Hand Fractures: Reduction, Fixation, and Early Motion

Hand fracture outcomes often hinge on what radiographs miss — rotation, post-reduction stability, and whether fixation permits early motion.In this episode of Plastics in Practice, we review metacarpal and phalangeal fracture management — rotational alignment, stability, fixation strategy, early motion, thumb-base injuries, proximal interphalangeal joint fracture-dislocations, and complications.Key takeaways:• Examine each injured digit in maximal extension and flexion. Scissoring reveals malrotation; persistent rotation after reduction is operative.³• Stable, nondisplaced closed fractures usually need splinting or buddy taping, early motion, and radiographs at seven to ten days. Clinical union commonly takes three to four weeks.¹• Open hand fractures except tuft fractures need same-day review and antibiotics. Treat definitively — or wash out and close — within twenty-four hours; stop antibiotics after closure or by seventy-two hours, whichever comes first.²• Selected isolated, closed fifth-metacarpal neck fractures with less than seventy degrees of volar angulation and no rotation can do well with buddy taping and early motion. Open, complex, displaced, rotational, or occupation-limiting patterns need separate judgment.³,⁴• Choose the least invasive construct that holds reduction and permits motion. Use at least two K-wires in different planes for rotational control; plates add rigidity but also dissection and tendon-adhesion risk.¹,⁷• For a Bennett fracture, restore a stable, concentric thumb carpometacarpal joint. Less than one millimeter of step-off is a target, not an absolute cutoff; congruity and stability drive treatment.⁶• For a dorsal proximal interphalangeal joint fracture-dislocation, less than thirty percent involvement is usually stable, thirty to fifty percent is tenuous, and more than fifty percent is usually unstable. Confirm dynamically after reduction.⁵This content is for educational purposes only and is not medical advice.🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ#PlasticSurgery #Residency #HandSurgery #HandFractures #MetacarpalFracture #PhalanxFracture #BennettFracture #PIPFractureDislocation #PlasticsInPractice #SurgicalEducationReferences: 1. BSSH. Closed hand fractures. Standards of Care in Hand Trauma. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/1%20Closed%20hand%20fractures%20final.pdf 2. BSSH. Open fractures other than tuft fractures. Standards of Care in Hand Trauma. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/2%20Open%20fractures%20Final.pdf 3. BSSH. Fifth metacarpal neck fractures. Standards of Care in Hand Trauma. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/9%20Metacarpal%20neck%20fractures.pdf 4. Martínez-Catalán N et al. Buddy taping versus reduction/casting for fifth-metacarpal neck fractures. J Hand Surg Am. 2020;45:1134-1140. doi:10.1016/j.jhsa.2020.05.013 5. Tyser AR et al. Stability of acute dorsal PIP fracture-dislocations. J Hand Surg Am. 2014;39:13-18. doi:10.1016/j.jhsa.2013.09.025 6. Kjaer-Petersen K, Langhoff O, Andersen K. Bennett's fracture. J Hand Surg Br. 1990;15(1):58-61. doi:10.1016/0266-7681_90_90049-A 7. Curtis BD et al. Metacarpal shaft fixation: biomechanical comparison. Orthop Surg. 2015;7:256-260. doi:10.1111/os.12195