Polyfractures in the Hand

When there are more than one fracture in the hand that are either unstable, displaced, or both, the hand is in particular jeopardy of becoming stiff, deformed, and dysfunctional. Occasionally, this can occur with closed injuries, and, in such instances, it is more common with crush and blast type injuries. We showed examples of multiple metacarpal fractures in Chapter 20, and in Chapter 28 we showed an example of a bicondylar phalangeal fracture along with another proximal phalanx fracture of an adjacent finger. Polyfractures in the hand and wrist are more common in open injuries, which are demonstrated in Chapter 39. Anatomic restoration and stabilization of bony architecture in these instances are important not only in securing bony union but also as an adjunct in soft tissues healing and healing of other deep structures that require repair or reconstruction. In this chapter, we show examples of both a metacarpal and a phalanx being fractured in the same hand in a closed injury. Stable fixation leading to good stability and pain control is certainly an advantage for implementation of early and aggressive active range of motion and institution of measures against swelling, such as the Jobst pump, isotoner glove, and Coban wrapping (Fig. 37-1 A Fig. 37-1 B Fig. 37-1 C Fig. 37-1 D and 37-2 A-D).>