Fracture & Dislocation of the Hand and Wrist

Generally, direct work or sport-related injuries that lead to a number of hand and finger disorders, such as fractures or dislocations of the carpus, metacarpus or fingers. Finger dislocations usually displace dorsally, but can also be lateral or volar. Classification depends on whether or not there is ligament injury and its severity. Dislocations are common in the interphalangeal joints, as they are trochlear joints with flexo-extension movements that do not allow lateral movement. Also worth mentioning, as it is very common, is the fracture-dislocation of the first metacarpal or Bennett’s injury. Fractures are common and can be transversal, spiroidal or oblique with the musculature and fascia preventing displacement. One of the most common types is scaphoid fracture, which is slow to consolidate and usually caused by a fall onto an outstretched hand in forced dorsiflexion. Boxer’s fracture, one of the most common, is caused by the impact of a clenched fist on a hard surface, resulting in fracture of the fifth and even the fourth metacarpal, producing an open wound in some cases. Sprains or dislocations of fingers usually compromise the proximal interphalangeal joints and are very common in sport.

Symptoms

Fractures usually cause diffuse pain in the fracture site, with oedema and the presence of late ecchymosis in the palm of the hand. Scaphoid fractures cause pain and functional limitation in the flexion and extension movements of the wrist with loss of the ability to press the thumb against the index finger. Boxer’s fracture of one (5th metatarsal) or more metatarsals produces pain with inflammation. Dislocations cause joint deformity with shortening of length and functional disability. Ligament tears are also possible, which determines the severity.

Orthotic Treatment

Immobilisation is usually used as a conservative method with finger, wrist and/or hand splints or forearm orthoses, or even a combination of both, for a maximum period of three weeks, followed by suitable rehabilitation techniques to prevent joint stiffness, especially in the fingers. Immobilisation with an orthosis requires the use of devices specifically designed for the condition being treated, taking into account aspects such as the positioning in abduction of a joint (Bennett’s dislocation) or the flexion of one or more joints (boxer’s fracture), as well as hyperextension of the distal interphalangeal joint in extensor fractures of the finger, which require correct selection of the optimum orthosis for proper orthotic treatment, given the wide range of orthoses. For wrist, hand, finger and multiple active and passive combinations, it is recommended that the specialist select the orthosis.

Wrist & Hand Support Braces

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