Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
_Treatment._--When the fracture is transverse, and especially when it
implicates the middle or ring fingers, the most convenient method is
to make the patient grasp a firm pad, such as a roller bandage covered
with a layer of wool, and to fix the closed fist by a figure-of-eight
bandage. In this way the adjoining metacarpals are utilised as side
splints. Active and passive movements must be carried out from the
first, and the bandage may be dispensed with at the end of a week or
ten days.
In oblique fractures with a tendency to overriding of the fragments,
especially in the case of the index and little fingers, it is
sometimes necessary to apply extension to the distal segment of the
digit, by means of adhesive plaster, to which elastic tubing is
attached and fixed to the end of a bow splint, reaching well beyond
the finger-tips (Fig. 52). This should be worn for a week or ten days.
[Illustration: FIG. 52.--Extension apparatus for Oblique Fracture of
Metacarpals.]
#Bennett's Fracture of the Base of the First Metacarpal
Bone.#--Bennett of Dublin described an injury of the thumb which,
although comparatively common, is often mistaken for a sub-luxation
backward of the carpo-metacarpal joint, or a simple "stave of the
thumb." It consists in an "oblique fracture through the base of the
bone, detaching the greater part of the articular facet with that
piece of the bone supporting it which projects into the palm" (Fig.
53). We have frequently observed the fracture extend for a
considerable distance along the palmar aspect of the shaft.
[Illustration: FIG. 53.--Radiogram of Bennett's Fracture of Base of
Metacarpal of Right Thumb.]
It usually results from severe force applied directly to the point of
the thumb, driving the metacarpal against the greater multangular bone
(trapezium), and chipping off the palmar part of the articular
surface, but it may result from a blow with the closed fist. The rest
of the metacarpal slips backward, forming a prominence on the dorsal
aspect of the joint. The pain and swelling in the region of the
fracture often prevent crepitus being elicited, and as the deformity
is not at once evident, the nature of the injury is liable to be
overlooked. The fracture is recognised by the use of the X-rays.
Unless properly treated this injury may result in prolonged impairment
of function, full abduction and fine movements requiring close
apposition of the thumb being specially interfered with.
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