Hand injuries are one of the most common orthopedic injuries. Most of the decisions of hand injuries are based on management of the soft tissues. The injured part must not be considered in isolation, rather, the treatment should center on functional outcome of the whole hand.
Mechanism of Injury
There is a broad spectrum of patterns of injuries by the hand.
- Axial loading as in catching a falling object or hitting a solid surface with fist.
- Trapping in clothing, furniture etc
- Sharp injuries
- Thermal injuries
- Chemical Injuries
A fracture or dislocation of the hand include may present with pain, swelling, stiffness, weakness, deformity, and loss of coordination. Involvement of a nerve may lead to numbness and tingling sensation.
Examination may reea tenderness, swelling, deformity, crepitus, and instability.
Open injuries are common in hand. Associated Injuries in tendon, nerves and vessels should be looked for especially in open injuries.
The term combined injuries is used for a hand fracture or dislocation with injury to at least one of the soft tissues listed above.
Bone loss is a frequent finding in massive hand injuries. Bone grafting, early or delayed is used for bone loss.
In routine, plain radiographs are sufficient. CT scan, ultrasound or Magnetic resonance imaging (MRI) may be used to look for foreign material.
The aim of treatment in hand injuries is to achieve sufficient stability to permit wound healing [in open injuries], early mobilization without any residual instability.
Five treatment options available are treatment alternatives
- Immediate motion
- Temporary splinting
- Closed reduction and internal fixation
- Open reduction and internal fixation
- Immediate reconstruction.
Following are hand injury pictures and xrays different age groups, different sites of the hand with different modes of trauma.
Photograph of Traumatic Amputation of Hand
54 years old man presented to emergency with history of crush injury of hand in fodder cutting machine. All the fingers excluding thumb were amputated just few centimeters from base of the fingers [All the amputations were proximal to proximal interphalangeal joint].
Multiple lacertated wounds over the dorsum of the hand also indicate towards hand being crushed.
In rural areas it is very common to use fodder cutting machines which are driven by motor but need ot be fed manually. A dangerous combination because once the hand gets caught in the machine everything happens very fast. The arm gets sucked in and before person could call for help the trauma would have already occurred.
I have seen people with amputated forearms arms because nobody was around to stop the motor when their limbs were being chopped.
A purely manual machine in contrast is much safer. Because you need person to run it and it is slow as compared to motor driven, the danger is much less.
Fracture Proximal Phalanges Fixed With K Wire
K wire is frequently used in treatment of fractures in children and in hand injuries among other things.
The xray below is post operative image of a 26 years old labrourer who injured his hand due to work related injury.
He suffered from fracture of proximal phalanx of second and third digit.
The injury was treated with closed reduction and K wire fixation under C Arm.
The fracture has united after 4 weeks and patient has been put on mobilization exercises.
Fracture of Proximal Phalanx Of Little Finger -Anteroposterior and Oblique Views
Proximal phalanx of this 40 years old man was broken into two parts following the little finger got stuck in in a moving chain.
There was a severe displacement of the fracture.
Fracture of Distal and Middle Phalanx of Middle Finger with Fracture Distal Phalanx of Ring Finger
24 years old male got injured when a slab fell on his hand during work. He presented with partial amputation of middle finger and ring finger.
There was a big lacerated wound palmar aspects of both the fingers. The circulation in the partially amputated parts was doubtful.
The patient was immediately taken to operation theater after xray. The xray revealed following picture.
Third ray (Middle finger) showed fractures in distal and middle phalanx, around the distal interphalangeal joint ( the joint between two phalanges).
Dislocation of Interphalangeal Joint of Thumb – Anteroposterior Xray
In contrast to other digits, thumb has only two phalanges. These are joined by interphalangeal joint.
Phalangeal dislocations are not very common.
The dislocation at this joint usually occurs due to a force causing hyperextension of the joint.
The following xray is of a 22 years old man who sustained this injury after he struck his thumb inadvertantly with a moving object.
The dislocation was noted in the interphalangeal joint and was reduced closed.
The reduction was stable ans thumb has been immobilized in the plaster for two weeks.
Vertical Fracture In Middle Phalanx of Second Ray of Hand
Xray of Hand Of 19 years old boy who had this injury due to fall of brick over the hand. He has middle phalanx of index finger [second ray] vertically split due to the impact
He was treated with conservative treatment.
Clinical Photograph Traumatic Amputation of Tip of Middle Finger
Clinical photograph of traumatic amputation of tip of middle finger in 48 years old male
The amputation also involved distal phalanx.
Needle [Foreign Body] In Finger With Congenital Anomaly
The xray belongs to a 18 years old girl who had congenital maldevelopment of first two fingers [ Note the first two fingers in xray.]
Here is another view
The finger also has a needle inside which is not in the bone though
Clinical Photograph of Injured Little Finger Split Vertically
Following injury was in 49 years old male who got this injury as a result of fall of a heavy object on his hand.
The finger is split vertically and there is a fracture of proximal phalanx. The wound was repaired and fracture was fixed with kwire.
Clinical Photograph of Mallet Finger
Clinical Photograph of mallet finger deformity in 43 years old male
He got this injury while playing volleyball and reported after three months of injury,
Clinical Photograph of Mallet Finger Deformity Index Finger
This is photograph of mallet finger deformity involving index finger of 29 years old male.
Here is view from side
The patient got this injury while playing football.
Xray of Amputation Through Proximal Phalanx of Index Finger and Fracture Middle Phalanx Middle Finger
47 years old male got injured while working in farm.
The xray shows amputation of index finger through proximal phalanx and oblique fracture of middle phalanx of middle finger.
Clinical Photograph of Open Dislocation of Interphalangeal Joint Fixed With Kwire
Eight year old girl got her thumb injured with grass cutting machine. On clinical examination and xray an open dislocation of the interphalangeal joint of thumb was found. The wound was on dorsal side of the thumb.
As shown in the clinical photograph above, the joint was reduced and fixed with Kwire. The wound was sutured in layers.
Xray of Chip Fracture Base of Proximal Phalanx of Third Digit of Hand
Comminuted Fracture of Proximal Phalanx of Little Finger – Xray
Following xray is of a 23 years old male who got injured following a motor vehicle accident.
There is a fracture of proximal phalanx of little finger and it was treated by splintage with plaster slab.
Xray of Fracture of Proximal Phalanx of Middle Finger
Following xray is of 34 years old male who had a injury to his right hand following a motor vehicle accident.
The xray shows fracture of proximal phalanx of middle finger
The fracture was treated with closed reduction and kwire fixation under Carm image intensifier.
Hand Fracture Images – Fracture of Third and Fourth Ray Proximal Phalanx
Following are AP and Oblique views of x-rays hand showing fracture of 3rd and fourth proximal phalanx.
The patient is 43 years old male and was treated with k-wiring.
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