0071643192.pdf

ORTHOPEDICS

DIAGNOSIS

■ Unable to fully extend PIP with the wrist and metacarpophalangeal (MCP)

joints fully flexed

TREATMENT

■ Treat by splinting PIP in extension for 4–6 weeks.

A 19-year-old man presents to a university health clinic with a swollen and

tender hand over the fourth and fifth metatarsal and a laceration over the

fifth knuckle. What fracture is most likely?

Aboxer’sfracture, and the laceration is probably due to a tooth. Do not

suture these lacerations. See Table 4.5 for acceptable degrees of angulation for

metacarpal fractures.

Hand Injuries

RUPTURE OF THEULNARCOLLATERALLIGAMENT

Also known as gamekeeper’s thumb andskier’s thumb

MECHANISM

Valgus force on thumb leads to tear of ulnar collateral ligament. It may also

occur with avulsion of tendon insertion site at the base of the proximal phalanx

(see Figure 4.2). 30% are associated with fractures.

FIGURE 4.2. Gamekeeper’s thumb. An avulsion fracture off the medial base of the
proximal phalanx due to the pull of the ulnar collateral ligament.