Common sports hand injuries. An overview of aetiology, management and prevention

Injuries to the hand are among the most common in all of sports. Appropriate care should include prompt diagnosis and treatment. Dislocations of the digits should be reduced promptly, particularly the carpometacarpal joint of the thumb. Volar dislocations of the proximal interphalangeal joint need to be splinted in full extension, and the more common dorsal dislocations in slight flexion. Collateral ligament injuries of the fingers respond well to initial immobilisation followed by early motion. Although ligament injuries to the thumb metacarpophalangeal joint may be treated closed, they generally respond better to operative management. This is true particularly for those occurring on the ulnar side which are at risk for soft tissue interposition. Metacarpal shaft fractures can usually be treated closed with acceptance of more significant deformity in the ulnar 2 shafts. Open reduction is reserved for multiple shaft fractures and deformity in the second and third metacarpals. Near-perfect alignment should be the goal in extra-articular fractures of the phalanges as well as fractures involving the articular surface. Closed tendon injuries occurring on the extensor side, i.e. mallet finger, may be treated with prolonged splinting if a congruous reduction can be achieved with closed reduction. Flexor side avulsions occurring most commonly in the ring finger also require prompt attention with the level of retraction of the tendon dictating the need for the immediacy of repair. Although often not initially debilitating, lack of recognition of hand injuries and improper treatment can lead to debilitating sequelae. Therefore, early recognition and diagnosis can easily avoid many of the pitfalls of care resulting in a less than optimal outcome.