Treatment of hand injuries

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Broken finger

A finger fracture most often occurs as a result of a direct injury (pinching with a door, hitting a hard object or falling on a hand). A broken finger shows pain, swelling, and an inability to move. A swollen finger does not always mean its fracture - if the soft tissues are damaged without breaking the continuity of the bones, a contusion is diagnosed. A bruised finger may hurt slightly when making movements, but X-rays do not confirm either a fracture or a dislocation of the finger.

Long-term immobilization of a broken finger is inadvisable due to the tendency of the hand tissues to the rapid scarring process limiting the finger's mobility. Therefore, a stable fixation of the fragments is very important, enabling the introduction of early movement of the finger to a limited extent, in order to prevent its stiffening.

All unstable finger fractures are treated surgically by closed method and percutaneous nailing, or by open method and internal bone fixation. Surgical treatment requires fractures:

multi-fragmentation,
spiral with displacement,
intra-articular - involving the proximal or distal metacarpophalangeal joint,
open.
Some types of stable fractures can be treated conservatively by immobilizing the finger in a neutral position. The location of the fracture is also important in choosing between the conservative and operative methods - fractures in places with a thick cortex bone heal slowly (up to 10-14 weeks). To avoid prolonged immobilization of a broken finger, fractures in the middle phalanx shaft are often treated with surgery.

Rehabilitation should take into account finger movements with manual fracture site stabilization performed in the first weeks after the injury. After complete bone union is achieved, exercises are introduced to increase the grip strength of the hand.

Stamped finger

A dislocated finger is associated with a dislocation of a specific finger joint. Dislocation is the complete displacement of the articular surfaces in relation to each other. Symptoms of a dislocated finger are pain and swelling in the area of ​​the joint, deformation of its outline, unnatural positioning of the finger and inability to move. Dislocation usually occurs in the proximal interphalangeal joint. A knocked out finger requires diagnosis and correct setting by an orthopedic doctor. Improper treatment of the injury can lead to permanent deformation of the finger and reduced mobility in the joint. After setting, the finger is locked in a neutral position in a special rail. Immobilization is performed during exercises that involve movements in adjacent undamaged joints. In the 5-6th week, active movement is started within the sprained joint, and the orthosis can be replaced with a rigid finger taping.

Skier's thumb

The term "skier's thumb" was introduced in 1973 when skiing caused frequent thumb injuries due to pressure on a ski stick or a fall on an abused thumb. The essence of the injury is damage to the ulnar collateral ligament of the thumb metacarpophalangeal joint (MCP).

Symptoms include pain, swelling, and hematoma of the index finger MCP metacarpophalangeal joint. The ailments worsen when trying to grab a large object. As part of the diagnosis, the orthopedic doctor performs a stress test of the ligament, which consists in valgus of the thumb bent up to 30 degrees. Complete rupture of the ulnar collateral ligament is suspected when the phalanx of the proximal thumb is radially abducted by min. 30-35 degrees. Partial ligament damage occurs when valgus pressure does not produce a marked deflection of the phalanx. A finger ultrasound is performed to confirm the diagnosis. X-rays, on the other hand, allow to exclude fractures within the finger.

Treatment of the skier's thumb

Stable lesions of the skier's thumb (partial collateral ligament damage) are treated conservatively. The procedure consists in immobilizing the MCP joint of the thumb in an orthosis for about 4 weeks. After removing the orthosis, rehabilitation begins, which takes into account the movements of the thumb, avoiding its valgus position, and mobilizing the ligament scar. After 6 weeks, you can start exercising to strengthen the grip strength of the hand - provided that the exercise is not accompanied by pain in the thumb. In order to avoid a recurrent injury, people practicing contact sports should wear a thumb brace for at least 2 months (the brace is worn during training and competition).

In the event of a complete rupture of the ligament and instability of the thumb, surgery is required. The ligament is repaired or reconstructed. After the procedure, the thumb is held in place with a special splint. Range of motion exercises are started in the 6th week after the procedure, and in the 8th week - exercises to strengthen the grip. The splint may be replaced with a thumb brace and then taped to protect the thumb against valgus movement. Full recovery is possible in the third month after the procedure.

Tendon injuries to the fingers

Injuries of the tendons bending the finger

The bellies of the muscles responsible for flexing the II-V fingers lie on the front side of the forearm, go into four single tendons running under the flexor cord in the wrist canal, and then end at each of the II-V fingers:

Each of the tendons of the superficial flexor muscle of the fingers at the level of the proximal phalanx splits and attaches to the lateral surfaces of the middle phalanx.
Each of the tendons of the deep flexor muscle of the fingers passes through a "bifurcation" of the superficial flexor tendon of the fingers and attaches to the base of the distal phalanx.
The deep flexor of the fingers is responsible for flexing the wrist and fingers together with the distal interphalangeal joints, while the superficial flexor of the fingers is responsible for flexing the wrist and fingers at the metacarpophalangeal and proximal interphalangeal joints.

The tendon injury is most often associated with a direct cut of the finger with a sharp object or it can occur as a result of a large force acting on a single finger in flexion. A specific type of injury is. "Jersey finger", which involves detaching the deep flexor tendon in a single finger. Injury often occurs when an athlete grabs the opponent's jersey - a sudden jerk causes the finger to forcefully extend and detach the flexor tendon from its attachment. Symptoms of deep flexor tendon rupture are the inability to actively flex the distal phalanx. The proximal tendon stump can be dislocated, therefore there are three types of injury:

The tendon retracts as far as the hand, which leads to disturbances in its blood supply and rapid loss of flexibility - the surgical attachment of the tendon to the distal phalanx should take place as soon as possible (up to 10 days after the injury),
The tendon retracts, stopping in the area of ​​the superficial flexor tendon bifurcation - the blood supply is preserved, the repair procedure may be postponed if necessary (e.g. when it is necessary to repair other important injuries within the arm),
The tendon does not move or retracts slightly - the damage usually consists in tearing off the bone fragment of the distal phalanx, which "stabilizes" the tendon, protecting it against excessive retraction. The lesion is replaced by fusing the broken off fragment with the proximal phalanx.

Direct traumatic injuries to the flexor tendons (superficial or deep) of the fingers or hands are classified into specific zones. The choice of the surgical method depends on the location of the tendon rupture and the accompanying soft tissue damage in the case of crush injuries to the hand. The general principle of treatment is the early repair of the injured tendon, as delaying this procedure can make it difficult to restore the required length of the tendon. Aged tendon injuries require stiffening the interphalangeal joint or performing a multi-stage reconstruction using a temporary silicone tendon implant.

Proceedings after repair procedures or reconstructions of finger flexor tendons include the use of a special DBS (dorsal blocking splint) on the forearm. The splint positions the wrist and the metacarpophalangeal joints of the fingers in flexion, thereby reducing the tension in the flexor tendons. The interphalangeal joints remain free, thanks to which it is possible to passively bend and straighten the fingers remaining in the pulley (the extension of the fingers reaches the limit set by the splint). The early passive movement of the fingers allows the tendons to slide to prevent adhesions, which are the most common complication of surgical treatment. Active movement is introduced not earlier than 5 weeks after surgery, and resistance grip exercises 8 weeks after surgery. The full function of the hand is restored in the third month, provided that the patient regularly participates in rehabilitation and follows the recommendations of the orthopedist and physiotherapist.

Finger extension tendons injuries

The bellies of the main muscles responsible for straightening the II-V fingers lie on the back side of the forearm, their tendons at the level of the wrist run under the extensor cord, and then reach the distal phalanges of the II-V fingers (extensor muscle of the fingers) or the distal phalanges of the second finger (the extensor muscle of the index finger) .

Extensor tendon injuries are also divided into zones on which general management and the choice of the surgical method depend.

One of the most common injuries is the extensor tendon injury in zone 1. The extensor tendon detaches from the distal phalanx with or without the bone fragment. A common mechanism of injury is a sudden forcible bend of the fingertip as a result of the ball hitting the finger when trying to catch it. The symptom of an injury is a lowered or bent distal phalanx of the finger - it is the so-called hammer toe deformation. The active finger extension is clearly difficult or impossible to perform.

Most extensor tendon attachment injuries are treated conservatively by wearing a plastic stacker to keep the distal interphalangeal joint in extension. The patient's task is to move the remaining joints of the fingers to avoid them stiffening. The treatment period is approximately 6 weeks. Some types of tendon rupture with bone fragment detachment and accompanying subluxation in the distal interphalangeal joint are treated with surgery. The surgeon performs anatomical alignment of the fragments and performs an anastomosis using the Kirschner wire.

A short account of a complex operation from one of our patients

The wound was originally treated in the HED conditions - anastomosis with Kirschner bars and partial suturing of the tendon. At the first visit, 10 days after the injury, the patient decided to fix the bone more firmly on a special titanium plate and re-stitch the long flexor tendon of the thumb.