fractures of the metacarpal bones and phalanges of the fingers

The metacarpal bones are located in the hand between the finger bones and the wrist bones. Fractures of the metacarpal bones usually occur due to direct impact - for example, hitting a hard object with a fist, falling on the hand. Based on location, fractures of the base of the metacarpal bone (the most proximal part, located near the bones of the wrist), the head of the metacarpal bone (near the metacarpophalangeal joints), and the diaphysis of the metacarpal bone (its middle part) are distinguished. Fractures can be either with displacement of bone fragments or without displacement.

For fractures without displacement of bone fragments, conservative treatment in a plaster cast is indicated. If there is displacement and unsatisfactory reposition (comparison of fragments), surgical treatment is necessary. This is due to the fact that such fractures can significantly affect the function of the hand (preservation of pain, decreased grip strength of the hand). Particular attention is paid to fractures of the head of the metacarpal bone, which is part of the metacarpophalangeal joint. Surgical treatment for fractures of the metacarpal bones with displacement of fragments contributes to the fastest and most complete restoration of hand function.

Conservative treatment of metacarpal fractures

Fractures without displacement are treated in a plaster cast, which is applied for 4-6 weeks. At the end of this period, control photographs are taken to evaluate the results of treatment and exclude secondary displacement of fragments. After removing the plaster cast, there may be some restrictions on movement in the metacarpophalangeal joints, which requires the development of movements with the help of special exercises and physical therapy. Conservative treatment is also possible with adequate reposition (comparison) of fragments in displaced fractures.

Features and diagnosis of a fracture.

There are two types of such injuries - the “Deuchlander” and “Jones” marching fractures (the latter is localized over a wide area of ​​the base of the fifth metatarsal bone). First of all, radiography is used as a diagnostic method, which makes it possible to establish the clinical picture characteristic of a given pathology.

The main symptoms of the disease are:

• Pain of varying strength in the front side of the foot (especially when walking while rolling);
• Painful lesions on the back of the upper foot (may be accompanied by small tumors about two centimeters in diameter);
• The edematous area resembles bone upon palpation in density;
• In some cases, the swelling is larger and may spread to the entire back of the ankle;
• Sharp pain in the metatarsal bone, arising due to its restructuring and changes in load;
• Painful syndrome when standing on half toes (in the final stages – inability to stand on them).

Diagnosis can be difficult because the problem is not easily identified on an x-ray. Often patients are treated for other diseases - tendonitis, bruises, and so on. In repeated photographs, the march fracture is easier to see - over time, the bone becomes deformed, and the fracture lines become more obvious. In general, the ability to recognize such fractures depends on how long ago the pathology began.

If the diagnostic situation is difficult, the doctor will:

• X-ray ¾ projection;
• Tomography.

At-risk groups.

The following are susceptible to the disease:

• Gymnasts;
• Ballerinas;
• Active tourists and travelers;
• Women who wear high heels;
• Athletes performing exercises after a long break;
• Sellers, waiters, nurses, hairdressers and representatives of other “standing” professions.

The procedure for reconstruction of the second metatarsal bone often has relapses, as well as complications in the form of a fracture with the presence of displacement of detached pieces, a slight dislocation of the proximal Lisfranc articular part.

Surgical treatment of metacarpal fractures

If there is a displacement of fragments along the length, width or angular deformation of the bone, then osteosynthesis is indicated - fixation of fragments using a plate, screws or pins. If the diaphysis of the metacarpal bone is fractured, it is fixed with a plate and/or screws; it is also possible to install a pin inside the bone . If the plate causes discomfort to the patient, it can be removed, but not earlier than after a year. However, in most cases, metal fixatives are not removed. The pin is installed intramedullary (inside the medullary canal) for approximately 4-6 weeks. This fixator is removed based on the results of a control x-ray - as the bone heals.

It is possible to fix the fragments using knitting needles through small punctures of the skin if adequate closed reposition (comparison) of the fragments is possible. The ends of the needles usually protrude above the skin, but can also be buried under the skin. These metal anchors are removed after the fracture has healed, approximately 6 weeks after placement. The main advantage of this method is the absence of skin incisions during the operation. Regardless of the chosen method of fixation, the patient usually begins to develop movements in the joints of the fingers a few days after the operation.

The final choice of osteosynthesis method remains with the attending physician, based on medical indications, the nature of the displacement of fragments, and the functional requirements for the hand.

After the operation, a plaster splint is applied for up to 2-3 weeks. Postoperative sutures (if any) are removed 14 days after surgical treatment; until this point, dressings are performed on an outpatient basis every other day. If the patient has undergone osteosynthesis with knitting needles, then dressings are done every other day for about 1.5 months. Limiting the load on the hand averages 3 months.

The average length of hospitalization for a fracture of the metacarpal bones is 5 days

What bones are affected by brachymetacarpy?

The fourth metacarpal bone is most often affected, less commonly the fifth and even less commonly the third metacarpal bone. Just one of these bones, or several in any combination, can be shortened. One hand can be affected, or both can, and it is not necessary that the number and/or number of shortened metacarpal bones will coincide. Another common symptom is shortening of the nail phalanx of the thumb on one or both hands. At the same time, the nail on the thumb is short and wide. Apparently, this pathology is present in the famous actress Megan Fox.

"Snapping finger" (Knott's disease)

This is a common and common disease of the ligaments of the fingers. The course of the pathological process consists in the difficulty of free sliding of the finger flexor tendons through the annular ligament of the hand. A situation occurs when the diameter of the flexor tendon of the finger is greater than the hole formed by the annular ligament of the finger in which this tendon slides.

The pathology occurs more often in children, and this is most likely due to the fact that their tendon grows faster than the growth of the annular ligament. In adults, this pathology can occur as a result of injury or an inflammatory process. Diagnosis is not difficult for a doctor. Clinically, the disease manifests itself in difficulty in independently straightening the finger, and if this is still possible, then a characteristic “click” is heard when straightening.

Treatment

Surgery is performed on an outpatient basis, under local anesthesia. After surgery, there is usually no need for immobilization and rehabilitation.

The most important thing for the patient

If you have severe symptoms and impaired hand function, do not delay contacting a hand surgeon.
If treatment is delayed, the prognosis for full recovery is significantly lower. In the Department of Traumatology and Orthopedics No. 2, patients with pain in the hands are seen by a hand surgeon -
Kirill Olegovich Turbin . Experience: more than 17 years. He deals with hand and wrist problems. Kirill Olegovich actively accepts patients from all over Russia, both on paid and under VHI and compulsory medical insurance policies (free of charge - within the allocated volumes of the state assignment).

Carpal tunnel syndrome

Carpal tunnel syndrome is one of the types of tunnel syndromes. When it occurs, the median nerve is compressed in an anatomically narrow space (anatomical tunnel) - under the so-called retinaculum (transverse ligament). This ligament is located in the palmar base and covers the tendons and neurovascular bundle. Women suffer from this pathology more often than men.

Diagnostics

Isolation of the symptom complex:

• numbness, decreased sensitivity of the 1st, 2nd, 3rd and part of the 4th fingers;
• decreased strength in the hand.

At the present stage of diagnosis, after examining the patient by a doctor and making a preliminary diagnosis, electroneuromyography (ENMG) can be prescribed.

Electroneuromyography

is a study that records the speed of impulse transmission along nerve fibers and the amplitude of the response of muscle tissue to electrical stimulation of the nerve. Needle myography (performed as part of general ENMG) allows you to determine signs of nerve death (chronic or acute denervation). In conclusion, ENMG shows how deeply the median nerve is affected by the pathological process. The axons (the constituent structure of the median nerve) have died or only the myelin sheath of the processes has been damaged (demyelination), which is responsible for protecting the fibers from damage and for the speed of transmission of the nerve impulse. Determining the type and depth of damage to the median nerve allows the doctor to determine the correct treatment method.

Risk factors

1. 1) Prolonged work at a personal computer, accompanied by non-physiological frequent movements with small amplitude when working with a mouse and keyboard, is a directly damaging factor.
2. 2) Professional activities related to fine motor skills of the hands and wrist joint.
3. 3) Hormonal disorders or changes (menopause, sudden weight loss, climate change).
4. 4) Conditions and diseases associated with impaired microcirculation of the extremities, leading to damage to peripheral nerves (diabetes mellitus, vitamin B12 deficiency in the body).
5. 5) Dysfunction of endocrine organs (hypo- and hyperthyroidism, hyperfunction of the pituitary gland).

Treatment

Operational. Decompression of the median nerve at the wrist level.

Prices for surgery

Consultation with a pediatric orthopedist

Treatment of congenital anomalies of the limbs is surgical. Parents should take this issue extremely responsibly, understanding the importance of early seeking medical help. Often, the outcome of treatment is influenced by the age of the child at which the operation was performed and the qualifications of the surgeon. Regardless of the type of congenital defect, medical consultation should be obtained as early as possible, in the first months of the child’s life. At the CONSTANTA Clinic in Yaroslavl you can make an appointment with an experienced hand surgeon, pediatric traumatologist-orthopedist Torno T.E.

During the consultation, the doctor:

• carefully examine the child (pathological changes are noticeable already in the first days of the baby’s life);
• determine the severity of the deformation;
• select the tactics of medical treatment;
• will calculate the exact cost of medical care.

The structure of the hand

In the composition of the bones of the human hand, namely the hand, the metacarpal bones play an important role. These are small tubular bones that extend from the wrist itself in the amount of five pieces, thereby forming peculiar rays.

There are five metacarpal bones on each hand. Their numbering begins with the bone that belongs to the thumb. Due to their structure and location, these bones take an active part in the motor ability of the fingers. They are involved in flexion and extension movements.

Each such bone includes:

• body;
• pineal gland

Despite their importance, these bones are easily vulnerable. They can be easily felt through the skin of the hand and are most often injured if any blow falls on the hand. Thus, the most common causes of fractures are fights and unfortunate falls. Medical statistics show that the first and fifth bones suffer the most.

Recovery period after a fracture

Any fracture requires a certain period of recovery so that the patient can feel the full motor capabilities of the injured area. A fracture of the fifth metacarpal bone is no exception in this matter.

For accelerated rehabilitation, the patient is prescribed a number of physiotherapeutic procedures and physical therapy exercises. The doctor may prescribe the use of special ointments and gels to quickly remove swelling from the hand.

Some useful exercises include the following:

1. Handling small parts or cereals, which allows you to restore fine motor skills of your fingers.
2. Unhurried, rather slow clenching and unclenching of fingers into a fist.
3. Slow circular movements with the hand.

If you carefully perform these exercises, as well as regularly attend medical rehabilitation procedures, the rehabilitation period will pass unnoticed.

Dupuetren's contracture

Dupuetren's contracture (shrinkage of the palmar aponeurosis of the hand) is a very common disease, 85% of patients are men. The pathological process consists of the degeneration of the palmar aponeurosis into denser tissue.

The etiology of this disease is still unclear, but surgical treatment methods have been developed and are effectively used. People whose profession involves constant stress and microtrauma to the hand suffer more often.

Diagnostics

It is quite simple and the diagnosis can be made based on a simple examination by a doctor. Clinically, the disease occurs in the form of the appearance of “dense balls and cords” on the palmar side of the hand, flexion contracture most often of the 4th and 5th fingers of the hand, and the inability to straighten them. There are 4 stages of the pathological process, depending on each stage the doctor individually selects the type of treatment.

Treatment

Taking into account the peculiarities of the course and development of this pathology, surgical treatment (partial aponeurectomy: open) is more often used, which gives a positive, relapse-free result in 90-100% of cases.

Hygroma (tendon ganglion)

Hygroma

- a benign formation that usually occurs as a result of traumatic injury. The development of the pathological process begins with synovial fluid entering the vagina surrounding the tendon, resulting in the formation of a “round lump” (hernia) at this site. The location of the hygroma can be very different, but most often it is the forearm, hand or wrist joint. Diagnosis, as a rule, does not cause difficulties for the doctor. An ultrasound examination is often required, but often one examination is sufficient. Hygroma can be painful and grow to a large size, causing significant suffering to the patient.

Treatment

In the absence of sufficient experience and knowledge, doctors may resort to such ineffective methods as punctures and “squeezing”. In fact, for hygroma, surgical treatment is indicated in the amount of its complete removal and plastic surgery of the damaged vagina (“hernial orifice”).

Rhizarthrosis

Arthrosis of the metacarpal joint of the thumb, located at its base and manifested by pain in this area. This process is chronic and causes a lot of suffering in everyday life, as it is an integral part of all movements and manipulations of the hand. The cause of arthrosis, as a rule, is increased load, traumatic effects, and impaired trophism of the joint. To diagnose rhizarthrosis, the same methods are used as for diagnosing arthrosis of the knee and hip joints; as a rule, radiographs are sufficient. Until recently, this pathology was not given much importance, but with the growing prosperity of society, patients strive to improve their quality of life in all aspects. And today, modern and effective methods of surgical treatment of rhizarthrosis have been developed.

Treatment

Surgical intervention on the joint (trapezectomy, arthrodesis and other surgical techniques).