CHAPTER 54 • WRIST AND HAND FRACTURES 315(Rettig et al, 1998; Cordrey and Ferrer-Torells, 1974;
Seitz, Jr, and Papandrea, 2001).
•Trapezial ridge fractures with minimal displacement
have high rates of nonunion and surgical excision of
the fragment allows for an uncomplicated recovery
and early return to sport (Palmer, 1981).
RETURN TOSPORTS
- Nondisplaced fractures treated nonoperatively may
return to sport with cast or splint immobilization once
symptoms permit with protection continuing for up to
12 weeks or until strength and motion return (Morgan
and Reardon, 1995).
•Trapezial body fractures treated operatively should be
protected with cast or splint immobilization until
complete healing and strength and motion has been
restored.
•Trapezial ridge fractures treated with excision may
return to sport once soft tissue healing allows; padded
gloves are often required to minimize wound sensitiv-
ity that may last for several months (Geissler, 2001;
Rettig et al, 1998).
TRAPEZOID FRACTURES
- The trapezoid is in a well-protected position anatomi-
cally and is the least commonly fractured carpal bone,
involved in less than 1% of carpal fractures (Ruby,
1992). - Fracture of the trapezoid is the result of high-energy
axially directed trauma along the index metacarpal.
•Trapezoid fractures are usually visualized on standard
AP, lateral, and oblique views.
•Treatment usually requires open reduction and inter-
nal fixation of the trapezoid with pinning of the index
metacarpal in a reduced position. The Kirschner wires
can be pulled at approximately 6 weeks followed by
the initiation of hand therapy to restore motion and
strength (Geissler, 2001).
RETURN TOSPORT
- Athletes may return to sport wearing a protective
splint once the Kirschner wires are removed or when
soft tissues allow (Geissler, 2001).
METACARPAL FRACTURES
- Metacarpal and phalangeal fractures are the most
common fractures in the skeletal system, accounting
for greater than 14% of all emergency room visits and
greater than 36% of all hand fractures (Capo and
Hastings, 1998; Packer and Shaheen, 1993).- Often the result of a direct blow or crush type injury
to the hand; can occur secondary to fall onto the hand.
•Typically presents with apex dorsal angulation sec-
ondary to deforming force of intrinsic muscles. - Rotational deformity must be recognized and cor-
rected in treating these fractures. - Rotational alignment is best visualized with full flex-
ion of the fingers. - Fractures best visualized with standard AP, lateral,
and oblique radiographs of the hand.
•Classified as transverse, oblique, spiral, and commin-
uted.
- Often the result of a direct blow or crush type injury
TRANSVERSE FRACTURES- Apex dorsal fracture angulation is secondary to forces
applied by intrinsic muscles. These forces are neutral-
ized by metacarpophalangeal(MCP) joint flexion. - Reduction is indicated for any angulation in the index
and middle fingers, greater than 20°for ring finger,
and greater than 30° for small finger (Capo and
Hastings, 1998; Henry, 2001; Freeland, 2000).
TREATMENT- Most stable fractures can be treated nonoperatively
with cast immobilization for 2 weeks, followed by
orthoplast splint immobilization of the affected digit
and its neighbor for an additional 2 weeks, and buddy
taping and initiation of active motion at 4 weeks post
injury (Capo and Hastings, 1998). - Rotational deformity is not acceptable—rotation is
the most critical factor in evaluating metacarpal frac-
tures.
•Treatment options for unstable fractures or fractures
that fail closed treatment comprise closed reduction
and percutaneous pinning, cross pinning to adjacent
metacarpal, closed reduction and internal fixation, and
open reduction and internal fixation (Capo and
Hastings, 1998). - Stable fixation requires no protection except for sport,
with light active use being permitted within 5 days
postoperatively (Capo and Hastings, 1998).
OBLIQUE AND SPIRAL FRACTURES- Result of torsional forces to the metacarpal.
- Untreated fractures tend to shorten and rotate.
- Rotational deformity is unacceptable as 5°of malro-
tation can lead to 1.5 to 2 cm of digital overlap (Rolye,
1990).
•Five millimeters of shortening can be accepted without
functional deficit (Bloem, 1971).