II. Management: General Principles of Hand Fracture Management

  1. Avoid over-immobilization
  2. Correct angular malalignment and rotation
    1. Splint in position of moderate flexion
    2. Avoid Splinting fingers in extension (esp MCP)
    3. Axes of all flexed fingers should point at Scaphoid
  3. Evaluate peri-articular Fractures for avulsed tendon
    1. Fragments are often attached to a tendon or ligament

III. Management: Open Reduction and Internal Fixation (ORIF)

  1. Advantages
    1. Avoid excessive manipulation
    2. Avoids prolonged Splinting
  2. Indications
    1. Unstable displaced intra-articular Fractures
      1. if >25-30% of joint surface involved

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