LOGIC March 2018 Vol 17 Vol 1 - Page 39

Figure 2: Midshaft oblique fractures: 5 th MC fracture confirmed fractures to the bones of the hand, treatment is dependent upon the bone and the position of the fracture. Treatment Options Hands should always be placed in the position of function when they are immobilised. This protects the soft tissues and allows for easier mobilisation when the cast is removed. The metacarpo-phalangeal joint is flexed to prevent collateral ligament shortening and the fingers extended to prevent volar plate damage and shortening. Figure 1 shows the position of safe immobilisation commonly known as the POSI . To manage pain, a local block is normally used prior to reducing acute fractures. March 2018 L.O.G.I.C DIFFERENT CASTS v DIFFERENT INJURIES Volar Slab (Backslab) In the Bone Shop, metacarpal (MC) fractures (Figure 2) are reduced and treated in casts and rotation if present must be corrected using traction prior to casting or splinting. The cast of choice for us is a volar slab with the wrist in extension and the cast ending at the palmer crease of the hand. The fingers are buddy strapped to prevent rotation and patients are encouraged to flex their fingers. It is important not to extend the cast further up than the palmer crease, because this will prevent the metacarpo-phalangeal joint being able to flex and cause shortening of collateral ligaments. For new injuries, no stockings are used under the casts but felt padding is applied at the point where moulding will take place to prevent pressure sores. With the exception of the thumb, mid-shaft, base and neck of MC fractures can all be adequately immobilised in a volar cast. The moulding of the cast will be dependent on the fracture’s location. Neck of MC fracture reduction can be achieved by traction and volar pressure under the MC head with dorsal counter pressure more proximally. Shaft of MC fracture reduction requires traction and pressure along the MC dorsally. Base of MC fractures can be reduced in a similar way, but may require further imaging afterwards to confirm the joint is enlocated and congruent. Hand fractures, like fingers, generally heal quickly and 4 weeks immobilisation is adequate. However, smoking can delay union and may necessitate longer casting. 37