Sports Medicine: Just the Facts

CHAPTER 54 • WRIST AND HAND FRACTURES 317

be treated with arthodesis without significantly com-

promising hand function (Palmer, 1998).

RETURN TOSPORTSFOLLOWING
METACARPALFRACTURES
•Most sports-related metacarpal fractures are stable
and are treated initially with splint or cast immobi-
lization. Return to sports with protection may be initi-
ated within 1 to 2 weeks from injury depending upon
the requirements of the specific sport. Protection is
usually continued for 8 to 12 weeks depending upon
the demands of the sport (Alexy and De Carlo, 1998).

• Fractures treated with rigid internal fixation may
  allow the athlete earlier return to play than nonopera-
  tive treatment. Athletes may begin early motion with
  return to sports with immobilization as early as
  2weeks and by 5 to 6 weeks buddy taping or a light
  splint may be all that is required to permit sport spe-
  cific activities (Graham and Mullen, 2003; Alexy and
  De Carlo, 1998; Breen, 1995).

THUMB METACARPAL FRACTURES

• Thumb metacarpal fractures are unique from fractures
  of the other digits secondary to the thumb’s critical
  role in hand function, especially grasp and power
  pinch.


• More than one fourth of all metacarpal fractures are to
  the thumb metacarpal base and result from axial load-
  ing across the partially flexed thumb (Gedda, 1954).


• Radiographic imaging requires views specifically of
  the thumb in AP and lateral projections.


• Joint anatomy comprises reciprocal saddle-shaped sur-
  faces of the distal trapezium and proximal metacarpal.
  •Intra-articular Bennett’s (partial articular) and
  Rolando’s (complete articular) fractures often have
  displacement dorsally and radially by pull of the
  abductor pollicis longus (Green and O’Brien, 1972;
  Langford, Whitaker, and Toby, 1998).
  •Treatment is directed at minimizing posttraumatic
  arthritis by obtaining anatomic joint reduction.


• If less than 15 to 20% of the joint surface is involved
  then closed reduction and percutaneous pinning is
  successful (Freeland, 2000).


• Immobilization in a short-arm thumb spica cast for 4
  to 6 weeks is recommended followed by removal of
  pins and initiation of motion (Palmer, 1998; Langford,
  Whitaker, and Toby, 1998).


• If greater than 25 to 30% of the joint surface is
  involved then open reduction and stable internal fixa-
  tion with screws or pins is indicated (Green, 1993).


• Range of motion is initiated at 5 to 10 days postoper-
  atively (Langford, Whitaker, and Toby, 1998).

•Severely comminuted intra-articular Rolando frac-

tures often require external fixation followed by lim-

ited open reduction and internal fixation with bone

grafting (Buchler, McCollam, and Oppikofer, 1991).

• Immobilization is continued for a minimum of 6 to
  8 weeks followed by the initiation of hand based ther-
  apy to regain motion and strength.


• Extra-articular thumb metacarpal fractures usually
  occur toward the metacarpal base.
  •Treatment often consists of closed reduction and
  immobilization in a thumb spica cast for 4 to 6 weeks
  followed by initiation of hand therapy.
  •Twenty to thirty degrees of angulation is acceptable
  because of the multiple planes of thumb motion (Capo
  and Hastings, 1998).


• Unstable fractures may require operative intervention
  with either closed reduction and percutaneous pinning
  or internal fixation similar to the treatment for other
  metacarpal fractures (Capo and Hastings, 1998;
  Freeland, 2000).

RETURN TOSPORTS

• Athletes may return to sport with immobilization in
  thumb spica splint or cast as symptoms and sport spe-
  cific activity permit.


• Protection should be maintained until fracture healing
  is evident on radiographs and strength, stability and
  motion are restored.


• Operative intervention with stable fixation may allow
  for earlier initiation of motion and return to sports
  (Langford, Whitaker, and Toby, 1998).

PHALANGEAL FRACTURES

PROXIMAL ANDMIDDLEPHALANXFRACTURES

•Very common fractures in athletes participating in

contact sports or sports requiring catching of a ball.

•Fracture displacement depends on mechanism of

injury and deforming forces of muscles and tendons on

bone.

• Proximal phalanx fractures typically have volar angu-
  lation with proximal segment flexed by the interossei
  and the distal segment extended by pull of the central
  slip portion of the extensor mechanism (Capo and
  Hastings, 1998; Henry, 2001).


• Middle phalanx fractures are deformed by both the
  central slip and by the flexor digitorum superficialis
  tendon resulting in either volar or dorsal angulation
  depending upon the location of the fracture (Capo and
  Hastings, 1998; Henry, 2001).
  •Treatment depends upon the stability of the fracture,
  correction of rotational deformation, and no greater
  than 10°of angulation in any plane.