It is the fracture at the neck of bones(esp. little finger’s) which form the knuckles of the hand. It almost always happens as a result of an impaction of the clenched fist against to a hard object.
Patients have swollen and painful knuckles. The diagnosis is confirmed with a direct radiology(figure 1).
The principle of the treatment is to realign the fracture sites. If it is possible the surgeon obtains the realignment manually and applies hard casts. But sometimes reduction of the fracture could not be possible, or the fracture may consist of multiple fragments. These cases need surgical approach.
Open or closed technique is chosen according to the pattern of the fracture. Operation is performed using axillary block or ulnar nerve anesthesia. The fracture is stabilized using wires(figure 2,3), and the patient is discharged from the hospital on the same day. A period of follow up for 4-6 weeks is needed. If X-Ray controls show good bone healing, then the wires and cast are removed. The patient is recommeded for a physiotherapy counselling afterwards.