Kinds
There are several classifications of marginal fractures.
Classification by reason of occurrence:
- trauma (blow, severe bruise, compression, falling of a heavy object onto the fingers);
- pathology (occurs with certain ailments (more details below), during which fragility develops and bone density decreases).
Difference in skin trauma:
- open (with this type of fracture the skin is damaged, a wound is formed, and part of the bone is visible from it);
- closed (in this case the skin is not injured).
Fracture location:
- nail phalanx;
- average;
- main;
- their combination.
Doctors also classify fractures based on how the bone was destroyed:
- splintered;
- a fracture in which bone fragments are displaced;
- fracture without displacement.
Finger fractures
Very often, as a result of direct trauma to the hand, a fracture of the finger occurs.
This injury is most often caused by fingers getting caught in moving mechanisms or heavy objects falling directly onto the fingers themselves. After an injury, patients most often complain of sharp pain in the injured finger, swelling and bruising over the fracture site, excessive mobility of the injured finger, or limited range of motion in the fingers. Upon examination, the traumatologist can determine the presence of moving bone fragments, deformation of the injured area of the finger, and curvature of its usual shape. To clarify the diagnosis and develop treatment tactics for a fractured finger, an x-ray of the injured limb and the injured finger must be taken, and the image must include not only the site of the suspected fracture, but also the two nearest joints. When taking pictures in elderly patients, it is imperative to also take a picture of the healthy arm in order to correctly understand what is in the picture - age-related changes after arthritis or the consequences of a recent injury.
According to the mechanism of action of the injury, a fracture of the fingers can be transverse - develops as a result of a fall of a heavy object, or oblique and splintered - such a fracture occurs when a finger gets caught in moving mechanisms. Depending on the immediate location, a finger fracture can be intra- or extra-articular. After performing x-rays of the hands and fingers, the traumatologist can select the appropriate treatment tactics for each specific case.
If the image shows a fracture without displacement, then the treatment tactics are usually chosen conservatively - a plaster splint is applied to the damaged finger for 18-21 days. If the image reveals a displaced fracture of the phalanx, then it is necessary to perform closed or open (during surgery) comparison of the fragments.
Careful treatment of even minor fractures (cracks) of the fingers is necessary precisely so that the injured hand does not lose its normal functions.
Closed reduction is carried out after local anesthesia, after which a plaster splint is applied to the injured finger for up to 21 days, and after 20-23 days a control photograph is necessarily taken, which makes it possible to verify the correct alignment of bone fragments.
If this does not happen, then for further treatment, skeletal traction is performed using knitting needles passed through the articular mice of the phalanges of the damaged fingers for a period of 14-18 days, after which control photographs of the damaged limb are taken and, if signs of healing are detected, a plaster cast is applied for 5-6 weeks . Then, to restore finger function, the patient is prescribed a course of physiotherapy and exercise therapy. If there are no signs of callus formation or the discrepancy of the fragments cannot be eliminated, surgical treatment is prescribed for open reposition of the fragments. In this case, the pieces of the phalanx are fastened together using special plates.
Despite the fact that a splint is applied to the injured finger or the fragments are repositioned, the patient must independently develop the adjacent uninjured fingers. This is done in order to prevent atrophy of the muscles of the fingers and hand, which will inevitably lead to disruption of the basic working functions of the injured hand.
Author
Pavlova Oksana Alekseevna
traumatologist-orthopedist, surgeon
16 years of experience
+7
Causes
The main reasons for the formation of a fracture are ailments that cause the bones to become less strong. This happens if there is:
- tumors;
- osteoporosis;
- osteomyelitis;
- hyperparathyroidism;
- tuberculosis.
Also important reasons are injuries received during accidents, playing sports, at home and at work, and being hit by heavy objects.
With a marginal fracture of the finger, a thin flat fragment is separated. It is worth noting that the injury is not very serious. In the toes, this type of fracture mainly occurs during running. This situation especially concerns the big toe for the reason that it takes the main load and protrudes on the foot stronger than the rest.
Metacarpal fracture
Fracture of the metacarpal bones. The most common metacarpal fractures include the base of the first toe, Bennett's fracture, and Roland's fracture. Bennett's fracture is characterized by the presence of a longitudinal fracture of the palmar-ulnar edge of the base of the first finger. As a rule, with this fracture the fragment is triangular in shape and moves slightly, as it is held by ligaments.
The first metacarpal bone moves proximally. A Roland fracture is a comminuted fracture of the base of the first metacarpal bone. this type of fracture. Upon examination, deformation and swelling in the area of the 1st metacarpal joint are revealed. Axial load on the 1st finger is painful. With a fracture of the first metacarpal bone, the thumb is adducted and slightly bent.
Treatment of these fractures meets the principles of treatment of intra-articular fractures, which means restoration of the exact anatomical relationships between the fragments and rigid fixation of the fragments. In cases where it is not possible to restore the articular surface of the base with the main phalanx of the 1st finger, arthrodesis of this joint is performed.
Signs
Very often people do not know how to distinguish an ordinary bruise from a marginal fracture. To do this, you need to familiarize yourself with the important signs of finger damage. They can be roughly divided into:
- relative;
- absolute.
Relative
Symptoms, which are called relative, appear:
- the presence of edema;
- painful manifestations;
- development of hemorrhage under the skin and nail plate.
Absolute
In the presence of absolute symptoms, a fracture is highly likely to be suspected. These include:
- crunching of bone fragments during pressure;
- unnatural position of the phalanx of the finger.
How severe the symptoms will be depends on where the fracture is located.
When the big toe is injured, the symptoms of the fracture are more pronounced and more intense. If the fracture is on the second, third, fourth finger or little finger, its manifestations are not immediately noticeable. For this reason, patients are not in a hurry to see a doctor to receive first aid.
Scaphoid fracture
A fracture of the scaphoid bone, as a rule, occurs when falling on an outstretched hand, with a direct blow to the palmar surface of the hand, etc. The peculiarity of the blood supply to the scaphoid bone determines various treatment options for fractures of this bone.
Clinical picture of a fracture of the scaphoid: in most cases, examination reveals swelling in the area of the anatomical snuffbox, movements in the dorsoradial direction are limited by pain, the patient usually cannot clench the hand into a fist. Diagnosis of a scaphoid fracture includes an X-ray examination in three projections (direct, lateral and oblique), in some cases CT and MRI are performed.
Treatment of scaphoid fractures . When treating scaphoid fractures, it is used conservatively with a plaster cast (the hand is fixed for 6–8 weeks in the position of thumb abduction and dorsal extension of 150–160°). So is surgery, in case of non-union of a fracture or formation of a false joint.
Treatment
This type of fracture is quite painful. For this reason, when providing first aid, the patient is given an injection with an anesthetic drug. After this, the traumatologist tries to immobilize the finger as efficiently as possible for the speedy fusion of the bone. If the manipulation is performed incorrectly, bone restoration will not occur physiologically, which will lead to the need for surgical intervention.
If the damage is minor, the patient is recommended to apply cold compresses to the injured area and give the limb an elevated position (place a pillow or a blanket rolled up under it). In this case, the doctor wants to achieve the following effects:
- a cold compress will numb the limb and reduce swelling;
- elevation promotes blood flow and prevents swelling.
In the first few hours after injury, ice packs should be used according to the following scheme: hold for 15 minutes and break for 30-45 minutes. You can also use an adhesive bandage or elastic bandage for fixation.
With normal healing, the patient can return to his normal lifestyle within 1-1.5 months.
Fractures of the phalanges of the fingers
When repositioning fragments, conduction anesthesia is used in the lower third of the forearm. The fragments are compared by manual traction along the longitudinal axis of the finger by the distal phalanx. Plaster immobilization of the injured finger is carried out in a functionally advantageous position with the palmar surface of the hand captured for 3-4 weeks. With oblique, comminuted and especially intra-articular fractures, secondary displacement of fragments is possible.
diaphyseal fractures of the phalanges with thin knitting needles. If closed reposition fails, surgical treatment—open reposition—is necessary. It is performed from the rear approach. The needles are removed after 3-4 weeks. Large-fragmented fractures with displacement of fragments of one of the articular ends of the interphalangeal joint require closed, and if unsuccessful, open reduction and fixation with thin knitting needles. Good results for intra-articular fractures are obtained by using Volkov-Oganesyan articulated compression-distraction devices, which allow reliable fixation of fragments and at the same time early movements in the damaged joint.
In case of significant destruction of one articular surface of the proximal interphalangeal joint, fragments should be removed and a platform should be formed for the remaining articular surface, or joint replacement should be performed. If both articular ends are destroyed, arthrodesis of this joint in a functionally advantageous position or replacement with a silicone endoprosthesis is indicated. To create ankylosis in the distal or proximal interphalangeal joint, their ends are cut off, carefully adapted and fixed with two intersecting knitting needles. The distal phalanx is bent at an angle of 20°, and the middle phalanx at an angle of 40-50°. After the operation, a plaster splint is applied for 3-4 weeks.
During endoprosthesis replacement, one or both damaged articular ends are resected and the bone marrow canals are expanded using conical reamers corresponding to the diameter of the endoprosthesis legs. The prosthesis is implanted between the ends of the bones with the legs immersed in the bone marrow canals. After this, the integrity of the joint capsule is restored, and, if necessary, the aponeurotic cords of the extensor tendon are restored. Movements after endoprosthetics begin on the 3-4th day.
A fracture of the tip of the distal phalanx does not require reduction. 0.5-1.0 ml of a 2% novocaine solution is injected into the fracture site, a plaster splint is applied from the tip of the finger to the proximal interphalangeal joint for 12-14 days, after which, as a rule, the ability to work is restored.
For fractures of the body of the distal phalanx, a similar plaster splint is applied for 2-3 weeks. Working capacity is restored by the end of the month
Rehabilitation
Immobilization takes 2-3 weeks. Additional recommendations:
- limit sudden and very active movements;
- do not play sports;
- do not stay on your feet for a long time;
- include in your diet the maximum amount of foods that contain a lot of protein and calcium.
To speed up the rehabilitation process, you can connect:
- massotherapy;
- physiotherapeutic procedures;
- gymnastic exercises.
All of the above activities are carried out only according to the clear instructions of the attending physician.
Prevention
Although a fracture does not pose a great danger, it is still better to prevent it. To do this you need:
- be careful and not allow heavy objects to fall on your fingers;
- fill your diet with foods rich in calcium;
- Reduce the use of products in your diet that contribute to the leaching of nutrients from the body (this includes coffee, soda, and alcoholic drinks).
If, however, a fracture could not be avoided, take a painkiller tablet, immobilize the injured area and contact the nearest medical facility for help.
Lunate fracture
A fracture of the lunate bone in most cases occurs from a fall on the hand, which is abducted to the ulnar side.
Clinical picture. Upon examination, swelling of the soft tissues in the area of the wrist joint is revealed; retraction in the area of the third metacarpal bone can be detected when the hand is clenched into a fist. With axial load, pain is detected in the third and fourth fingers.
Treatment of fractures of the bones of the hand (lunate bone) is conservative - with a plaster cast for 6-10 weeks, in some cases surgically.