Core Knowledge in Orthopaedics: Hand, Elbow, and Shoulder by Thomas Trumble

By Thomas Trumble

Основные знания в области ортопедии: рука, локоть, плечо.

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Additional info for Core Knowledge in Orthopaedics: Hand, Elbow, and Shoulder

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If the fracture line between the condyles and the shaft is in a short oblique pattern, it may be possible to fix both condyles to the shaft with individual lag screws. However, in the more common transverse fracture pattern, a 90-degree condylar plate usually is required, as collapse may occur with screws alone. Fixation proceeds with lag screw fixation of one condyle to the other, followed by plate fixation of the condyles to the shaft. Occasionally bone grafting at the metaphysis is necessary to prevent undue shortening of the digit in highly comminuted fractures.

Rettig ME, Dassa G, Raskin KB:Volar plate arthroplasty of the distal interphalangeal joint. J Hand Surg 26A:940-944, 2001. Volar plate arthroplasty of the distal interphalangeal joint was used to treat 10 patients with impaction of the volar base of the distal phalanx and chronic dorsal subluxation of the distal phalanx at an average of 8 weeks after injury. 8. Leddy JP, Packer JW:Avulsion of the profundus tendon insertion in athletes. J Hand Surg [Am] 2:66-69, 1977. 9. Deitch MA, Kiefhaber TR, Comisar BR, Stern PJ: Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results.

Complications of using the 90-degee condylar plate include infection, joint stiffness, and tendon adhesion. Most nondisplaced extraarticular fractures can be treated with buddy taping for 3 to 4 weeks. For spiral fractures or others with potential for instability, splinting can be used for 3 weeks, with close follow-up to monitor for any displacement. Displaced Fractures ● London Type III Bicondylar Fractures ● Closed extraarticular fractures of the proximal and middle phalanges can be transverse, oblique, spiral, or comminuted.

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