Metacarpals are short tubular bones that are connected to the proximal side of the joints with the bones of the wrist, and the peripheral portion is connected to the base joints of the first phalanx of fingers.
Fracture of first metacarpal bone. It occurs most often among the fractures of the metacarpal bones and most often in men. The mechanism of injury - a direct hit on the knuckle of first finger hard predmet.Vydelyayut:
fractures of the base
fractures of the diaphysis (middle part) of the first metacarpal bone.
Fracture of base of first metacarpal bone are intraarticular and extraarticular or transverse. The patient complains of pain in the fracture. The first finger is bent and pressed against the palm of your hand. Usually there is edema or swelling in the area of damage. When probing the fracture pain can be greatly amplified and otlomok probe in the "anatomical snuffbox". If a small triangular piece of the first metacarpal bone is left in place, and dislocate a bone in the direction of the radius, a fracture is a fracture Bennett. Fracture with dislocation, but multisplintered is called a fracture Roland. Diagnosis confirmed by radiographs in two projections.
Treatment. Of great importance is the precise mapping of fragments of bones, which must take place in the shortest possible time, not later than the second day after the fracture. Simultaneous comparison of the fragments is performed under local anesthesia, with the success of a plaster bandage with binding of the capture of the first finger under the control of x-ray. If there is a second shift, you need to apply skeletal traction for up to three weeks, or perform surgery. Fragments are fixed with one or two spokes to 3 weeks. After that, the spokes removed, and a plaster cast is left up to 5 weeks. Then prescribe physical therapy and exercise therapy. Fracture of the diaphysis of the first metacarpal bone.
Fracture of the shaft - the body of the first metacarpal bone is uncommon, because the bone is mobile enough. The mechanism of injury is usually a direct blow to the bone. Fracture can be offset without it. The patient is worried about the pain of injury, aggravated by movement of the first finger, with a load on the first finger.
Treatment. If there is no evidence of X-displacement at the pictures, a plaster bandage from the middle third of the forearm to the base of the fingers, but the first finger must be completely immobilized for a month. Full comparison of the fragments usually do not seek, as a small angular deformation of the bone does not affect its function. With a large displacement of bone fragments carried cross-sectional comparison of the fragments, followed by the imposition of the cast. Very rarely have to resort to surgical treatment and fixation of bone fragments by means of spokes.
Fractures of the second, third, fourth and fifth metacarpal bones occur less frequently. They arise by direct trauma vozdeytviem brush and less when struck with a fist or a fall in the fist. Most fractures occur not one but several metacarpal bones. The patient complains of pain in the wrist, palm, worse when you try to compress the brush in his hand. To determine the fracture patient pull the finger at the turn of the corresponding metacarpal bone, the pain increases sharply. Clarify the diagnosis with X-rays.
Treatment. If bias is found, the plaster cast is applied from the upper third of the forearm to the base of the fingers, complete with obligatory finger grip, which the corresponding metacarpal bone is broken. The term immobilization of one month. In the presence of the displacement is carried out cross-sectional comparison of the fragments by hand, followed by the imposition of the cast for one month. Sometimes the fragments are still not able to compare, in this case, surgical treatment with fixation of bone fragments and needles miniplates.
Fractures of the phalanges. Fractures of the fingers occur frequently, are influenced by a direct blow or indirect trauma. There are transverse fractures, comminuted, helical, extraarticular and intraarticular. The patient complains of pain in a broken finger, swelling and edema of the finger. Movement in the finger is limited and sharply painful, especially the attempt to finger extension. On examination, pronounced deformation and bending of the finger. Refine the diagnosis of X-ray examination.
Treatment. Be sure to seek matching fragments, so that there was no loss of function of the finger. If there was a fracture without displacement, the finger is applied to the damaged palmar plaster splint or bus Belair for up to one month. If it is impossible to compare fragments conservatively, surgery is performed. Fragments reveal and record one or two needles, a bone pin, and then impose a plaster cast for a month. Sometimes used for skeletal traction nail phalanx. Movement of adjacent fingers is recommended shortly after the imposition of plaster or surgical treatment.
