Finger injuries

Mallet finger

Clinical features

  • Extensor tendon avulsed from distal phalanx
  • Mechanism: ball striking tip of finger causing hyperextension

Investigation

  • XR to ensure no avulsion fracture

Management

  • Splint for 6 weeks

Hand fractures

FOOSH- fall onto the outstretched hand

  • Occurs with forced dorsiflexion

Younger patients:

  • Scaphoid fracture

Older patients:

  • Colles’ fracture

Scaphoid fracture

Clinical features

  • Pain and swelling radial aspect wrist
  • Poor grip
  • Pain when telescoping thumb
  • Tender anatomical snuffbox / palmar aspect scaphoid

Radiology

  • XR- specialist views: AP, lateral, right and left obliques (scaphoid views)
  • Can consider MRI

Management

  • Treat if suspect fracture clinically OR radiologically as can be missed on XR and risk of complications (see below)
  • Scaphoid plaster (beer glass position) or Futuro splint
  • Follow up in 2 weeks for repeat imaging 

Specific complications

  • Higher risk in proximal or displaced fractures
  • Non-union
  • Avascular necrosis
    • Impairment of vascular supply to involved bone fragment
    • Stiff and painful wrist
    • Later on: loss of strength, reduced ROM wrist and osteoarthritis
  • Management: 
    • Surgical: Open reduction internal fixation (ORIF)

Colles fracture

Distal radial fracture

  • Results in dorsal displacement of distal fragment
  • ‘Dinner-fork’ deformity

Risk factors

  • Older patients
  • Osteoporosis

Clinical features

  • Neurovascular compromise
    • Median nerve- thumb abduction
    • Radial artery
  • Tenderness, swelling, and ecchymosis over the wrist 

Investigations

  • X-rays- dorsal angulation and displacement of the distal radius fragment
  • CT or MRI may be required for complex fractures or to assess for associated injuries

Management

  • Immobilise in dorsal backslab cast and elevate with sling
  • Manipulation under anaesthetic (MUA) if above does not results in satisfactory position
  • If complex (comminuted, intra-articular, re-displaced) or above fails- surgical fixation 

Elbow fractures

  • XR if reduced ROM - fat pad sign= fracture (even if fracture not visible on XR)

Olecranon Fracture

Clinical features

  • Falls onto point of elbow
  • Tenderness, swelling around elbow

Management

  • Backslab- elbow flexed 90 degrees

Radial head/neck fracture

Clinical features

  • FOOSH/direct trauma

Management

  • Sling/backslab

Supracondylar fracture

Clinical features

  • Children following FOOSH
  • Often complicated- displaced, angulated, rotated
  • Swollen, deformed

Management

  • MUA
  • ORIF
  • Immobilise with above elbow backslab

Complications

  • Displaced can cause damage to brachial artery

  

Useful links

Radiopaedia- Upper Extremity Fractures