It’s the fracture that occurs at the neck of the bones which form the knuckles of the hand. It almost always occurs as a result of an impact of a clenched fist to a hard object.
In the suspected cases, it’s useful to apply some ice and to raise the arm above the heart until the patient has arrived at the doctor’s. It is diagnosed with the pain, swelling after the trauma and with the determination of the fracture on direct radiography (figure 1).
Open or closed technique is chosen according to the position of the fracture. Operation is performed using axillaries or ulnar nerve complex. The patient doesn’t need to be under anaesthesia completely and discharged from hospital on the same day. If the fracture is recovered following 4-6 weeks, the hard casts and strings then can be removed. A physiotherapy counselling or support is very useful following this period.
The treatment is to realign the fracture by hand and to apply hard casts. However, in some cases the fracture has multiple parts and cannot be realigned by hand (or can’t keep its position after realignment). In these cases, the multiple fracture parts may need to be splinted using strings. (figure 2,3)