Hand injuries are one of the most common orthopedic injuries. There is a broad spectrum of patterns of injuries by the hand.
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.
The examination may reveal 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.
Bone loss is a frequent finding in massive hand injuries. Bone grafting, early or delayed is used for bone loss.
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 the functional outcome of the whole hand.
Following are hand injury pictures and x-rays 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 a history of crush injury of hand in fodder cutting machine. All the fingers excluding thumb were amputated just a few centimeters from the base of the fingers [All the amputations were proximal to proximal interphalangeal joint].
Multiple lacerated wounds over the dorsum of the hand also indicate towards hand being crushed.
Fracture Proximal Phalanges Fixed With K Wire
K wire is frequently used in the treatment of fractures in children and in hand injuries among other things.
The x-ray below is a postoperative image of a 26 years old laborer who injured his hand due to a work-related injury.
He suffered from the fracture of proximal phalanx of the 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 the patient has been put on mobilization exercises.
Fracture of Proximal Phalanx Of Little Finger
Proximal phalanx of this 40 years old man was broken into two parts following the little finger got stuck in a moving chain.
There was a severe displacement of the fracture.
Fracture of Distal and Middle Phalanges 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 the middle finger and ring finger.
There were big lacerated wounds palmar aspects of both the fingers. The circulation in the partially amputated parts was doubtful.
The patient was immediately taken to operation theater after an x-ray. The x-ray revealed the following picture.
Third ray (Middle finger) showed fractures in the distal and middle phalanx, around the distal interphalangeal joint ( the joint between two phalanges).
Dislocation of Interphalangeal Joint of Thumb
In contrast to other digits, the 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 x-ray is of a 22 years old man who sustained this injury after he struck his thumb inadvertently with a moving object.
The dislocation was noted in the interphalangeal joint and was reduced closed.
The reduction was stable and 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 a fracture 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 the tip of the middle finger in 48 years old male
The amputation also involved distal phalanx.
Needle [Foreign Body] In Finger With Congenital Anomaly
The x-ray belongs to an 18 years old girl who had congenital maldevelopment of first two fingers [ Note the first two fingers in x-ray.]
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 a fall of a heavy object on his hand.
The finger is split vertically and there is a fracture of the proximal phalanx. The wound was repaired and the fracture was fixed with k-wire.
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 a photograph of mallet finger deformity involving the index finger of 29 years old male.
Here is the view from the side
The patient got this injury while playing football.
Amputation Through Proximal Phalanx of Index Finger and Fracture Middle Phalanx Middle Finger
47 years old male got injured while working in a farm.
The x-ray shows the amputation of index finger through proximal phalanx and oblique fracture of the middle phalanx of the middle finger.
Clinical Photograph of Open Dislocation of Interphalangeal Joint Fixed With K-wire
The eight-year-old girl got her thumb injured with grass cutting machine. On clinical examination and x-ray, an open dislocation of the interphalangeal joint of thumb was found. The wound was on the 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
The following x-ray is of a 23 years old male who got injured following a motor vehicle accident.
There is a fracture of the proximal phalanx of the little finger and it was treated by splintage with plaster slab.
Xray of Fracture of Proximal Phalanx of Middle Finger
The following x-ray is of 34 years old male who had an injury to his right hand following a motor vehicle accident.
The x-ray shows a fracture of the proximal phalanx of the middle finger
The fracture was treated with closed reduction and K-wire 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.
Metacarpal Fracture Xrays
#Image 1 – Fourth and Fifth Metacarpal Fracture Xray
The image is the anteroposterior view of x-ray wrist with hand. The present x-ray shows a badly comminuted fracture of the base of the fifth metacarpal. Also seen is a fracture of the fourth metacarpal.
The type of fracture indicates that there was a strong traumatic force that caused so much comminution. In such case of damage to articular cartilage, the functional results are often poor.
# Image 2 – Fractures of First and Second Metacarpal
The picture shows x-ray of fracture of the first and second metacarpal. The first metacarpal is broken at shaft and the second metacarpal has got its head broken.
While fracture of the first metacarpal is oblique in type, head of the second metacarpal is comminuted.
#Image 3 – Xray of Dislocation of Second, Third, Fourth Metacarpal and Fracture of Metacarpal Fifth Base
Xray showing dislocation of 2nd, 3rd and fourth metacarpophalangeal joint along with a fracture of the fifth metacarpal base.
The patient suffered this injury in a motor vehicle accident.
#Image 4 – United Fracture of Second and Third Metacarpal Showing Callus – Xray Hand
Xray of hand showing a united fracture of the second and third metacarpal
Callus is also visualized.
#Image 5 – Dislocation of First Metacarpophalangeal Joint – Xray
Xray of hand showing dislocation of the first metacarpophalangeal joint.
Though this view does not clearly show it, the dislocation is probably volar.
#Image 6 – Intra-articular Fracture of First Metacarpal Base With Subluxation of Carpometacarpal Joint- Bennett’s Fracture
Bennett’s fracture is an intraarticular fracture of the first metacarpal base that extends into the carpometacarpal joint as shown in the image below. In most of the cases, this fracture is accompanied by either subluxation or dislocation of the carpometacarpal joint.
Above x-ray belongs to 55 years old male who suffered this injury following a fall from the bike. Patient
#Image 7 – Oblique Fracture of Shaft of Fifth Metacarpal
The patient, 39 years old male had injured his hand in a motor vehicle accident.
#Image 8 – Oblique Fracture of Fifth Metacarpal – Xray
Fifty-five years old with the fracture of the fifth metacarpal.
The patient refused any kind of treatment.
#Image 9 – Xray of Oblique Fracture of Shaft of Fifth Metacarpal
Oblique fracture of the fifth metacarpal of hand.
The fracture resulted from fall from a bike.
#Image 10 – Fifth Metacarpal Fracture Xray
Nineteen years old male had a hand injury following fall of a heavy object on it. Xray revealed a fracture of the fifth metacarpal below the neck of the metacarpal.
The patient was advised closed reduction and internal fixation with k-wire but the patient chose to get nonoperative treatment.
#Image 11 – Base First Metacarpal Fracture Xray
Fracture of base of the first metacarpal in 34 years old male.
Under local anesthesia, the fracture was reduced by closed reduction methods and fixed by a K-wire.
At present time, the patient is in the third week of followup and showing good improvement.
#Image 12 – Xray Hand Showing Fracture of Base of Fifth Metacarpal
37 years old man with a history of injury to the hand.
The x-ray shows a fracture of the base of the fifth metacarpal.