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La funcion de la mano es el resultado de la combinacion de la estructura osea, la estabilidad ligamentaria y la potencia muscular intrinseca y extrinseca. El tratamiento de una fractura digital tiene como objetivo recuperar la mejor funcion con el minimo de secuelas (dolor, rigidez). En ciertos tipos de fracturas es posible la inmovilizacion cuando esta es corta (menos de 4 semanas), adecuada (en buena posicion) porque el dedo permanece virgen (no operado). El tratamiento quirurgico se hace necesario cuando existe una fractura abierta, lesiones asociadas o un desplazamiento inaceptable; se basa en una reduccion y una fijacion estables. En caso de tratamiento quirurgico, la reaccion cicatricial relacionada con la exposicion que se sobreanade a las lesiones solo se puede combatir con una movilizacion inmediata. Esta movilizacion solo es posible si la cicatrizacion de los tejidos blandos y el dolor estan bajo control. Independientemente del tratamiento realizado, es necesario un seguimiento regular para descartar complicaciones: desplazamiento secundario, mal control del dolor, exclusion del dedo.

Riassunto La funzione della mano e il risultato della combinazione della struttura ossea, della stabilita legamentosa e della potenza muscolare intrinseca ed estrinseca. Il trattamento di una frattura digitale ha come obiettivo il ritrovamento della migliore funzione con le minime conseguenze (dolori, rigidita). L’immobilizzazione e possibile in certi tipi di fratture, se breve (meno di 4 settimane), adattata (in buona posizione), per mantenere il dito vergine (non operato). Un trattamento chirurgico e reso necessario da un’apertura della frattura, da lesioni associate o da uno spostamento grave; esso poggia su una riduzione e una fissazione stabile. In caso di trattamento chirurgico, la reazione cicatriziale legata all’apertura che si sovrappone alle lesioni puo soltanto essere combattuta da una mobilizzazione immediata. Questa mobilizzazione e possibile solamente se la cicatrizzazione delle parti molli e il dolore sono sotto controllo. Qualunque sia il trattamento, e necessario un controllo regolare per individuare una complicanza: spostamento secondario; cattivo controllo del dolore; esclusione del dito.

Metacarpal diaphyseal fractures are classically treated using a non-removable glove for 4 to 6 weeks. Here, we report the results of treatment by immediate active protected mobilization (buddy taping for four weeks) of minimally displaced M2 to M5 fractures. Fifty-four fractures (15 transverse or short oblique and 39 spiral or long oblique) in 51 patients were included during a one-year period; the average age of patients was 31 years. Clinical and radiographic assessments were carried out at day 15 and then months 1, 2 and 6 post-fracture. Thirty-one cases were reviewed at day 15, 27 at 1 month, and 22 at 2 months. The initial volar tilt was 26° on average for the short oblique or transverse fractures, and 11.5° for the long oblique or spiral fractures. Six fractures (11%) experienced 16.6° of secondary displacement on average. The fracture was healed in 37% of cases at 1 month, and in 100% of cases at 2 months in the patients who were reviewed clinically. Reduction in the QuickDASH and VAS for pain was evidence of fast functional recovery. The range of motion was comparable to that of the contralateral side in 90% cases after 2 months. Grip and pinch strength was 33% less than the contralateral side at 2 months. Although secondary displacement occurs in some cases, the functional results of this simple and practical treatment method are good after 2 months, as there is little pain, stiffness, strength loss and no cases of nonunion.

The authors present the case of a patient with a rare combination of open volar radiocarpal dislocation and complete destruction of the dorsal capsule-ligament complex and tendons. The treatment consisted of open reduction and arthrorisis (temporary arthrodesis during 45 days) with four K-wires (radiocarpal and radioulnar). The capsule-ligament complex was fixed with anchors and the extensor tendons were repaired by suturing. A long-arm cast was applied for six weeks. After an 18-month follow-up, the Cooney-modified Green and O'Brien score was 70 and the wrist range of motion was 85°. Dynamic intraoperative X-rays are needed to look for bone or ligament (intracarpal or radioulnocarpal) injuries. Arthrography, arthroscopy or MRI may provide additional information. In cases of stable lesions without intracarpal ligament injuries, conservative treatment may be sufficient. Otherwise, surgical treatment is required, using temporary external fixation or arthrorisis (temporary arthrodesis) associated with anatomic repair of capsular ligaments. The average duration of postoperative immobilization is 6.6 weeks. An external fixator seems to be useful for reduction and for placing optimal tension on repaired ligament repair. Twenty-three cases of volar radiocarpal dislocation are described in published studies. None of them was associated with bone, tendon, skin or capsule-ligament complex injuries. Few studies describe the long-term functional and radiological outcomes of these injuries.