[Classification of hand fractures and their treatment].

Fractures and fracture-dislocations of the hand can inhibit directly and indirectly the precision of the hand mobility. The fracture of the scaphoid mostly occurs through his middle third and is stable. In unstable fractures or fractures through the proximal third pseudarthrosis or aseptic necrosis of the proximal fragment is seen. The fracture of the trapezium can prevent the normal mobility of the thumb, and therefore an anatomical reduction is desirable. The most important fractures of the metacarpals are Bennett's fracture and Rolando's fracture of metacarpal I and the boxer's fracture of metacarpal V. Fractures of the shaft of the metacarpals tend to heal in a dorsal angulation and rotational deformity. The distal intra-articular fracture of the metacarpals also needs an anatomical reduction and fixation. Frequently there is a volar angulation of the fracture of the proximal phalanx. The angulation of the fracture of the middle phalanx depends on the place of attachment of the superficial flexor tendon. The fractures of the distal phalanx mostly are stable and doesn't need a reduction. The fracture-dislocations of the little joints directly threaten the function of the lesioned joint. The fracture-dislocation of the carpometacarpal joints are always combined with an important soft-tissue damage. The treatment of the fracture-dislocations of the metacarpophalangeal or interphalangeal joints depends on the magnitude and displacement of the fracture fragments.