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Distal phalanx of the finger. Damage to the extensor tendons in the area of ​​the distal and middle phalanges of the finger

Fractures of the distal phalanges divided into extra-articular (longitudinal, transverse and comminuted) and intra-articular. Knowledge of the anatomy of the distal phalanx is important for the diagnosis and treatment of these types of injuries. As shown in the figure, fibrous bridges are stretched between the bone and skin to help stabilize the distal phalanx fracture.

In the space between these jumpers, a traumatic hematoma, causing severe pain due to increased pressure inside this confined space.
TO distal phalanges of fingers II-V two tendons are attached. As shown in the figure, the deep flexor tendon is attached to the palmar surface, and the terminal portion of the extensor tendon is attached to the dorsal surface. If too much force is applied, these tendons can tear off. Clinically, there is a loss of function, and radiologically, minor avulsion fractures at the base of the phalanx can be detected. These fractures are considered intra-articular.

Mechanism of damage in all cases there is a direct blow to the distal. The force of the impact determines the severity of the fracture. The most typical fracture is a comminuted fracture.
At inspection Usually there is tenderness and swelling of the distal phalanx of the finger. Subungual hematomas are often observed, indicating a rupture of the nail bed.

IN diagnostics fracture and possible displacement, images in both frontal and lateral projections are equally informative.
As mentioned earlier, it is often observed subungual hematomas and nail bed tears. Often, in combination with a transverse fracture of the distal phalanx, incomplete separation of the nail is observed.

Hairpin type splint used for distal phalanx fractures

Treatment of extra-articular fractures of the distal phalanges of the fingers

Class A: Type I (longitudinal), Type II (transverse), Type III (comminuted). These fractures are treated with a protective splint, elevating the limb to reduce swelling, and analgesics. A simple palmar splint or a hairpin splint is recommended. Both allow some degree of tissue expansion due to edema.

Subungual hematomas should be drained by drilling out the nail plate using a hot paper clip. These fractures require protective splinting for 3-4 weeks. Comminuted fractures may remain painful for several months.

Draining a subungual hematoma with a paper clip

Class A: Type IV (with displacement). Transverse fractures with angular deformation or width displacement may be difficult to reduce because soft tissue interposition between the fragments is likely. If left uncorrected, this fracture may be complicated by nonunion.

Reposition often perform traction in the dorsal direction for the distal fragment, followed by immobilization with a palmar splint and control radiography to confirm the correctness of the reposition. If unsuccessful, the patient is referred to an orthopedist for surgical treatment.

Class A (open fractures with nail bed rupture). Fractures of the distal phalanges in combination with tears of the nail plate should be considered as open fractures and treated in the operating room. The treatment for these fractures is described below.
1. For anesthesia, a regional block of the wrist or intermetacarpal spaces should be used. Then the brush is processed and covered with sterile material.
2. The nail plate is bluntly separated from the bed (using a spoon or probe) and the matrix.
3. Once the nail plate is removed, the nail bed can be raised and repositioned. The nail bed is then closed with a No. 5-0 Dexon ligature using a minimal number of sutures.
4. Xeroform gauze is placed under the roof of the matrix, separating it from the root. This prevents the development of synechiae, which can lead to deformation of the nail plate.
5. The entire finger is bandaged and splinted for protection. The outer bandage is changed as needed, but the adaptation layer separating the root from the matrix roof must remain in place for 10 days.
6. To confirm the correctness of the reposition, control radiographs are shown. If the bone fragments remain unmatched, osteosynthesis can be performed with a wire.

A. Treatment technique for an open fracture of the distal phalanx.
B. The nail is removed and the nail bed is sutured with an absorbable suture.
B. Simple suturing of the nail bed results in good alignment of the bony fragments of the phalanx.
D. The nail bed is covered with a small strip of xeroform-soaked gauze, which is placed over the nail bed and under the eponychium fold.

Complications of extra-articular fractures of the distal phalanges of the fingers

Fractures of the distal phalanges There may be several serious complications associated with it.
1. Open fractures are often complicated by osteomyelitis. Open fractures include fractures associated with a nail bed rupture and fractures with a drained subungual hematoma.
2. Nonunion usually results from interposition of the nail bed between the fragments.
3. With comminuted fractures, as a rule, delayed healing is observed.

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Of the phalanges, the nail is most often damaged, then the proximal and middle ones, often without displacement of the fragments. For marginal fractures, immobilization with a plaster splint lasts 1-1 1/2 weeks; for fractures of the nail phalanx, the nail acts as a splint.

Reposition of fragments is carried out by traction along the axis of the finger while simultaneously giving it a functionally advantageous position. Immobilization is carried out with two plaster splints (palmar and dorsal) from the tip of the finger to the upper third of the forearm (Fig. 1). For intra-articular fractures, shorter periods are required (up to 2 weeks), for periarticular fractures - up to 3 weeks, for diaphyseal fractures - up to 4-5 weeks. Fractures of the proximal phalanx heal faster than fractures of the middle phalanx.

Rice. 1. Therapeutic immobilization for fractures of the phalanges of the fingers: a - plaster splint; b - Böhler splint; c - rear modeled tire

Rehabilitation - 1-3 weeks.

Surgical treatment indicated for fractures of the metacarpal bones and phalanges with a tendency to secondary displacement. The fragments are compared and fixed with pins percutaneously (Fig. 2). Immobilization is carried out with a plaster splint on the palmar surface for 4 weeks. The needles are removed after 3-4 weeks. For intra-articular and periarticular fractures of the phalanges with displacement of fragments, a distraction device is used.

Rice. 2. Transosseous fixation with wires of fractures and fracture-dislocations of the phalanges of the fingers: a - with wires (options); b - distraction external device

Damage to the ligaments of the finger joints

Reasons. Damage to the lateral ligaments occurs as a result of a sharp deviation of the finger at the level of the joint (impact, fall, “breaking off”). More often, the ligaments are partially torn, but a complete rupture leads to instability of the joint. The ligaments of the proximal interphalangeal joints and the first metacarpophalangeal joint are mainly damaged.

Signs: pain and swelling in the joint area, limitation of movements, lateral mobility. The diagnosis is clarified by pinpoint palpation with a button probe or the end of a match. To exclude avulsion of a bone fragment, it is necessary to take radiographs in two projections. When the ulnar collateral ligament of the metacarpophalangeal joint of the first finger is ruptured, the swelling may be insignificant. Characterized by pain when abducting the finger to the radial side and decreased grip strength. The ligament may be damaged along its length, or it may be torn from its attachment to the proximal phalanx.

Treatment. Local cooling, immobilization of the finger in a semi-bent position on a cotton-gauze roll. Application of a simulated plaster splint along the palmar surface of the finger to the middle third of the forearm. Flexion at the joint to an angle of 150°. UHF therapy is prescribed as a decongestant.

The period of immobilization is 10-14 days, then light thermal procedures and exercise therapy.

The first finger is immobilized in a position of slight flexion and ulnar adduction for a period of 3-4 weeks. In case of complete rupture of the ligament or its separation, early surgical treatment (suture, plastic surgery) in a specialized medical institution is indicated. After the operation - immobilization with a plaster splint also for 3-4 weeks. Rehabilitation - 2-3 weeks.

Working capacity is restored after 1-1 1/2 months.

Damage to the extensor tendons of the fingers

Features of the anatomy are presented in Fig. 3.

Rice. 3. Scheme of the structure of the dorsal aponeurosis: a - common extensor tendon; b — tendon of the interosseous muscles; c — tendon of the lumbrical muscles; d - spiral fibers; d - retinacular ligaments; e - triangular ligaments; g - central tape; h - side tapes; and - a portion of the aponeurosis to the base of the proximal phalanx; j - medial stripes of the tendons of the interosseous and lumbrical muscles; l - middle portion of aponeurosis; m - lateral stripes of the tendons of the interosseous and lumbrical muscles; n - lateral portions of the aponeurosis; o - the final part of the tendon-aponeurotic stretch; n - transverse intermetacarpal ligaments; p - transverse portion of the reticular ligament

Injuries to the extensor tendons of the fingers and hand account for 0.6-0.8% of all fresh injuries. From 9 to 11.5% of patients are hospitalized. Open damage accounts for 80.7%, closed - 19.3%.

Causes of open extensor tendon injuries:

  • incised wounds (54.4%);
  • bruised wounds (23%);
  • lacerations (19.5%);
  • gunshot wounds and thermal injuries (5%).

Causes of closed extensor tendon injuries:

  • traumatic - as a result of an indirect mechanism of injury;
  • spontaneous - arise as a result of degenerative-dystrophic changes in the tendons and unusual load on the fingers.

Subcutaneous rupture of the tendon of the long extensor of the first finger was described in 1891 by Sander under the name “drummers' paralysis.” In army drummers, with prolonged stress on the hand in the dorsiflexion position, chronic tendovaginitis develops, causing degeneration of the tendon and, as a consequence, its spontaneous rupture. Another cause of subcutaneous rupture of the tendon of the long extensor of the first finger is microtrauma after a fracture of the radius in a typical place.

Diagnostics fresh open injuries of the extensor tendons do not present any particular difficulties. The localization of wounds on the dorsum of the fingers and hand should alert the doctor, who will pay special attention to the study of motor function. Damage to the extensor tendons, depending on the area of ​​damage, is accompanied by characteristic dysfunction (Fig. 4).

Rice. 4.

1st zone - zone of the distal interphalangeal joint to the upper third of the middle phalanx - loss of the function of extension of the distal phalanx of the finger.

Treatment surgical - suturing the extensor tendon. If the extensor tendon is damaged at the level of its attachment to the distal phalanx, a transosseous suture is used. After surgery, the distal phalanx is fixed in the extension position with a wire passed through the distal interphalangeal joint for 5 weeks.

2nd zone - the zone of the base of the middle phalanx, the proximal interphalangeal joint and the main phalanx - loss of the function of extension of the middle phalanx of the II-V fingers. If the central extensor fascicle is damaged, its lateral fascicles shift to the palmar side and begin to extend the distal phalanx, the middle phalanx takes a flexion position, and the distal phalanx takes an extension position.

Treatment surgical - suturing the central bundle of the extensor tendon, restoring the connection of the lateral bundles with the central one. If all three bundles of the extensor apparatus are damaged, a primary suture is applied with separate restoration of each bundle.

After surgery - immobilization for 4 weeks. After applying a suture to the tendon and immobilization for the period of fusion, an extension contracture of the joints develops, which requires long-term rehabilitation.

3rd zone - the zone of the metacarpophalangeal joints and metacarpus - loss of the function of extension of the main phalanx (Fig. 5).

Rice. 5.

Treatment surgical - suturing the extensor tendon, immobilization with a plaster splint from the fingertips to the middle third of the forearm for 4-5 weeks.

4th zone - the zone from the wrist joint to the transition of the tendons into the muscles on the forearm - loss of the function of extension of the fingers and hand.

Treatment operational. When revising the wound to mobilize the extensor tendons near the wrist joint, it is necessary to cut the dorsal carpal ligament and the fibrous canals of the tendons that are damaged. Each tendon is sutured separately. The dorsal carpal ligament is reconstructed with lengthening. Fibrous channels are not restored. Immobilization is performed with a plaster splint for 4 weeks.

Diagnosis, clinical picture and treatment of fresh closed injuries of the extensor tendons of the fingers. Subcutaneous (closed) damage to the extensor tendons of the fingers is observed in typical locations - the long extensor of the first finger at the level of the third fibrous canal of the wrist; triphalangeal fingers - at the level of the distal and proximal interphalangeal joints.

With a fresh subcutaneous rupture of the tendon of the long extensor of the first finger at the level of the wrist joint, the function of extension of the distal phalanx is lost, extension in the metacarpophalangeal and metacarpal joints is limited. The function of stabilizing these joints is lost: the finger sag and loses its grip function.

Treatment operational. The most effective method is the transposition of the tendon of the extensor muscle of the second finger onto the extensor muscle of the first finger.

Fresh subcutaneous ruptures of the extensor tendons of the II-V fingers at the level of the distal phalanx with separation of a bone fragment and at the level of the distal interphalangeal joint are accompanied by loss of the function of extension of the nail phalanx. Due to the traction of the deep flexor tendon, the nail phalanx is in a forced flexion position.

Treatment of fresh subcutaneous ruptures of the extensor tendons of the II-V fingers is conservative. For closed tendon fusion, the distal phalanx is fixed in extension or hyperextension using various splints for 5 weeks. or fixation is performed with a Kirschner wire through the distal interphalangeal joint.

For fresh subcutaneous avulsions of the extensor tendons with a bone fragment with significant diastasis, surgical treatment is indicated.

A fresh subcutaneous rupture of the central part of the extensor apparatus at the level of the proximal interphalangeal joint is accompanied by limited extension of the middle phalanx and moderate edema. With correct diagnosis in fresh cases, the finger is fixed in the position of extension of the middle phalanx and moderate flexion of the distal one. In this position of the finger, the lumbrical and interosseous muscles are most relaxed, and the lateral bundles are shifted towards the central bundle of the extensor apparatus. Immobilization continues for 5 weeks. (Fig. 6).

Rice. 6.

Old damage to the extensor tendons of the fingers. A wide variety of secondary deformities of the hand in chronic injuries of the extensor tendons is due to a violation of the complex biomechanics of the flexor-extensor apparatus of the fingers.

Damage in the 1st zone manifests itself in two types of finger deformation.

1. If the extensor tendon is completely damaged at the level of the distal interphalangeal joint, the function of extension of the distal phalanx is lost. Under the influence of tension in the deep flexor tendon, a persistent flexion contracture of the distal phalanx is formed. This deformity is called “hammer finger.” A similar deformity occurs when the extensor tendon is torn off with a fragment of the distal phalanx.

2. When the extensor tendon is damaged at the level of the middle phalanx proximal to the distal interphalangeal joint, the lateral bundles, having lost connection with the middle phalanx, diverge and shift in the palmar direction. In this case, active extension of the distal phalanx is lost and it takes a flexed position. Due to the violation of the fixation point of the lateral bundles, over time, the function of the central bundle, which extends the middle phalanx, begins to prevail. The latter occupies a hyperextension position. This deformity is called the “swan neck.”

Treatment of chronic damage to the extensor tendons in the 1st zone is surgical. The most important condition is the complete restoration of passive movements in the joint.

The most common operations are the formation of a scar duplication with or without dissection, and fixation of the distal interphalangeal joint with a wire. After removal of the needle after 5 weeks. After the operation, a course of rehabilitation treatment is carried out. In case of old injuries and persistent flexion contracture, arthrodesis of the distal interphalangeal joint in a functionally advantageous position is possible.

Old damage to the tendon-aponeurotic sprain in the 2nd zone at the level of the proximal interphalangeal joint is accompanied by two main types of deformity.

1. If the central bundle of the extensor tendon is damaged, the function of extension of the middle phalanx is lost. The lateral bundles, under the tension of the lumbrical muscles, shift in the proximal and palmar directions, promoting flexion of the middle phalanx and extension of the distal phalanx of the finger. Into the gap formed in the extensor aponeurosis, the head of the proximal phalanx moves like a button passing into a loop.

A typical flexion-hyperextension deformity occurs, which has received several names: loop rupture, button loop phenomenon, triple contracture, double Weinstein contracture.

2. With chronic damage to all three bundles of the extensor tendon apparatus, a flexion position of the middle phalanx occurs. Hyperextension of the distal phalanx does not occur due to damage to the lateral bundles.

Treatment of chronic damage to the extensor tendon apparatus at the level of the proximal interphalangeal joint is surgical. In the preoperative period, a course of restorative treatment is carried out to eliminate contractures and restore the range of passive movements.

Weinstein's operation: after mobilization of the lateral bundles of the tendon-aponeurotic stretch, they are brought together and sutured “side to side” over the proximal interphalangeal joint. In this case, excessive tension of the lateral bundles occurs, which can lead to limited flexion of the finger (Fig. 7).

Rice. 7.

For chronic injuries of the extensor tendons with impaired finger function, surgical treatment is indicated. The choice of surgical treatment method depends on the condition of the skin, the presence of scars, deformities and contractures. One of the common methods is the formation of a scar duplication.

In the postoperative period, immobilization lasts 4-5 weeks, after which a course of restorative treatment is carried out - ozokerite applications, lidase electrophoresis, massage, exercise therapy on the fingers and hand.

Traumatology and orthopedics. N. V. Kornilov

The phalanges of the human fingers have three parts: proximal, main (middle) and terminal (distal). On the distal part of the nail phalanx there is a clearly visible nail tuberosity. All fingers are formed by three phalanges, called the main, middle and nail. The only exception is the thumbs - they consist of two phalanges. The thickest phalanges of the fingers form the thumbs, and the longest - the middle fingers.

Structure

The phalanges of the fingers belong to the short tubular bones and have the appearance of a small elongated bone, in the shape of a semi-cylinder, with the convex part facing the back of the hand. At the ends of the phalanges there are articular surfaces that take part in the formation of interphalangeal joints. These joints have a block-like shape. They can perform extensions and flexions. The joints are well strengthened by collateral ligaments.

Appearance of the phalanges of the fingers and diagnosis of diseases

In some chronic diseases of the internal organs, the phalanges of the fingers are modified and take on the appearance of “drumsticks” (spherical thickening of the terminal phalanges), and the nails begin to resemble “watch glasses”. Such modifications are observed in chronic lung diseases, cystic fibrosis, heart defects, infective endocarditis, myeloid leukemia, lymphoma, esophagitis, Crohn's disease, liver cirrhosis, diffuse goiter.

Fracture of the phalanx of the finger

Fractures of the phalanges of the fingers most often occur as a result of a direct blow. A fracture of the nail plate of the phalanges is usually always comminuted.

Clinical picture: the phalanx of the fingers hurts, swells, the function of the injured finger becomes limited. If the fracture is displaced, then the deformation of the phalanx becomes clearly visible. In case of fractures of the phalanges of the fingers without displacement, sprain or displacement is sometimes mistakenly diagnosed. Therefore, if the phalanx of the finger hurts and the victim associates this pain with injury, then an X-ray examination (fluoroscopy or radiography in two projections) is required, which allows making the correct diagnosis.

Treatment of a fracture of the phalanx of the fingers without displacement is conservative. An aluminum splint or plaster cast is applied for three weeks. After this, physiotherapeutic treatment, massage and exercise therapy are prescribed. Full mobility of the injured finger is usually restored within a month.

In case of a displaced fracture of the phalanges of the fingers, comparison of bone fragments (reposition) is performed under local anesthesia. Then a metal splint or plaster cast is applied for a month.

If the nail phalanx is fractured, it is immobilized with a circular plaster cast or adhesive plaster.

The phalanges of the fingers hurt: causes

Even the smallest joints in the human body - the interphalangeal joints - can be affected by diseases that impair their mobility and are accompanied by excruciating pain. Such diseases include arthritis (rheumatoid, gout, psoriatic) and deforming osteoarthritis. If these diseases are not treated, then over time they lead to the development of severe deformation of the damaged joints, complete disruption of their motor function and atrophy of the muscles of the fingers and hands. Despite the fact that the clinical picture of these diseases is similar, their treatment is different. Therefore, if the phalanges of your fingers hurt, you should not self-medicate. Only a doctor, after conducting the necessary examination, can make the correct diagnosis and accordingly prescribe the necessary therapy.

The phalanx of the human finger has 3 parts: proximal, main (middle) and terminal (distal). On the distal part of the nail phalanx there is a clearly visible nail tuberosity. All fingers are formed by 3 phalanges, called the main, middle and nail. The only exception is the thumbs; they consist of 2 phalanges. The thickest phalanges of the fingers form the thumbs, and the longest - the middle fingers.

Our distant ancestors were vegetarians. Meat was not part of their diet. The food was low in calories, so they spent all their time in the trees, obtaining food in the form of leaves, young shoots, flowers and fruits. The fingers and toes were long, with a well-developed grasping reflex, thanks to which they stayed on branches and deftly climbed trunks. However, the fingers remained inactive in the horizontal projection. The palms and feet were difficult to open into a flat plane with the toes spread wide apart. The opening angle did not exceed 10-12°.

At a certain stage, one of the primates tried meat and found that this food was much more nutritious. He suddenly had time to take in the world around him. He shared his discovery with his brothers. Our ancestors became carnivores and descended from the trees to the ground and rose to their feet.

However, the meat had to be cut. Then a man invented a chopper. People still actively use modified versions of the handaxe today. In the process of making this instrument and working with it, people's fingers began to change. On the arms they became mobile, active and strong, but on the legs they became shortened and lost mobility.

By prehistoric times, human fingers and toes acquired an almost modern appearance. The opening angle of the fingers at the palm and foot reached 90°. People learned to perform complex manipulations, play musical instruments, draw, draw, engage in circus arts and sports. All these activities were reflected in the formation of the skeletal basis of the fingers.

The development was made possible thanks to the special structure of the human hand and foot. It is, in technical terms, all “hinged”. Small bones are connected by joints into a single and harmonious shape.

The feet and palms have become mobile, they do not break when performing turning and turning movements, arching and torsion. With the fingers and toes, a modern person can press, open, tear, cut and perform other complex manipulations.

Anatomy is a fundamental science. The structure of the hand and wrist is a topic that interests not only doctors. Knowledge of it is necessary for athletes, students and other categories of people.

In humans, the fingers and toes, despite noticeable external differences, have the same phalanx structure. At the base of each finger are long tubular bones called phalanges.

The toes and hands are the same in structure. They consist of 2 or 3 phalanges. Its middle part is called the body, the lower part is called the base or proximal end, and the upper part is called the trochlea or distal end.

Each finger (except the thumb) consists of 3 phalanges:

  • proximal (main);
  • average;
  • distal (nail).

The thumb consists of 2 phalanges (proximal and nail).

The body of each phalanx of the fingers has a flattened upper back and small lateral ridges. The body has a nutrient opening that passes into a canal directed from the proximal end to the distal end. The proximal end is thickened. It contains developed articular surfaces that provide connection with other phalanges and with the bones of the metacarpus and foot.

The distal end of the 1st and 2nd phalanges has a head. On the 3rd phalanx it looks different: the end is pointed and has a bumpy, rough surface on the back side. The articulation with the bones of the metacarpus and foot is formed by the proximal phalanges. The remaining phalanges of the fingers provide a reliable connection between the bones of the finger.

Sometimes a deformed phalanx of a finger becomes the result of pathological processes occurring in the human body.

If round thickenings appear on the phalanges of the fingers and the fingers become like drumsticks, and the nails turn into sharp claws, then the person probably has diseases of the internal organs, which may include:

  • heart defects;
  • pulmonary dysfunction;
  • infective endocarditis;
  • diffuse goiter, Crohn's disease (severe disease of the gastrointestinal tract);
  • lymphoma;
  • cirrhosis;
  • esophagitis;
  • myeloid leukemia.

If such symptoms appear, you should immediately consult a doctor, because in an advanced state, these diseases can become a serious threat to your health and even life. It happens that deformation of the phalanges of the fingers and toes is accompanied by excruciating, nagging pain and a feeling of stiffness in the hand and foot. These symptoms indicate that the interphalangeal joints are affected.

Diseases that affect these joints include:

  • deforming osteoarthritis;
  • gouty arthritis;
  • rheumatoid arthritis;
  • psoriatic arthritis.

In no case should you self-medicate, because due to illiterate therapy you can completely lose the mobility of your fingers, and this will greatly reduce your quality of life. The doctor will prescribe examinations that will identify the causes of the disease.

Determining the causes will allow you to make an accurate diagnosis and prescribe a treatment regimen. If all medical recommendations are strictly followed, the prognosis for such diseases will be positive.

If painful bumps appear on the phalanges of your fingers, then you are actively developing gout, arthritis, arthrosis, or deposited salts have accumulated. A characteristic sign of these diseases is compaction in the area of ​​the cones. A very alarming symptom, because this is a compaction that leads to immobilization of the fingers. With such a clinic, you should go to a doctor so that he can prescribe a therapy regimen, draw up a set of gymnastic exercises, prescribe massage, applications and other physiotherapeutic procedures.

Injuries to joints and bone structures

Who among us has not pressed our fingers against doors, hit our nails with a hammer, or dropped some heavy object on our feet? Often such incidents result in fractures. These injuries are very painful. They are almost always complicated by the fact that the fragile body of the phalanx splits into many fragments. Sometimes the cause of a fracture can be a chronic disease that destroys the bone structure of the phalanx. Such diseases include osteoporosis, osteomyelitis and other severe tissue damage. If you have a high risk of getting such a fracture, then you should take care of your arms and legs, because treating such fractures of the phalanges is a troublesome and expensive undertaking.

Traumatic fractures, according to the nature of the damage, can be closed or open (with traumatic ruptures and tissue damage). After a detailed examination and x-ray, the traumatologist determines whether the fragments have shifted. Based on the results obtained, the attending physician decides how to treat this injury. Victims with open fractures always go to the doctor. After all, the sight of such a fracture is very unsightly and frightens a person. But people often try to endure closed fractures of the phalanges. You have a closed fracture if after the injury:

  • pain on palpation (touch);
  • finger swelling;
  • restriction of movements;
  • subcutaneous hemorrhage;
  • finger deformation.

Immediately go to a traumatologist and get treatment! Closed fractures of the fingers can be accompanied by dislocations of the phalanges, damage to tendons and ligaments, so you will not be able to cope without the help of a specialist.

Rules for providing first aid

If the phalanx is damaged, even if it is just a bruise, you should immediately apply a splint or a tight polymer bandage. Any dense plate (wooden or plastic) can be used as a tire. Pharmacies today sell latex splints that do a good job of fixing a broken bone. You can use the adjacent healthy finger together with the splint. To do this, bandage them firmly together or glue them with a band-aid. This will immobilize the injured phalanx and allow you to calmly work with your hand. This will also help prevent bone fragments from dislodging.

Conservative treatment (wearing tight bandages and plaster) for fractures lasts about 3-4 weeks. During this time, the traumatologist conducts x-ray examinations twice (on days 10 and 21). After removing the plaster, active development of the fingers and joints is carried out for six months.

The beauty of hands and feet is determined by the correct shape of the phalanges of the fingers. You need to take care of your hands and feet regularly.

Among all bone fractures, the data is 5%.

Fractures of the second finger are more common, with the fifth finger in second place.

In almost 20% of cases, multiple fractures of the phalanges of various fingers are observed.

Damage to the main phalanges most often occurs, then to the nail and rarely to the middle phalanges.

Four of the five fingers of the hand consist of three phalanges - the proximal (upper) phalanx, the middle and the distal (lower).

The thumb is formed by a proximal and distal phalanx.

The distal phalanges are the shortest, the proximal ones are the longest.

Each phalanx has a body, as well as a proximal and distal end. For articulation with neighboring bones, the phalanges have articular surfaces (cartilage).

Reasons

Fractures occur at the level of the diaphysis, metaphysis and epiphysis.

They are available without offset or with offset, open and closed.

Observations show that almost half of phalangeal fractures are intra-articular.

They cause functional disorders of the hand. Therefore, phalangeal fractures should be considered as a severe injury in a functional sense, the treatment of which must be approached with the utmost seriousness.

The mechanism of fractures is predominantly direct. They occur more often in adults. The blows fall on the back surface of the fingers.

Symptoms

Throbbing pain, deformation of the phalanges, and in case of non-displaced fractures - deformation due to swelling, which spreads to the entire finger and even the back of the hand.

Displacements of fragments are often angular, with lateral deviation from the axis of the finger.

Typical for a phalangeal fracture is the inability to fully extend the finger.

If you place both hands with your palms on the table, then only the broken finger does not adhere to the plane of the table. With displacements along the length, shortening of the finger and phalanx is noted.

For fractures of the nail phalanges

Subungual hematomas occur. Active and passive movements of the fingers are significantly limited due to exacerbation of pain, which radiates to the tip of the finger and is often pulsating.

The severity of the pain corresponds to the site of the phalanx fracture.

Not only the function of the fingers is impaired, but also the grasping function of the hand.

When the dorsal edge of the nail phalanx is torn off

When the dorsal edge of the nail phalanx is torn off (Bush fracture) with the extensor tendon, the nail phalanx is bent and the victim cannot actively straighten it.

Intra-articular fractures cause deformation of the interphalangeal joints with axial deviations of the phalanges.

Axial pressure on the finger aggravates the pain at the site of the phalanx fracture. In fractures with displacement of fragments, pathological mobility is always a positive symptom.

Diagnostics

X-ray examination clarifies the level and nature of the fracture.

First aid

Any fracture requires temporary fixation before medical intervention, so as not to aggravate the injury.

If the phalanges of the hand are fractured, two or three ordinary sticks can be used for fixation.

They need to be placed around the finger and wrapped with a bandage or any other cloth.

As a last resort, you can bandage the damaged finger to a healthy one. If a painkiller tablet is available, give it to the victim to reduce pain.

A ring on an injured finger provokes an increase in swelling and tissue necrosis, so it must be removed in the first seconds after the injury.

In the case of an open fracture, it is prohibited to set the bones yourself. If disinfectants are available, you need to treat the wound and carefully apply a splint.

Treatment

No offset

Fractures without displacement are subject to conservative treatment with plaster immobilization.

Displaced fractures with a transverse or close to it plane are subject to closed, one-step comparison of fragments (after anesthesia) with plaster immobilization for a period of 2-3 weeks.

Working capacity is restored after 1.5-2 months.

With an oblique fracture plane

Treatment with skeletal traction or special compression-distraction devices for the fingers is indicated.

For intra-articular fractures

Intra-articular fractures, in which it is not only possible to eliminate the displacement, but also to restore the congruence of the articular surfaces, are subject to surgical treatment, which is carried out with open reduction with osteosynthesis of fragments, and early rehabilitation.

Must be remembered that treatment of all phalangeal fractures should be carried out in the physiological position of the fingers (half-bent at the joints).

Rehabilitation

Rehabilitation for finger fractures is one of the components of complex treatment, and it plays an important role in restoring finger function.

On the second day after the injury, the patient begins to move the healthy fingers of the injured hand. The exercise can be performed synchronously with a healthy hand.

The damaged finger, which is accustomed to being in a motionless state, will not be able to freely bend and straighten immediately after the immobilization is removed. To develop it, the doctor prescribes physiotherapeutic treatment, electrophoresis, UHF, magnetic therapy, and physical therapy.