phalanx fracture
Introduction
Introduction to phalangeal fracture Fractures of the phalanges are most common in the hands, mostly open fractures. Mostly caused by direct violence, it can cause various types of fractures in any part of the finger. Due to the different parts of the phalanx fracture, the tendon is pulled by different directions, resulting in different directions of displacement, such as the proximal phalanx fracture, which is pulled by the interosseous muscle and the sacral muscle, and the volar angle is formed. The middle phalanx is a distal fracture of the superficial flexor tendon, which is also caused by the traction to the volar side; if the proximal fracture of the superficial flexor tendon is fractured, the extensor tendon is pulled to form an angle to the dorsal side. . The proximal phalanx intra-articular fracture can be divided into three categories: collateral ligament tear, compression fracture and longitudinal split fracture. Most of the distal phalanx fractures are comminuted fractures, often without obvious displacement; and the avulsion fractures on the dorsal side of the base of the distal phalanges usually form hammer-shaped deformities. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: soft tissue injury
Cause
Cause of phalangeal fracture
Trauma factor (95%)
Both direct and indirect violence can cause phalangeal fractures, but most are caused by direct violence, and most of them are open fractures; violence leads to impaired bone integrity and causes fractures. The fracture has a transverse, oblique, spiral, comminuted or affected joint surface. Among them, closed fractures are more common with transverse fractures, followed by oblique fractures. Open fractures are more common in comminuted fractures.
Pathogenesis
1. proximal phalangeal fractures: mostly caused by indirect violence, more common with bone fractures, because the proximal end of the fracture is pulled by the bones and the sacral muscles, and the distal end of the fracture is pulled by the extensor tendon, often causing the volar Angled deformity. If the neck is fractured, due to the extensor tendon traction, the distal eye can be rotated up to 90° to the back, so that the dorsal side of the distal end is opposite to the proximal section, which hinders the fracture.
2. Middle phalanx fracture: The middle phalanx can be caused by direct violence and can cause transverse fracture. Indirect violence can cause oblique or spiral fracture. Different deformities can occur due to different fracture sites. If the fracture site is proximal to the fingertip of the superficial flexor muscle, the distal fracture end is pulled by the superficial flexor tendon, forming an angular deformity to the dorsal side. If the fracture site is on the distal side of the superficial flexor tendon, the proximal fracture end is displaced to the volar side due to the traction of the superficial flexor tendon, forming an angular deformity to the volar side.
3. The distal phalanx fractures are caused by direct violence, such as being bruised by heavy objects and crushing injuries. Lighter has only bone cracks, and severe ones can be broken into bones. More combined with soft tissue laceration. Due to the localized dead muscle spasm, the fracture is generally not significantly displaced or deformed. The dorsal basal side of the phalanx is avulsed. Because of the straightening of the fingers, indirect violence acts on the fingertips, causing the distal phalanx to suddenly flex. Due to the stretching of the extensor tendon, avulsion fractures can occur on the dorsal side of the basal phalanx. The fingers flexed at the end of the fracture and showed a typical "hammered finger" deformity.
Prevention
Finger bone fracture prevention
Most of the phalanx fractures can cause phalangeal fractures due to direct violence and indirect violence, but most of them are caused by direct violence, and most of them are open fractures. The fractures have transverse, oblique, spiral, comminuted or affected joint surface. Therefore, in daily life, everything should have the possibility of anticipating accidents, and make full use of the tools around us to help reduce the risk of accidents caused by accidents. Second, once the disease occurs, actively treat and strive for the best therapeutic effect. Complications need to be dealt with in a timely and effective manner to minimize disability and improve the quality of life of patients. Third, actively perform functional exercises under the guidance of a physician to prevent the occurrence of complications.
Complication
Fracture of phalangeal fracture Complications, soft tissue injury
Often complicated by knuckles and rigidity.
Symptom
Symptoms of phalangeal fractures Common symptoms Joint migration pain, swollen joint pain Thumb only soft tissue... Finger stiffness, joint stiffness, ring finger, unknown cause, pain, nail clip, joint, rigidity, wrist fracture
The position of the phalanx is superficial. In addition to obvious pain, swelling, tenderness and limited function of the injury, there are obvious deformities. For suspected fractures, X-ray films can be diagnosed. The treatment of phalangeal fractures often fails to attract great attention. Often due to poor positioning or fixed fixation, malunion or non-healing, often due to improper fixation or long fixation time, the joint capsule and collateral ligament contracture, resulting in joint stiffness; especially near the joint or through the joint Fractures often lead to joint stiffness and severely affect the function of the fingers.
According to the medical history, clinical manifestations and X-ray examination can be diagnosed.
Examine
Examination of phalangeal fractures
1, comprehensive physical examination: pay attention to the presence or absence of shock, soft tissue injury, bleeding, check the size, shape, depth and pollution of the wound. Exposed with bone ends, with or without nerves, blood vessels or other damage.
3, X-ray examination: In addition to the positive and lateral X-ray film, the special body phase should be photographed according to the injury, such as the opening position, the dynamic side position, the axial position and the tangent position. X-ray film can accurately display the degree of damage and the type of fracture.
Diagnosis
Diagnosis and differentiation of phalangeal fractures
diagnosis
Local swelling, pain, and flexion and extension of the fingers are limited after fracture. When there is obvious displacement, the proximal and middle phalanx fractures may have an angular deformity; the abutment of the dorsal basal part of the distal phalanx has a hammer-like deformity, and the fingers cannot actively extend. There are displaced fractures that can smash and bones, and there are abnormal activities. X-ray examination can identify the location and type of fracture.
(1) Diagnostic basis
1. Have a history of trauma.
2. Local swelling, pain or bone rub, finger dysfunction.
3. X-ray examination can determine the location and type of fracture.
(2) Syndrome classification
1. Fracture of the phalanx: local swelling, pain, and lateral movement of the interphalangeal joint can be increased.
2. Fracture of the phalanx neck: the fracture is angled to the volar side, the distal end can be rotated to the dorsal side, and the dorsal side of the injured finger can be licked and rounded.
3. Fracture of the phalanges: the fractures are more angled to the volar side, local tenderness, longitudinal axis impact pain, abnormal activity.
4. The basal fracture of the humerus at the distal end: swelling and tenderness at the fracture site, limited flexion and extension function, and may be hammer-like.
