- Nondisplaced and stable fractures can be treated with
buddy taping and early range of motion (Capo and
Hastings, 1998). Careful clinical and radiographic
follow-up is required to detect subsequent fracture
displacement. - Displaced fractures require closed reduction and
immobilization with cast or splint and an outrigger
with the affected finger held in the intrinsic-plus posi-
tion including an adjacent digit to help maintain rota-
tional alignment (Capo and Hastings, 1998). - Fracture immobilization should be limited to 3 weeks
prior to initiation of hand based therapy to facilitate
maximal restoration of motion, protective splinting
should be continued during sport specific activities
until healing is evident (Capo and Hastings, 1998;
Posner, 1995; Strickland et al, 1982). - Intra-articular, unstable, or rotationally malaligned
fractures may benefit from open or closed reduction
and internal or percutaneous fixation to restore
anatomic alignment and rotational control. - If rigid fixation is obtained, mobilization to regain
range of motion and edema control should begin
within the first week after surgery, permitting earlier
return to sport and a more predictable functional out-
come (Capo and Hastings, 1998; Breen, 1995). - Protective splinting should be maintained for 4 weeks
or until fracture healing is evident. Simple buddy
taping should be continued until range of motion and
strength are restored.
DISTALPHALANXFRACTURES
- Account for 50% of all hand fractures—especially
thumb and middle finger (McNealy and Lichtenstein,
1940). - Fibrous septa from skin minimize fracture displace-
ment. - Must examine for evidence of nail bed injury.
•Treatment is dictated by presence of soft tissue injury. - If a nail bed injury is present, the nail bed must be
repaired to prevent nail deformity (Simon and Wolgin,
1987). - Immobilization is restricted to the distal interpha-
langeal joint for a period of 3 to 4 weeks after which
motion is initiated (Capo and Hastings, 1998).
•Tenderness may persist for greater than 6 months
requiring a program of desensitization to allow full
return of function (DaCruz, Slade, and Malone, 1988). - Mallet finger deformity can occur from loss of conti-
nuity of extensor mechanism through bony or tendi-
nous disruption.
•Treatment is almost always nonoperative with contin-
uous extension splinting of the distal interphalangeal
(DIP) joint for at least 6 weeks followed by the
removal of the splint several times a day for active
range of motion exercises for an additional 2 weeks
(Henry, 2001; Posner, 1995).RETURN TOSPORTSAFTERPHALANGEALFRACTURES- Athletes with stable fractures treated nonoperatively
may return to sports with rigid cast immobilization,
thermoplast splint protection, or buddy taping (as
sport specific activities permit) as soon as symptoms
allow often within the first week (Alexy and De Carlo,
1998). - Close follow-up must be maintained to ensure that
loss of reduction or malrotation do not occur. - Protection should be maintained until radiographic
evidence of complete healing is evident and func-
tional recovery of range of motion and strength are
complete (Posner, 1995). - Athletes with surgically treated fractures may return
to sports with protective splinting or casting once soft
tissue healing allows. - Edema control and active motion are typically initi-
ated at 2 weeks and by 4 weeks 75% of motion should
have been regained and strengthening can be initiated.
Protective splinting should be maintained for sport
specific activities until healing is evident (Capo and
Hastings, 1998; Graham and Mullen, 2003; Alexy and
De Carlo, 1998). Buddy taping should be maintained
until strength and motion have been regained.
REFERENCES
Alexy C, De Carlo M: Rehabilitation and use of protective
devices in hand and wrist injuries. Clin Sports Med
17:635–655, 1998.
Alffram PA, Bauer GC: Epidemiology of fractures of the fore-
arm. A biomechanical investigation of bone strength. J Bone
Joint Surg [Am]44A:105–114, 1962.
Amadio PC: Epidemiology of hand and wrist injuries in sports.
Hand Clin 6:379–381, 1990.
Arner M, Hagberg L: Wrist flexion strength after excision of the
pisiform bone. Scand J Plast Reconstr 18:241–245, 1984.
Barton JR: Views and treatment of an important injury of the
wrist. Med Exam 1:365, 1838.
Bass RL, Blair WF, Hubbard PP: Results of combined internal
and external fixation for the treatment of severe AO-C3 frac-
tures of the distal radius. J Hand Surg 20A:373–381, 1995.
Batillas J, Vasilas A, Pizzi WF, et al: Bone scanning in the detec-
tion of occult fractures. J Trauma 21:564–569, 1981.
Beckenbaugh RD, Shiver TC, Dobyns JH, et al: The natural his-
tory of Kienbock’s disease and consideration of lunate frac-
tures. Clin Orthop 149:98–106, 1980.
Bindra RR, Cole RJ, Yamaguchi K, et al: Quantification of the
radial torsion angle with computerized tomography in cadaver
specimens. J Bone Joint Surg 79A:833–837, 1997.318 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE