Rommens P
Dienst Algemene Heelkunde, Universitair Ziekenhuis Gasthuisberg, Leuven.
Acta Chir Belg. 1988 Jan-Feb;88(1):55-60.
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.
手部骨折和骨折脱位可直接或间接影响手部活动的精确性。舟骨骨折多发生于其中部三分之一处，且骨折稳定。在不稳定骨折或近端三分之一处骨折时，可出现近端骨折块假关节形成或无菌性坏死。大多角骨骨折可妨碍拇指正常活动，因此需要解剖复位。掌骨最重要的骨折是第一掌骨的 Bennett 骨折和 Rolando 骨折以及第五掌骨的拳击手骨折。掌骨干骨折往往在背侧成角和旋转畸形状态下愈合。掌骨远端关节内骨折也需要解剖复位和固定。近端指骨骨折常出现掌侧成角。中指骨骨折的成角情况取决于浅屈肌腱的附着部位。远端指骨骨折大多稳定，无需复位。小关节的骨折脱位直接威胁受伤关节的功能。腕掌关节的骨折脱位总是合并有重要的软组织损伤。掌指关节或指间关节骨折脱位的治疗取决于骨折块的大小和移位情况。
