Hand and finger dislocations: Difference between revisions

Revision as of 10:51, 1 June 2015

Radial and median nerve blocks
Pressure directed distally on base of prox phalanx w/ metacarpal flexed and abducted

Stable reduction: Immobilize in thumb spica w/ MCP joint in 20 deg flexion for 4wk
Unstable reduction: ORIF

Also known as gamekeeper's thumb or skier's thumb
Ulnar ligament ruptures at insertion into prox phalanx (due to radial deviation of MCP)
X-ray (perform before joint stressing)
- Bony avulsion from insertion of UCL into proximal phalanx
- Associated condylar fracture
- Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture
Exam
- Swelling and localized tenderness over ulnar border of joint
- Weakness of pinch
- Partial versus complete rupture
  - Valgus stress testing with joint in full extension and in 30 deg of flexion
    - >35 deg of joint laxity or 15 deg of laxity beyond that present in uninjured thumb is consistent w/ complete UCL rupture

Authors:

@@ Line 3: / Line 3: @@
 ==Thumb ==
-===IP Joint===
-*Uncommon
-*Dislocations often associated w/ open injuries
-====Reduction====
-*Median nerve block
-*Reduce similar to IP joint of other digits
-====Management====
-*Immobilization in mild flexion for 3wk is usually all that is required
 ===MCP Joint===
 *Like other MCP joint dislocations, may be simple or complex