Pediatric and Adult Hand Fractures: A Clinical Guide to Management

Contents
Part I: Pediatric Hand Fractures
	1: Anatomy and Osseous and Functional Development of the Hand
		Introduction
		Anatomy
			Bones
			Joints
			Muscles and Tendons
			Flexors
			Extensors
			Nerves
			Vascular System
		Osseous Development
		Functional Development
		Conclusion
		References
	2: Examination of the Pediatric Hand
		Introduction
		General Examination
		Physical Examination
		Palpation
		Range of Motion
		Neurovascular Examination
		Radiographic Examination
		Conclusion
		References
	3: Pediatric Metacarpal Fractures
		Epidemiology
		Anatomy
		Clinical Assessment
		Treatment
			Base
			Shaft
			Neck
			Physeal/Head
		Conclusion
		References
	4: Pediatric Phalangeal Base and Shaft Fractures
		Introduction
		Pathoanatomy
		Clinical Evaluation
		Radiographic Evaluation
		Nonoperative Management
			Proximal Phalanx Fractures
			Middle Phalanx Fractures
			Radiographic Follow-Up
		Operative Management
			Proximal Phalanx Fractures
			Middle Phalanx Fractures
			Surgical Technique
		Outcomes
			Malunion
			Stiffness
			Pin Site Complications
			Skin Complications
		Conclusion
		References
	5: Pediatric Phalangeal Neck and Condylar Fractures
		Phalangeal Neck Fractures
			Clinical Presentation
			Classification
			Imaging
			Treatment
			Outcomes
			Complications
		Phalangeal Condylar Fractures
			Introduction
			Clinical Presentation
			Classification
			Imaging
			Treatment
			Outcomes
			Complications
		Conclusion
		References
	6: Seymour Fractures and Bony Mallet Fractures in the Pediatric Population
		Introduction
		Seymour Fractures
			Clinical Presentation
			Classification
			Imaging
			Treatment
			Outcomes
			Complications
		Bony Mallet Fractures
			Clinical Presentation
			Classification
			Imaging
			Treatment
			Outcomes
			Complications
		Conclusion
		References
	7: Fingertip Injuries and Tuft Fractures in the Pediatric Population
		Introduction
		Evaluation
		Specific Injuries: Nail Bed Injuries
			Epidemiology
			Clinical Evaluation
			Antibiotics
			Repair (Emergency Department Vs. Operating Room)
				Technique
				Post-op Care
			Outcomes
				Complications
		Tuft Fracture (Distal Phalanx)
			Epidemiology
			Clinical Evaluation
			Antibiotics
			Repair (Reduction)
				Technique
				Post-op Care
					Outcomes
				Complications
		Amputations
			Epidemiology
			Clinical Evaluation
			Antibiotics
			Repair (Emergency Department Vs. Operating Room)
			Partial Amputations
			Complete Amputations
			Composite Grafting
			Post-op Care
			Outcomes
		FDP Avulsion
			Epidemiology
			Clinical Evaluation
			Repair
				Technique
			FDP Avulsions
			Local Vs General Anesthesia
				Post-op Care
				Outcomes/Complications
		Conclusion
		References
	8: Pediatric Thumb Fractures
		Background
			Ossification
		Anatomy
		Incidence
		Specific Injury Patterns
			Carpometacarpal Fracture Dislocations
			Thumb Metacarpal Base Fractures
			Thumb Metacarpal Shaft and Neck Fractures
			Proximal Phalanx Fractures
			Distal Phalanx Fractures
		Conclusion
		References
	9: Pediatric Hand Fractures: Rehabilitation and Orthoses
		Introduction
		Therapy Considerations
		Specific Fractures
			Metacarpal Fractures
				Case Example
			Phalanx Fractures
				Case Example
			Phalangeal Neck Fractures
				Case Example
			Bony Mallet Fracture
			Seymour Fracture
			Tuft Fracture
				Case Example
		Conclusion
		References
Part II: Adult Hand Fractures
	10: Physical and Radiographic Examination of the Adult Hand
		Physical Examination of the Adult Hand
		Radiographic Examination of the Adult Hand
			Carpometacarpal Joints
			Metacarpals
			Metacarpophalangeal Joints
			Phalanges
			Interphalangeal Joints
		References
	11: Adult Metacarpal Base and CMC Dislocations Fractures
		Background
		Anatomy
		Diagnosis and Imaging
			History and Mechanism of Injury
			Physical Examination
			Imaging
			Classification Systems
		Treatment
			Nonoperative
			Operative
		Arthrodesis
		Salvage
		Hamatometacarpal Base Fracture-Dislocation
		Other Distal Carpal Row Fracture-Dislocation
		Complications
		Psychological Influence on Outcomes
		Summary
		References
	12: Adult Metacarpal Shaft Fractures
		Introduction
		Anatomy/Pathoanatomy of the Non-thumb Metacarpals
			Osteology
			Muscular/Ligamentous Anatomy
		Pathoanatomy/Mechanism/Clinical Relevance
		Treatment Indications/Options
			Nonoperative
				Angulation, Shortening, and Reduction
			Immobilization
		Operative
			Indications
			Techniques
		Plate and Screw Fixation
		Percutaneous and Wire Fixation
		Isolated Screw Fixation
		IM Screw Fixation
			Brief History of IM Screws
			Implants
			Techniques/Articular Considerations
			Indications/Applications
		Outcomes (Biomechanical/Clinical)/Complications
			Biomechanical Outcomes
			Clinical Outcomes/Cost/Complications
			Other Techniques/Combination Techniques
			Rotational Assessment
		Conclusion
		References
	13: Metacarpal Head and Neck Fractures
		Epidemiology and Mechanism
		Classification
		Physical Exam
		Imaging
		Treatment
		Nonoperative Management
		Operative Management
		Outcomes
		References
	14: Adult Thumb Metacarpal Fractures
		Epidemiology
		Mechanism of Injury and Biomechanics
		Classification
		Physical Exam
		Imaging
		Treatment
			Non-operative Management
			Operative Management
		Outcomes
		References
	15: Adult Phalangeal Base Fractures: Pilons, Avulsions, PIPJ Fracture-Dislocations
		Introduction
		Anatomy of the Metacarpophalangeal Joint
		Anatomy of the Proximal Interphalangeal Joint
		Anatomy of the Distal Interphalangeal Joint
		Assessment
			History and Mechanism
		Clinical Findings and Physical Examination
			Imaging: Radiographs
			Imaging: Computed Tomography (CT)
			Imaging: Magnetic Resonance Imaging (MRI)
			Imaging: Ultrasound
		Classification
			Stable Versus Unstable
			Dorsal PIP Fracture-Dislocation
			Volar PIP Fracture-Dislocation
			Pilon Type Fracture-Dislocation
		Treatment
			Non-operative Treatment
				Buddy Taping
				Extension Block Splint
				Dorsal AlumaFoam Splint
			Operative Treatment
				Extension Block Pinning
				Closed Reduction and Percutaneous Pinning
				Open Reduction and Internal Fixation
				Static and Dynamic External Fixator
				Volar Plate Arthroplasty
				Bridge Plating
			Salvage Options
				Hemi-hamate Arthroplasty
				Implant Arthroplasty
				Arthrodesis
		Summary
		References
	16: Adult Phalangeal Shaft Fractures
		Introduction
		Fracture Assessment
		Treatment
			Nondisplaced Fractures
			Stable Fracture After Closed Reduction
		Unstable Fracture After Closed Reduction Percutaneous Kirschner Wire Fixation
			Transverse Fracture of the Proximal Phalanx
		Closed Reduction and Percutaneous Kirschner Wire Fixation of Unstable Spiral or Oblique Diaphyseal Fractures
		Open Reduction and Internal Fixation
		Fracture Fixation
			External Skeletal Fixation
		Complications
		References
	17: Adult Phalangeal Condyle Fractures
		Anatomy and Pathophysiology
		Principles of Management
		Nonoperative Management
		Operative Management
		Post-operative Care
		Complications
		References
	18: Adult Bony Mallet Fractures
		Introduction
		Presentation
		Classification
		Evaluation
		Treatment
			Nonoperative Treatment
			Operative Treatment
		Complications
		Discussion
		References
	19: Fingertip Injuries
		Section I: Anatomy
			Nail Complex
			Distal Phalanx and Finger Pulp
			Neurovascular Supply
			Innervation and Sensation
		Section II: Classification and Evaluation of Injuries
			Classification
			Physical Exam
			Radiographic Evaluation
		Section III: Management of Nailbed Injuries
			Subungual Hematoma
				Management
			Nail Laceration and Avulsion
				Management of Laceration and Avulsion
		Section IV: Soft Tissue Reconstruction
			Secondary Intention
				Indications
				Methods
			Skin Grafting
				Indications
			Cap Grafting ([19], 49)
				Indications
				Methods
			Local Flaps
				Volar V-Y Advancement Flap aka Atasoy
					Indications
					Advantages
					Disadvantages
					Methods
				Lateral V-Y Advancement Flap aka Kutler
					Indications
					Advantages
					Disadvantages
					Methods
				Visor Flap
					Indications
					Advantages
					Disadvantages
					Methods
				Homodigital Volar Advancement Flap aka Moberg and O’Brien Modification
					Indications
					Advantages
					Disadvantages
					Methods
				Regional Flaps
				Thenar Flap
					Indications
					Advantages
					Disadvantages
					Methods
				Cross-Finger Flap
					Indications
					Advantages
					Disadvantages
					Methods
				Reverse Homodigital Island Flap
					Indications
					Advantages
					Disadvantages
					Methods
				Dorsal Metacarpal Artery aka Kite Flap
					Indications
					Advantages
					Disadvantages
					Methods
				Heterodigital Island Flap
					Indications
					Advantages
					Disadvantages
					Methods
				Revision Amputation
					Indications
					Advantages
					Disadvantages
					Methods
				Other Options for Soft Tissue Coverage
		Section V: Distal Phalanx Fractures
			Classification
		Section VI: Rehabilitation
		References
	20: Arthroscopy for Adult Hand Fractures
		Introduction
		Intra-Articular Fractures of the Thumb Metacarpal Base
			Technique
			Current Literature
		Fractures Involving the Thumb Metacarpophalangeal Joint
			Technique
			Current Literature
		Intra-Articular Fractures of the Finger Metacarpophalangeal Joints
			Intra-Articular Finger Metacarpal Head Fractures
				Technique
			Intra-Articular Finger Proximal Phalanx Base Fractures
				Technique
				Current Literature
		Conclusion
		References
	21: WALANT for Adult Hand Fractures
		What Is WALANT?
		Why Use WALANT for Hand and Finger Fractures?
		How to Inject the Local Anesthesia for WALANT Hand Fracture Reduction
		Other Suggestions to Eliminate Problems with WALANT Local Anesthesia Injection
		Where to Inject the Local Anesthetic for Finger Fracture Reduction
		Where to Inject the Local Anesthetic for Metacarpal Fracture Reduction
		Wrist and Distal Radius Fracture Reduction
		Patients Need to See Their Finger Move During Surgery
		Intraoperative Unsedated Patient Education During WALANT Hand Fracture Reduction
		References
	22: Rehabilitation and Orthoses for Adult Hand Fractures
		Introduction
		Evaluation
		Client Factors
			Edema
			Range of Motion
				AROM/AAROM
				PROM
			Pain
			Strength
		Pin Site Care
		Adherence
		Protocols
		Orthosis/Splinting
		References
Index