crushing injury 12 cases (32.4%), direct trauma 2 cases (5.4%). Fracture site was metacarpal bone 7 cases, proximal phalanx 17 cases, middle phalanx 8 cases, distal phalanx 5 cases. Time to bone graft was average 20.7 weeks. Grafted bone fixation method was fixation with K-wire 27 cases (73.0%), fixation with only plate 6 cases (16.2%), fixation with K-wire plus plate 2 cases (5.4%), fixation with K-wire plus cerclage wiring 2 cases (5.4%). Grafted bone size was average 0.93 cm3 and bony union time was average 11.1 weeks and we had bone union in all cases.
CONCLUSION
Autogenous iliac bone graft is the useful method in the reconstruction of non-union as complication after hand fracture.

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Treatment of Post-traumatic Dislocation of Metacarpophalangeal Joints of the Hand: Seung Koo Rhee, Seok Whan Song, Joo Yup Lee, Chang Youn Moon, Jae Chan Oh; J Korean Soc Fract 2003;16(2):253-261. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.253

Abstract PDF: PURPOSE
To analyse the obstacles to prevent the reduction for dislocation of the metacarpophalangeal (MP) joints of the hand and evaluate the relationship between the sex and dislocation type in closed reduction case.
MATERIALS AND METHODS
Total 27 cases of MP joint dislocation of the hand (11 cases of thumb, and 14 index and 2 little finger) were reviewed retrospectively. The anatomical structures to prevent the reduction were confirmed at operation and the cases which were reduced immediately were also analysed for their ages and differences of damaged structures, and finally their complications or outcome were reviewed for average 7 months after reduction.
RESULTS
In 11 cases of thumb MP joint dislocations, the complex dorsal dislocations in which the protruded metacarpal neck was caught by buttonhole of torn anterior joint capsule, volar plate and FPB were reduced by open method in 8 cases, and closed reduction was done in 2 cases but one old case required arthrodesis. In other finger MP joint dislocations, the Kaplan's concept to prevent the reduction was confirmed. But reduction of torn volar plate and incision of transverse metacarpal ligament were sufficient to reduce the dislocation with gentle longitudinal traction during the operation. In two cases of little finger MP joint dislocation, the ruptured radial collateral ligaments were noted after open reduction and it must the repaired to prevent the finger instability later. Their overall end results were good without any significant restriction of MP joints motions and finger instabilities.
CONCLUSION
One or two times of closed reduction with proper local anesthesia could be tried, but simple reducible dislocation can be converted to complex irreducible ones by the inappropriate traction method, and so proper reduction technique by closed or even in open way is important with the knowledge of anatomical obstacles to prevent the reduction of the metacarpophalangeal joints.

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Usefulness of Miniplate Fixation for the Fractures of Metacarpal and Phalangeal Bones of the Hand: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Kim, Chul Hong Park; J Korean Soc Fract 1997;10(1):156-163. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.156

Abstract PDF: Before the introduction of internal fixation, the healing of a fracture was an unpredictable event. Internal fixation provides stability, and fractures heal predictably. The miniplate is used for unstable metacarpal and phalangeal fractures of the hand to provide stability and to allow early motion. We analysed 32 patients, 41 cases of metacarpal and phalangeal fractures of the hand which were treated with miniplates from Jan. 1990 to June 1995. The following results were obtained. 1. Mean age was 35 years and the male was predominent(81.3%). The most common fracture site was the metacarpal(51.2%). 2. TAM(total active motion) was 2240 in average and the best result was obtained in the metacarpal fractures(TAM = 239). The roentgenographic union was 16.8 weeks in average. 3. There were 6 complications(complication rate 14.6%) which were 3 cases of joint stiffness, a case of wound infection, a case of loss of reduction, and a case of delayed union. 4. Miniplate fixation is considered to be an useful method to get fracture union and good range of motion with low complication rate in the treatment of metacarpal and phalangeal fractures of the hand.

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A Clinical Study of complicated Fractures in the Hand: Eung Shick Kang, Hyung Kon Kim; J Korean Soc Fract 1988;1(1):24-35. Published online November 30, 1988; DOI: https://doi.org/10.12671/jksf.1988.1.1.24

Abstract PDF: Fractures of the metacarpals and phalanges are the most common fractures in the skeletal system. Because these fractures are so common, they are considered as minor injuries frequently and treated in improper methods in many cases. As a result, complications such as malunion, stiffness, nonunion, traumatic arthritis, and infection may develop and cause severe functional disability and economic loss. The authers reviewed 138 cases of fractures of the hand and 20 complicated cases which were admitted and treated in the department of orthopedic surgery, Severance hospital from 1983 to 1987. 1. Fractures occured more commonly in man(81.9%) than woman, and more commonly in the second decade(32.6%). 2. The most common cause was the machinary injury(42.8%), the traffic accident was the second(34.8%). 3. Open fractures occured in 57 cases(41.3%), and the cases with multiple fractures were 54(39.1%). 4. The most frequently fractured bone was the metacarpal(44.6%), especially metcarpal neck, then the proximal phalanx(33.0%), middle phalanx(12.7%), distal phalanx(9.7%) in decreasing frequency. 5. The most frequent associated injuries were dislocation and subluxation(45.8%), tendon injury was the second(28.8%). 6. Complications were found in 20 cases(14.5%), and malunion and stiffness occured most frequently. 7. The incidence of malunion was 7.5% of all fractures. Malunion occured most frequently in metacarpal fractures(10.9%) and angulatory deformity was most common(55.0%). 8. Stiffness occured in 12 cases(8.7%). The most common sites were distal and proximal interphalangeal joints(33.3%, respectively). 9. Traumatic arthritis occured in 8 cases, which were all intraarticular fractures. The metacarpophallangeal joint was the most common site(50.0%). 10. Nonunion occured in 3.0% of the all fractures and was most common in proxiaml phalangeal fractures(4.5%). The bone graft and internal fixation were carried out in 2 cases, and the results were good. 11. Infection occured in 6 cases(4.3%) and confined to pin tract and soft tissue. They were treated well with conservative treatment.

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