Mga Pagsira ng Daliri Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mo ang agad na sakit at pamamaga sa apektadong daliri o kamay. Karaniwang matalas ang sakit sa simula, pagkatapos ay nagiging pulso-pulso o maninibabaw na sakit. Maaari kang maramdaman ang pagkakasikip kapag sinusubukan mong galawin ang kasukasuan. Normal ito dahil ang buto at mga nakapaligid na tisyu ay tumutugon sa pinsala.

Karaniwan at kadalasang matatag ang mga simpleng saradong fracture. Maaaring mahirapan kang hawakan ang mga bagay. Maaaring maging mahirap o masakit ang pag-abot sa likod upang isara ang bra o ang pagtupi ng damit. Maaaring magdulot ng discomfort ang pag-angat ng kahit magaan na bagay, tulad ng tasa ng kape. Nagiging mas mahirap ang mga gawaing ito sa araw-araw dahil kailangan pahinga ng kamay upang gumaling.

Kung ang fracture ay bukas, ibig sabihin ang balat ay nasira, maaaring mas malala ang sakit. Ang isang quarter ng mga bukas na fracture ng daliri ay nangangailangan ng higit sa isang operasyon. Lalo itong totoo para sa mga malubhang nasirang daliri o mga may problema sa daloy ng dugo. Maaari kang maranasan ang pagtaas ng sakit kung ang lugar ay napiga o kung ang sirkulasyon ay sira.

Mas malaki ang posibilidad na kailangan ng unplanned na reoperation ang mga pinsala sa hinlalaki at hintutuhin. Maaari kang maranasan ang mas mataas na pag-aalala tungkol sa mga partikular na daliri na ito dahil kritikal sila para sa pagganap ng kamay. Susubaybayan ng iyong surgeon ang mga lugar na ito nang mahigpit sa mga follow-up upang matiyak ang tamang paggaling.

Ang mga fracture ng phalangeal (mga buto ng daliri) ay kadalasang nawawalan ng mas maraming kabuuang galaw kumpara sa mga fracture ng metacarpal (mga buto ng kamay). Maaaring mapansin mo na mas nakakapit ang iyong daliri sa paglipas ng panahon kung hindi ito maayos na pamamahalaan. Gayunpaman, ang karamihan sa mga fracture ng metacarpal ay may minimal na epekto sa kabuuang kalusugan at gumagaling nang maayos nang walang operasyon.

Madalas ang mga komplikasyon sa mga fracture ng distal phalanx ng mga bata. Maaaring makita mo ang pamamaga o瘀伤 na tila mas malala kaysa sa totoo. Ang karamihan sa mga fracture ng kamay ng mga bata ay pinamamahalaan nang walang operasyon at may magandang resulta.

Karaniwan ang sakit sa gabi. Maaari kang gumising na may nakakapit at masakit na kamay. Karaniwang hindi posible ang pagtulog sa nasirang gilid. Ang pagtaas ng iyong kamay sa mga unan ay makakatulong upang bawasan ang pamamaga at sakit.

Iiaangkop ng iyong surgeon ang paggamot sa iyong partikular na pattern ng fracture. Isasalang-ala nila ang displacement at kalagayan ng malambot na tisyu. Ang karamihan sa mga fracture ng metacarpal ay pinamamahalaan nang nonoperatively. Hindi kailangan ang mga follow-up radiograph para sa karamihan sa mga fracture ng base at leeg ng ika-limang metacarpal.

Layunin naming tulungan kang bumalik sa buong pagganap. Sa tamang pag-aalaga, 92% ng mga pasyente ay bumabalik sa buong pagganap nang walang komplikasyon sa loob ng 10 linggo. Inaasahan mo ang patuloy na pagpapabuti sa kaginhawaan at galaw habang nagpapatuloy ang paggaling.

Ano ang nangyayari talaga

Ang iyong mga daliri ay binubuo ng maliliit na buto na tinatawag na phalanges, habang ang mga buto ng palad ay kilala bilang metacarpals. Ang mga butong ito ay nagtutulungan sa mga tendon at kasukasuan upang payagan kang humawak at mag-pinches. Kapag may fracture, basag ang istruktura ng buto. Binabasag nito ang makinis na ibabaw na nagpapahintulot sa iyong mga kasukasuan na gumalaw nang walang friction.

Karamihan sa mga metacarpal fractures ay simple at stable. Madalas silang gumaling nang maayos nang walang operasyon. Gayunpaman, may ilang fractures na unstable o displaced. Ibig sabihin, lumipat ang mga piraso ng buto mula sa kanilang tamang posisyon. Kung hindi pantay ang ibabaw ng kasukasuan, maaari itong magdulot ng sakit at stiffness sa hinaharap. Titingnan ng iyong surgeon kung paano basag ang buto at kung nasira ang malambot na tisyu upang magdesisyon sa pinakamainam na landas para sa iyo.

Sa mga bata, karamihan sa mga fracture ng kamay ay gumagaling nang maayos sa non-surgical na pag-aalaga tulad ng buddy taping. Ito ay kinabibilangan ng pagtatape ng sugatang daliri sa kalusugang daliri sa tabi nito para sa suporta. Kahit na displaced ang buto, madalas na gumagana ang simpleng paraang ito. Sa ilang kaso, nangangailangan ang fracture ng isang bata ng mabilisang operasyon upang maiwasan ang mga pangmatagalang problema.

Para sa mga matatanda, maaaring mas komplikado ang sitwasyon. Kung mayroon kang open fracture, kung saan basag ang balat, mas mataas ang panganib ng impeksyon. Isang quarter ng mga kasing ito ay malamang na nangangailangan ng higit sa isang surgical na prosedura. Lalo itong totoo kung ang suga ay kinabibilangan ng malubhang pagkukrus o mga isyu sa daloy ng dugo.

Ang mga suga sa hinlalay at index finger ay mas malamang na nangangailangan ng unplanned na reoperation. Ito ang dahilan kung bakit maaaring mahusay na subaybayan ng iyong surgeon ang mga daliring ito pagkatapos ng paunang paggamot. Kung kailangan ng operasyon, maaaring hawakan ng mga plate at screws ang buto sa tamang posisyon. Gayunpaman, maaari itong magdulot ng stiffness sa ilang mga kaso. Ang postoperative na stiffness ng daliri ay nangyari sa 43% ng mga unstable na proximal phalangeal fractures na ginamutan ng mga titanium plate at/o screws.

Mahalaga ang posisyon ng hardware. Kung masyadong malapit ang gilid ng plate sa linya ng kasukasuan, maaari itong limitahan ang range of motion ng iyong daliri. Sa parehong paraan, ang ilang mga teknik ng screw ay maaaring lumikha ng maliliit na defects sa cartilage. Ito ang makinis na coating sa mga dulo ng buto. Sa paglipas ng panahon, maaari itong makaapekto sa kung gaano kalinis ang galaw ng iyong kasukasuan.

Sa kabila ng mga panganib na ito, karamihan sa mga pediatric unicondylar phalangeal fractures ay nakakamit ang magandang bony healing at functional na galaw. Sa maingat na alignment at pag-aalaga sa malambot na tisyu, maaaring muling makuha ng iyong daliri ang kanyang function. Ang layunin ay palaging ibalik ang natural na anatomiya upang muling makagamit ng iyong kamay nang normal.

Mga maitutulong namin dito

Ang pamamaraan ni Dr Kieran Hirpara, isang iskargiyang espesyalista sa itaas na bahagi ng katawan sa Mater Private Hospital Rockhampton, ay nakatuon sa pagbabalik sa normal na pag-andas ng katawan nang ligtas. Karamihan sa mga basag ng kamay ay simpleng matatag, kaya madalas namin pinagsisimulan ang hindi pampasurgical na paggamot. Para sa mga bata, karaniwang epektibo ang pagtatape ng daliri sa katabing malusog na daliri. Ibig sabihin, iniiyakap ng tape ang sugatang daliri sa katabing daliri para sa suporta. Gumagana ito kahit medyo nalipat ang buto at nangangailangan ng pagwawasto. Para sa mga matatanda, maaari kaming gumamit ng splint o espesyal na thermoplastic traction platform upang panatilihin ang buto sa tamang posisyon habang gumagaling. Nagbibigay din kami ng hand therapy upang gabayan ang iyong paggaling. Tinitiyak nito ang pagbabalik ng galaw at lakas nang walang katigasan.

Ang pamamahala ng sakit ay mahalagang bahagi ng iyong proseso ng paggaling. Inirerekomenda namin ang pag-inom ng gamot pang-alis ng sakit at anti-inflammatories ayon sa pangangailangan upang mapanatili ang kontrol sa pamamaga at hindi kasiyahan. Kung mayroon kang matagal nang sakit o arthritis sa kasukasuan, maaari kaming magmungkahi ng injeksyon. Ang mga injeksyon ng cortisone ay nagbabawas ng pamamaga upang matulungan ang sakit. Ang mga injeksyon ng hyaluronic acid ay naglulubos ng kasukasuan upang mapabuti ang paggalaw. Ang mga injeksyon ng platelet-rich plasma (PRP) ay gumagamit ng sarili mong sangkap ng dugo upang hikayatin ang paggaling. Hindi binabago ng mga tratong ito ang mga basag na buto, ngunit maaari nitong pamahalaan ang sakit at mapabuti ang kasiyahan habang gumagaling ang basag. Nag-iiba-iba ang epekto, ngunit nag-aalok ito ng hindi pampasurgical na paraan upang suportahan ang iyong paggaling.

Isinasalang-aling ang pampasurgical na paggamot kapag hindi sapat ang konservatibong paggamot o kapag malala ang sugat. Inirerekomenda namin ang operasyon para sa mga bukas na basag, kung saan sira ang balat, o kung may pinsala sa mga ugat ng dugo. Kailangan ng isang quarter ng mga bukas na basag na higit sa isang pagkakataon upang gumaling nang maayos. Ginagamit din ang operasyon kung ang buto ay hindi matatag, nakabaluktot, o kung hindi gumaling ang buto sa pamamagitan ng hindi pampasurgical na paggamot (non-union). Kasama sa aming mga pampasurgical na pagpipilian ang paglalagay ng mga turnilyo o pins upang ikabit ang mga piraso ng buto. Nagbibigay ito ng katatagan upang muling mag-ugnay ang buto nang tama. Layunin namin ang mahusay na resulta sa mga operasyong ito, upang mabawi mo ang buong saklaw ng paggalaw at lakas. Kung ang iyong basag ay kumplikado o hindi gumagaling sa unang paggamot, usapin namin ang pampasurgical na pag-aayos bilang isang maaasahang susunod na hakbang upang ibalik ang normal na pag-andas ng kamay.

Ano ang inaasahan

Karamihan sa mga pagsira ng daliri at kamay ay gumagaling nang maayos, kahit walang operasyon. Para sa maraming tao, lalo na sa mga bata, ang buto ay nag-aayos sa tamang posisyon gamit ang simpleng suporta tulad ng buddy taping. Maaari kang mag-expect ng magandang resulta sa mga kaso na ito. Ang karamihan sa mga fracture ng metacarpal ay matatag at gumagaling nang hindi nangangailangan ng operasyon.

Kung ang iyong fracture ay mas kumplikado, maaaring irekomenda ng iyong surgeon ang operasyon upang maayos ang pagkakahanay ng mga buto. Ito ay karaniwan para sa mga open fractures, kung saan sira ang balat, o para sa mga sugat sa hinlalay at hintuturo. Ang mga espesipikong sugat na ito ay may mas mataas na tsansang magkaroon ng pangalawang prosedura. Humigit-kumulang isa sa apat na open finger fractures ay nangangailangan ng higit sa isang operasyon. Mas malaki ang posibilidad nito kung ang sugat ay may kasamang pagpiga o nakaaapekto sa daloy ng dugo.

Ang paggaling ay nag-iiba depende sa uri ng sugat. Para sa mga fracture ng metacarpal, 92% ng mga pasyente ay bumabalik sa buong kakayahan nang walang komplikasyon sa loob ng 10 linggo pagkatapos ng sugat. Kung mayroon kang proximal phalangeal fracture na ginamutan ng mga turnilyo, maaari kang mag-expect ng mahusay na galaw at halos normal na lakas ng hawak. Karamihan sa mga tao ay nag-uulat ng positibong mga resulta na walang komplikasyon pagkatapos ng isang taon. Gayunpaman, ang stiffness ay isang kilalang panganib. Ang postoperative na stiffness ng daliri ay nangyari sa 43% ng mga unstable na proximal phalangeal fractures na ginamutan ng mga titanium na plato at/turnilyo.

Dapat mong malaman na ang ilang tao ay nangangailangan ng pangalawang operasyon upang alisin ang hardware na nagdudulot ng iritasyon. Ang rate ng hindi inaasahang maagang reoperation ay 8.0% pagkatapos ng operative fixation ng mga acute na fracture ng metacarpal. Ang average na oras para sa maagang reoperation na ito ay humigit-kumulang 2.1 buwan. Karamihan sa mga prosedurang ito ay nakatuon sa pag-alis ng symptomatic na hardware imbes na pag-aayos ng bagong pagsira.

Habang ang karamihan sa mga fracture ay gumagaling nang buo, ang isang maliit na bilang ng mga pasyente ay nananatiling hindi nasiyahan sa huling resulta. Dapat kang magplano para sa isang panahon ng paggaling na ilang linggo hanggang buwan. Gabay ng iyong surgeon kung kailan ka makakabalik sa trabaho o sports. Ang mga sugat sa hinlalay at hintuturo ay maaaring tumagal nang mas matagal para gumaling dahil sa kumplikadong mga istruktura na kinasasangkutan.

Kailan kumonsulta sa doktor

Kumonsulta sa iyong doktor kung ang sakit ay nananatili kahit may pahinga, o kung mapapansin mo ang kahinaan at kawalan ng katatagan sa daliri. Magpakonsulta sa isang espesyalista kung ang kasukasuan ay nakakabit o biglang bumabagsak, o kung ang mga sintomas ay nakakaapekto sa iyong pagtulog o trabaho. Ang biglang paglala ng sakit o pamamaga ay nangangailangan din ng mabilis na pagsusuri. Bagama’t ang karamihan sa simpleng fracture ay gumagaling nang maayos nang walang operasyon, ang ilang uri ng sugat—lalo na ang bukas na fracture o mga kabilang sa hinlalaki at pangalawang daliri—ay maaaring nangangailangan ng operasyon upang maiwasan ang mga komplikasyon. Ang maagang pagkilala ay tumutulong upang bawasan ang mga panganib tulad ng pagkakasikip o pangangailangan ng karagdagang mga prosedura. Sinusuri ng iyong doktor ang pattern ng fracture at kalagayan ng malambot na tisyu upang matukoy ang pinakamainam na paraan para sa iyong paggaling.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

The majority of hand fractures can be treated without surgery [1].
Surgery offers distinct advantages in properly selected cases of hand fractures [1].
Most hand fractures can be managed successfully without operation [5].
Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
Most pediatric phalangeal fractures can be treated nonsurgically [14].
A small subset of pediatric phalangeal fractures benefits from surgical intervention [14].
A quarter of open finger fractures will likely need more than one surgical procedure [3].
Open finger fractures in more severely injured fingers are especially likely to need more than one surgical procedure due to crush or vascular impairment [3].
Taping finger fractures can be recommended irrespective of the degree of displacement or the need for reduction in children with displaced extra-articular phalangeal finger fractures [19].
External fixation is an efficient alternative treatment method for combined open fractures of the thumb metacarpal and trapezium, with encouraging short-term clinical and radiographic results [6].
Retrograde intramedullary screw (RIS) fixation in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications [20].
More high-quality studies are needed to fully examine retrograde intramedullary screw fixation as a modality for metacarpal fractures [20].
Intramedullary fixation is an approach reviewed for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis [23].
Surgeons who treat metacarpal and phalangeal fractures inevitably treat complications associated with these fractures [4].
A poorly functioning finger may represent a liability to the hand [16].
Achievement of union or improved alignment alone may not be sufficient to justify retention of a digit if it is poorly functioning [16].

Anatomy & Pathophysiology

Achievement of union or improved alignment alone may not be sufficient to justify retention of a digit [16].
Surgical treatment is usually indicated for fractures and dislocations of the base of the thumb metacarpal to restore the anatomy and biomechanics of the trapeziometacarpal joint [22].
Conservative treatment of base of thumb metacarpal fractures and dislocations often yields poor results [22].
Mini-external fixation and Kirschner wire internal fixation have similar effects on postoperative traumatic arthritis and postoperative hand functions in Bennett fracture treatment [25].
Each of eight patients treated with traction for hand fractures achieved a useful, painless range of motion while in traction and afterward [26].
Full use of the hand was obtained eight to ten weeks from the time of injury in patients treated with traction [26].
Both volar plating and external fixation can obtain a good range of motion at the proximal interphalangeal joint in unstable dorsal fracture-dislocations [33].
The pins and rubbers traction system (PRTS) significantly increases flexion forces of the proximal interphalangeal (PIP) joint [38].
The pins and rubbers traction system (PRTS) prevents narrowing of the PIP joint [38].
Most pediatric hand fractures can be treated by closed methods with immobilization for 3 to 4 weeks [41].
Children have a great potential for malalignment correction of hand fractures by remodeling with growth [41].
Osteochondral autograft from the hamate for treating partial defect of the proximal interphalangeal joint results in generally acceptable functional recovery and well-restored joint architecture [44].
Mini-external fixators (MEFs) are effective to establish union and correct alignment of the hand skeleton with minimal tissue trauma [45].
Mini-external fixators (MEFs) retain a good clinical outcome even in the most complex hand injuries [45].

Classification

Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction [18].
Reoperation for open finger fractures is especially likely in more severely injured fingers due to crush or with vascular impairment [3].
Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone [12].
External fixation is an efficient alternative treatment method for combined open fractures of the thumb metacarpal and trapezium [6].
Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups [10].
Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures [9].
Phalangeal fractures tend to deteriorate in total active motion (TAM) more than metacarpal fractures [13].
Taping finger fractures can be recommended irrespective of the degree of displacement or the need for reduction in children [19].
Patients with type 3 and 5 jersey finger fractures treated with buttress plating exhibited a functional distal interphalangeal joint range of motion [47].

Clinical Presentation

Open finger fractures requiring more than one surgical procedure are especially associated with more severely injured fingers, crush injuries, or vascular impairment [3].
Most pediatric phalangeal fractures can be treated nonsurgically, but a small subset benefits from surgical intervention [14].
Isolated fifth metacarpal fractures can be managed definitively in the ED without further face to face review, with good patient satisfaction and acceptable functional results [29].
Early diagnosis and appropriate treatment can allow athletes to return to play quickly after they sustain fractures or dislocations of the hand or wrist [11].

Treatment

With non-operative treatment of fractures of the neck of the fifth metacarpal, similar results were achieved with dorsal angulation either above or below 30 degrees [17].
Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture [18].
Treatment of fractures of the proximal phalanx and metacarpals is based on the degree of displacement [18].
Treatment of fractures of the proximal phalanx and metacarpals is based on the difficulty in maintaining fracture reduction [18].
Buddy taping after reduction of displaced extra-articular phalangeal finger fractures in children can be recommended irrespective of the degree of displacement or the need for reduction [19].
The vast majority of metacarpal fractures in athletes are managed nonoperatively with protective bracing and rapid return to play [30].
Patients with a single displaced spiral and/or oblique finger metacarpal shaft fracture treated with unrestricted mobilization have outcomes comparable to those treated operatively [31].
Operative treatment of single displaced spiral and/or oblique finger metacarpal shaft fractures may result in metacarpal shortening [31].
Intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic advantage compared to conservative treatment [32].
Intramedullary splinting for displaced fractures of the little finger metacarpal neck does not offer a functional advantage compared to conservative treatment [32].
Surgical indications for fractures or fracture-dislocations include displaced articular fragments [36].
Surgical indications for fractures or fracture-dislocations include rotational misalignment [36].
Surgical indications for fractures or fracture-dislocations include significant digit angulation or shortening [36].
Surgical indications for fractures or fracture-dislocations include irreducible dislocation [36].
Surgical indications for fractures or fracture-dislocations include significant injury to the joint supporting structures [36].
Buddy taping is a non-inferior treatment modality for most paediatric finger fractures compared to splint immobilization [37].
Non-locking plates are appropriate for most metacarpal and phalangeal fractures necessitating plate fixation [39].
Social deprivation influences the pattern of hand fractures [46].
Social deprivation influences the management of hand fractures [46].

Complications

A quarter of open finger fractures require more than one surgical procedure [3].
Reoperation is especially likely in more severely injured fingers due to crush injury or vascular impairment [3].
Surgeons treating metacarpal and phalangeal fractures inevitably encounter associated complications [4].
A poorly functioning finger may represent a liability to the hand, and achieving union or improved alignment alone may not justify retention of the digit [16].
Retrograde intramedullary screw fixation in metacarpal fractures is associated with minimal complications [20].
Transcarpal migration of a broken Kirschner wire can cause ulnar neurapraxia [28].

Recovery

The majority of hand fractures can be treated without surgery, though surgery offers distinct advantages in properly selected cases [1].
A quarter of open finger fractures will likely need more than one surgical procedure, especially in more severely injured fingers, due to crush or with vascular impairment [3].
Both cases of combined dislocation of the trapezoid and finger carpometacarpal joints demonstrate similar mechanisms resulting in nearly identical wrist injuries with good short-term functional outcomes when injuries are quickly recognized and appropriately addressed at initial surgery [15].
A poorly functioning finger may represent a liability to the hand, and achievement of union or improved alignment alone may not be sufficient to justify retention of the digit [16].
The patient regained satisfactory grip and thumb function with minimal donor site morbidity following functional reconstruction of a subtotal thumb metacarpal defect with a vascularized medial femoral condyle flap [21].
Each of the eight patients in the traction study achieved a useful, painless range of motion while in traction and afterward, and full use of the hand was obtained eight to ten weeks from the time of injury [26].
The only variables that lessen the return-to-play time for metacarpal fractures in the National Football League are involvement of lesser digit metacarpals and operative intervention for treatment of thumb metacarpal fractures [27].
DEF provides excellent functional results for closed phalangeal fractures at the PIP joint, with a low incidence of postoperative complications similar to other commonly used surgical techniques [42].
Recent reports confirm that small amounts of metacarpal shortening or dorsal angulation cause minimal functional impairment, and early motion of adjacent joints in closed simple metacarpal fractures expedites recovery of motion and strength without adversely affecting fracture alignment [43].

Key Evidence

[L5] The majority of hand fractures can be treated without surgery, though surgery offers distinct advantages in properly selected cases. [1] (10.1016/j.jhsa.2013.02.017)
[L3] A quarter of open finger fractures will likely need more than one surgical procedure, especially in more severely injured fingers, due to crush or with vascular impairment. [3] (10.1177/15589447211043191)
[L5] Surgeons who treat metacarpal and phalangeal fractures inevitably treat complications associated with these fractures. [4] (10.1016/j.hcl.2010.01.005)
[L5] Most hand fractures can be managed successfully without operation, and conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures. [5] (10.1177/1753193420928820)
[L4] Short-term clinical and radiographic results encouraged the authors about the efficiency of external fixation as an alternative treatment method for combined open fractures of the thumb metacarpal and trapezium. [6] (10.1007/s11552-007-9026-6)
[L4] Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation. [7] (10.1177/1753193414562706)
[L1] Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures. [9] (10.1186/s12891-019-2988-z)
[L4] The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups. [10] (10.1177/1558944719900565)
[L5] Early diagnosis and appropriate treatment can allow athletes to return to play quickly after they sustain fractures or dislocations of the hand or wrist. [11] (10.1016/j.csm.2016.05.005)
[L2] Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone. [12] (10.1016/j.jhsa.2018.04.032)
[L2] The phalangeal fractures tend to deteriorate %TAM than metacarpal fractures. [13] (10.1016/s0363-5023(11)60047-6)
[Paper] Most pediatric phalangeal fractures can be treated nonsurgically, but a small subset benefits from surgical intervention. [14] (10.1016/j.jhsa.2025.08.015)
[Case_report] Both cases demonstrate similar mechanisms resulting in nearly identical wrist injuries with good short-term functional outcomes when injuries are quickly recognized and appropriately addressed at initial surgery. [15] (10.1016/j.jhsa.2010.06.005)
[L5] A poorly functioning finger may represent a liability to the hand, and achievement of union or improved alignment alone may not be sufficient to justify retention of the digit. [16] (10.2106/00004623-200506000-00028)
[L3] With non-operative treatment of fractures of the neck of the fifth metacarpal, similar results were achieved with dorsal angulation either above or below 30 degrees. [17] (10.1016/j.injury.2008.03.016)
[L5] Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction. [18] (10.5435/00124635-200810000-00004)
[L1] With the current data, we can conclude that taping these finger fractures can be recommended irrespective of the degree of displacement or the need for reduction. [19] (10.1177/17531934241293338)
[L2] RIS use in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications, although more high-quality studies are needed to fully examine this modality. [20] (10.1177/1558944720988073)
[Case_report] The patient regained satisfactory grip and thumb function with minimal donor site morbidity. [21] (10.1016/j.jhsa.2014.06.002)
[L4] Surgical treatment is usually indicated to restore the anatomy and biomechanics of the trapeziometacarpal joint, as conservative treatment often yields poor results. [22] (10.1177/1753193414554357)
[L5] The article reviews the background, biomechanics, applications, techniques, outcomes, and costs of this approach for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis. [23] (10.1016/j.jhsa.2023.08.011)
[L1] Both fixations have similar effects on postoperative traumatic arthritis and postoperative hand functions. [25] (10.1016/j.otsr.2012.07.015)
[L4] The only variables that lessen the return-to-play time are involvement of lesser digit metacarpals and operative intervention for treatment of thumb metacarpal fractures. [27] (10.1016/j.jhsa.2022.01.011)
[L4] The mechanism in this case was purely traumatic without predisposing causes such as inflammatory arthropathy or distal radius fracture. [28] (10.1177/1753193408102118)
[L4] Isolated fifth metacarpal fractures can be managed definitively in the ED without further face to face review, with good patient satisfaction and acceptable functional results. [29] (10.1007/s11552-015-9749-8)
[L5] The vast majority of metacarpal fractures in athletes are managed nonoperatively with protective bracing and rapid return to play. [30] (10.1016/j.hcl.2012.05.028)
[L2] Patients with a single displaced spiral and/or oblique finger metacarpal shaft fracture treated with unrestricted mobilization have outcomes comparable to those treated operatively, despite metacarpal shortening. [31] (10.2106/jbjs.22.00573)
[L2] Intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic, but not a functional advantage compared to conservative treatment. [32] (10.1177/1753193410377845)
[L4] Both methods can obtain a good range of motion at the proximal interphalangeal joint. [33] (10.1177/17531934211059300)
[L5] Surgical indications for fractures or fracture-dislocations include displaced articular fragments, rotational misalignment, significant digit angulation or shortening, irreducible dislocation, and significant injury to the joint supporting structures. [36] (10.1016/j.csm.2014.09.002)
[L1] Buddy taping is a non-inferior treatment modality for most paediatric finger fractures compared to splint immobilization. [37] (10.1177/1753193418822692)
[L4] The PRTS significantly increases flexion forces of the PIP joint and prevents narrowing of the joint. [38] (10.1007/s00402-007-0526-1)
[L5] Non-locking plates are appropriate for most metacarpal and phalangeal fractures necessitating plate fixation. [39] (10.1016/j.jhsa.2011.09.023)
[L5] Most pediatric hand fractures can be treated by closed methods with immobilization for 3 to 4 weeks, as children have a great potential for malalignment correction by remodeling with growth. [41] (10.1016/j.hcl.2005.10.001)
[L2] DEF provides excellent functional results for closed phalangeal fractures at the PIP joint, with a low incidence of postoperative complications similar to other commonly used surgical techniques. [42] (10.1177/17531934251350453)
[L5] Recent reports confirm that small amounts of metacarpal shortening or dorsal angulation cause minimal functional impairment, and early motion of adjacent joints in closed simple metacarpal fractures expedites recovery of motion and strength without adversely affecting fracture alignment. [43] (10.1097/01.blo.0000205888.04200.c5)
[L4] The functional recovery is generally acceptable, with a well-restored joint architecture. [44] (10.1016/j.jhsa.2021.11.007)
[L4] The findings demonstrate the efficacy of versatile MEFs to establish union and correct alignment of hand skeleton with minimal tissue trauma while retaining a good clinical outcome even in the most complex injuries. [45] (10.1016/j.jhsa.2008.12.017)
[L3] Social deprivation influences both the pattern and management of hand fractures. [46] (10.1177/1753193410381823)
[L4] Patients with type 3 and 5 injuries exhibited a functional distal interphalangeal joint range of motion. [47] (10.1016/j.jhsa.2025.07.038)

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