FRACTURE OF CARPAL,

METACARPAL, PHALANK AND

WRIST DISLOCATION

Fera Santika
Laras Werdiningsih
Nabila Claudya

Hand

The hand is made up of many bones that

make the wrist and fingers move.
A fracture occurs when enough force is
applied to a bone
there is pain, swelling, stiffness and
decreased use of the injured part

Bones of the Hand & Wrist

Ulna
Radius
Carpals (8)
Metacarpals (5)
Phalanges (14)

Distal
Intermediate
Proximal
http://www.sports-injury-info.com/hand-anatomy.html

Carpal Bones

(Starting with distal row, lateral to medial)

1. Trapezium
2. Trapezoid
3. Capitate
4. Hamate
5. Pisiform
2
3
4
1
5
6. Scaphoid
6
8
7. Lunate
7
8. Triquetrum

Scaphoid fractures: Most common

carpal fracture
5

Mechanism:
Fall on an outstretched hand (compression)
Forceful wrist hyperextension

Signs & Symptoms:

Pain
Point tenderness
Swelling
Numbness
Loss of wrist and finger flexion
Treatment:
Immobilization 12 weeks
Operative intervenion may be indicated if scaphoid nonunion persists
after 4 months of immobilization

Triquetral fracture: 2nd most

common carpal fracture
7

mechanism

direct blow of extreme dorsiflexion.

Sign and symtomp

Point tenderness.
Treatment:

Chip fracture:
symptomatic with 2-3 weeks immobilization. ROM
exercise once symptoms decrease.
Body fracture:
Minimally displaced: cast immobilization for 4-6
weeks + ROM exercise
Displaced: Open reduction and internal fixation

Trapezium fracture

This is the third most common carpal

fracture.
mechanism:
direct blow to the dorsum of the hand
Sign and symtomps:
point tenderness over the trapezium.
weak and painful pinch grip.

Hamate fracture : Usually seen in

individuals who use racquet,
baseball bat, or golf stick

Mechanism:
fall on to the outstretched hand.
falls while holding an object and the object lands
between the ground and the ulnar side of the palm
while gripping the handle of a racquet, bat or golf
club, with an abnormal swing.
Sign and symptoms:
Pain while gripping.
Grip strength may be reduced.
Treatment:
immobilized with a cast for 6 weeks.
ROM exercises after the cast is removed
Displaced hamate hook fractures and displaced
hamate body fractures suggest with ORIF

13

Metacarpal Fractures: Relatively

common. 30-40% of hand
fractures

o
o
o
o
o

o
o
o
o

Mechanism:
Direct blow, compression force or twisting
Signs & Symptoms:
Pain
Swelling
Loss of ROM and grip strength
Treatment:
Follow RICE
Immobilized with cast for 3-4 weeks
Splint in flexion
Refer for x-ray

14

Phalangeal Fractures: Phalanx fractures

can occur at the base, neck, shaft or head
of the phalanx.
15

Mechanism:
direct trauma to the finger (e.g. during
ball sports).
Crush injuries to the distal phalanx are
also common, and can result in nail
trauma and open fractures.
Sign and symptoms:

Pain
Rapid swelling
Loss of motion, grip strength

Treatment

immobilising the proximal and distal

interphalangeal joints
For proximal fractures, the splint needs
to be longer and immobilise the
metacarpophalangeal joint and the wrist
Surgical treatment: because of instability
and rotation trouble

17

Methods of Pain Management

Phase I
Technique

1. Ice
2. Compression w/
Ace wrap
3. Immobilize w/
splint or brace
4. NSAIDs

Goal

1. Limit / control
pain
2. Limit swelling
3. Restrict
movement

Restore ROM
PHASE II
Technique

1. Passive ROM

Goal

2. Active-assistive
ROM

3. Active ROM

1. Perform ROM of
the affected joint for
the injured athlete
2. Assist the person
perform ROM at the
affected joint
3. Ask the person to
perform ROM until
full movement is
reached

Proprioception
Phase III
Technique

1. Catching a ball
2. Close eyes or
face away from
person throwing
ball, then open
eyes or turn to find
and catch the ball

Goal

1. Restore
functional skills
2. Improve reaction
time

Strength
Phase IV
Technique

1. Perform resistive
ROM
2. Squeeze hand
grip or tennis ball
3. Use thera-putty
or other moldable
substance

Goal

1. Apply manual
resistance during
full ROM
2. Increase grip
strength
3. Manipulate putty
through pinching,
rolling or stretching

Endurance
Phase V
Technique

1. Perform ROM or
RROM at affected
joint

Goals

1. Decrease
amount of
resistance and
increase number of
repetitions

Sport Specific Skills

Phase VI
Sport

1. Basketball
2. Tennis
3. Football

Skills

1. Catching,
dribbling, shooting
the ball
2. Serving, volleying
3. Passing or catching
the ball; firing out of
3-point stance
(depends on the
position)

Dislocation of Wrist

o
o

o
o
o
o
o

A condition when the surface of wrist joint occure

direct or indirect friction.
Mechanism:
fallen on an outstretched hand
Sport injury
Sign and symptom
Pain
Swelling
Limitation of movement
Spasm of extensor and flexor wrist
Localized tenderness, especially over the dorsoradial
aspect of the wrist
Crepitus or a click with radial or ulnar deviation
movement
A decrease in grip strength

Treatment

Achute phase, The rehabilitation of wrist injuries

can be divided into 5 phases:
Phase I: Control inflammation and edema by
using rest, ice, compression, and elevation
(RICE).
Phase II: Restore the normal soft-tissue
environment by using modalities such as scar
massage, whirlpool therapy, and elastomer
application.
Phase III: Increase range of motion (ROM).
Phase IV: Increase strength.
Phase V: Work on hardening and/or conditioning.
Surgical intervention

Thankyou