Forensic medical characteristics of bone fractures of the hand

Abstract

BACKGROUND: The forensic medical aspects of closed bone fractures of the hands are important in connection with the need to establish the nature, mechanism of occurrence, severity, and duration of these injuries.

AIM: This study aimed to assess the severity of closed bone fractures of the hands based on the features of the formation, course, and outcomes.

MATERIAL AND METHODS: Fractures of wrist bones (n = 24) and metacarpal bones (n = 218) were examined in persons struck by blunt objects.

RESULTS: Scaphoid bone fractures (81.8%) most often occurred on the side of the carpals, and fractures of other carpal bones are detected relatively less frequently (18.2%). With closed fractures of the navicular bone, especially in cases of late seeking medical help, complications such as a false joint and aseptic necrosis can be observed, causing pronounced radiocarpal joint dysfunction. In the metacarpal bones, periarticular fractures of the proximal epiphysis (49.1%) are often noted, followed by intra-articular fractures (26.6%) and periarticular diaphyseal fractures (20.6%). Complications such as finger contractures in chronic metacarpal bone fractures were most observed in intra-articular, comminuted with mixed, and transverse fractures.

CONCLUSION: Isolated uncomplicated closed fractures of wrist bones have moderate severity. Moreover, scaphoid bone fractures, complicated by a false joint and aseptic necrosis, causing severe wrist joint dysfunction, and ultimately joint immobility in a functionally disadvantageous position, according to the criterion of total disability, qualify as severe injury. The severity of the harm caused to the health of complicated and uncomplicated isolated metacarpal fractures can be classified as moderate.

Keywords

carpal bones / metacarpal bones / closed fractures / types of fractures / outcomes / harm to health / severity of injury

References

[1] Bakhmetiev VI, Buromsky IV, Kryukov VN, Nagorny MN. Diagnosis of the mechanisms of destruction of bone tissue along the fracture surface. Forensic Medical Expertise. 1991;(1):11–17. (In Russ).

[2] Бахметьев В.И., Буромский И.В., Крюков В.Н., Нагорный М.Н. Диагностика механизмов разрушения костной ткани по поверхности излома // Судебно-медицинская экспертиза. 1991. № 1. С. 11–17.

[3] Bakhmetiev VI, Buromsky IV, Kryukov VN, Nagorny MN. Diagnosis of the mechanisms of destruction of bone tissue along the fracture surface. Forensic Medical Expertise. 1991;(1):11–17. (In Russ).

[4] Matveev RP, Petrushin AL. Questions of classification and terminology of open hand injuries (literature review). Traumatology and orthopedics of Russia. 2011;(2):191–198. (In Russ).

[5] Матвеев Р.П., Петрушин А.Л. Вопросы классификации и терминологии открытых повреждений кисти (обзор литературы) // Травматология и ортопедия России. 2011. № 2. С. 191–198.

[6] Matveev RP, Petrushin AL. Questions of classification and terminology of open hand injuries (literature review). Traumatology and orthopedics of Russia. 2011;(2):191–198. (In Russ).

[7] Grishin IG, Divakov MG. Traumatology and orthopedics. Guidelines for doctors. Ed. by Yu.G. Shaposhnikov. Moscow: Medicine; 1977. Р. 220–249. (In Russ).

[8] Гришин И.Г., Диваков М.Г. Травматология и ортопедия. Руководство для врачей / под ред. Ю.Г. Шапошникова. Москва: Медицина, 1977. С. 220–249.

[9] Grishin IG, Divakov MG. Traumatology and orthopedics. Guidelines for doctors. Ed. by Yu.G. Shaposhnikov. Moscow: Medicine; 1977. Р. 220–249. (In Russ).

[10] Traumatology: National guidelines. Ed. by G.P. Kotelnikov, SP. Mironova. 3nd revised and updated. Moscow: GEOTAR-Media; 2008. 776 p. (Series “National Guidelines”). (In Russ).

[11] Травматология: национальное руководство / под ред. Г.П. Котельникова, С.П. Миронова. 3-е изд., перераб. и доп. Москва: ГЭОТАР-Медиа, 2018. 776 с. (Серия «Национальные руководства»).

[12] Traumatology: National guidelines. Ed. by G.P. Kotelnikov, SP. Mironova. 3nd revised and updated. Moscow: GEOTAR-Media; 2008. 776 p. (Series “National Guidelines”). (In Russ).

[13] Chung KС. Surgery techniques: hand and wrist surgery. 1st ed. Vol. 1. Saunders; 2017. 1136 p. Available from: https://www.researchgate.net/publication/328555719_Operative _Techniques_Hand_and_Wrist_Surgery. Accessed: 15.12.2022.

[14] Chung K.С. Surgery techniques: hand and wrist surgery. 1st ed. Vol. 1. Saunders, 2017. 1136 p. Режим доступа: https://www.researchgate.net/publication/328555719_Operative _Techniques_Hand_and_Wrist_Surgery. Дата обращения: 15.12.2022.

[15] Chung KС. Surgery techniques: hand and wrist surgery. 1st ed. Vol. 1. Saunders; 2017. 1136 p. Available from: https://www.researchgate.net/publication/328555719_Operative _Techniques_Hand_and_Wrist_Surgery. Accessed: 15.12.2022.

[16] McGuigan FH, Culp RW. Surgical treatment of intra-articular fractures of the trapezium. Multicenter Study. 2002;27(4):697–703. doi: 10.1053/jhsu.2002.33705

[17] McGuigan F.H., Culp R.W. Surgical treatment of intra-articular fractures of the trapezium // Multicenter Study. 2002. Vol. 27, N 4. P. 697–703. doi: 10.1053/jhsu.2002.33705

[18] McGuigan FH, Culp RW. Surgical treatment of intra-articular fractures of the trapezium. Multicenter Study. 2002;27(4):697–703. doi: 10.1053/jhsu.2002.33705

[19] Pulos N, Kollitz KM, Bishop AT, Shin AY. Free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery. J Bone Joint Surg Am. 2018;100(16):1379–1386. doi: 10.2106/JBJS.17.00955

[20] Pulos N., Kollitz K.M., Bishop A.T., Shin A.Y. Free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery // J Bone Joint Surg Am. 2018. Vol. 100, N 16. Р. 1379–1386. doi: 10.2106/JBJS.17.00955

[21] Pulos N, Kollitz KM, Bishop AT, Shin AY. Free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery. J Bone Joint Surg Am. 2018;100(16):1379–1386. doi: 10.2106/JBJS.17.00955

[22] Rodomanova LA, Kutyanov DI, Melikhov KS, et al. Modern structure of severe hand injuries caused by the action of blunt traumatic force. Traumatology and orthopedics of Russia. 2011;(4):5–10. (In Russ). doi: 10.21823/2311-2905-2011-4-5-10

[23] Родоманова Л.А., Кутянов Д.И., Мелихов К.С., и др. Современная структура тяжелых повреждений кисти, вызванных действием тупой травмирующей силы // Травматология и ортопедия России. 2011. № 4. С. 5–10. doi: 10.21823/2311-2905-2011-4-5-10

[24] Rodomanova LA, Kutyanov DI, Melikhov KS, et al. Modern structure of severe hand injuries caused by the action of blunt traumatic force. Traumatology and orthopedics of Russia. 2011;(4):5–10. (In Russ). doi: 10.21823/2311-2905-2011-4-5-10

[25] Beidik OV, Zaretskov AV, Butovsky KG, et al. Features of treatment of patients with hand bone injuries. Bulletin of the Tambov University. Series: Natural and Technical Sciences. 2011;16(5):1376–1382. (In Russ).

[26] Бейдик О.В., Зарецков А.В., Бутовский К.Г., и др. Особенности лечения пациентов с повреждениями костей кисти // Вестник Тамбовского университета. Серия: Естественные и технические науки. 2011. Т. 16, № 5. С. 1376–1382.

[27] Beidik OV, Zaretskov AV, Butovsky KG, et al. Features of treatment of patients with hand bone injuries. Bulletin of the Tambov University. Series: Natural and Technical Sciences. 2011;16(5):1376–1382. (In Russ).

[28] Clifton M, Roy M. Hand fractures: A review of current treatment strategies. Review. 2013;38(5):1021–1031. doi: 10.1016/j.jhsa.2013.02.017

[29] Clifton M., Roy M. Hand fractures: a review of current treatment strategies // Review. 2013. Vol. 38, N 5. P. 1021–1031. doi: 10.1016/j.jhsa.2013.02.017

[30] Clifton M, Roy M. Hand fractures: A review of current treatment strategies. Review. 2013;38(5):1021–1031. doi: 10.1016/j.jhsa.2013.02.017

[31] Yankovsky VE, Shadymov AB, Pyatchuk SV, Vaskin PA. On the nature of the fracture of the metacarpal bone with axial loading. In: Topical issues of forensic medicine and expert practice: Collection of articles. Issue 8. Barnaul-Novosibirsk; 2003. Р. 219–221. (In Russ).

[32] Янковский В.Э., Шадымов А.Б., Пятчук С.В., Васькин П.А. О характере перелома пястной кости при осевом нагруженные // Актуальные вопросы судебной медицины и экспертной практики: сборник статей. Вып. 8. Барнаул-Новосибирск, 2003. С. 219–221.

[33] Yankovsky VE, Shadymov AB, Pyatchuk SV, Vaskin PA. On the nature of the fracture of the metacarpal bone with axial loading. In: Topical issues of forensic medicine and expert practice: Collection of articles. Issue 8. Barnaul-Novosibirsk; 2003. Р. 219–221. (In Russ).

[34] Galiev BX. Features of damage biomechanics research. In: Actual issues of mechanical damage examination: Republican collection of scientific papers. Moscow; 1990. Р. 78–81. (In Russ).

[35] Галиев Б.X. Особенности исследования биомеханики повреждений // Актуальные вопросы экспертизы механических повреждений: Республиканский сборник научных трудов. Москва, 1990. С. 78–81.

[36] Galiev BX. Features of damage biomechanics research. In: Actual issues of mechanical damage examination: Republican collection of scientific papers. Moscow; 1990. Р. 78–81. (In Russ).

[37] Imaev AA. Forensic medical diagnosis of the mechanisms of fractures of the bones of the foot under the action of blunt solid objects [dissertation abstract]. Moscow; 1986. 42 р. (In Russ).

[38] Имаев А.А. Судебно-медицинская диагностика механизмов переломов костей стопы при действии тупых твердых предметов: Автореф. дис. … канд. мед. наук. Москва, 1986. 42 с.

[39] Imaev AA. Forensic medical diagnosis of the mechanisms of fractures of the bones of the foot under the action of blunt solid objects [dissertation abstract]. Moscow; 1986. 42 р. (In Russ).

[40] Baibulatov TD. Forensic medical establishment of the mechanisms of formation of fractures of short tubular bones of the hand with various types of trauma with hard blunt objects [dissertation abstract]. Barnaul; 2005. 23 р. (In Russ).

[41] Байбулатов Т.Д. Судебно-медицинское установление механизмов образования переломов коротких трубчатых костей кисти при различных видах травмирования твердыми тупыми предметами: Автореф. дис. … канд. мед. наук. Барнаул, 2005. 23 с.

[42] Baibulatov TD. Forensic medical establishment of the mechanisms of formation of fractures of short tubular bones of the hand with various types of trauma with hard blunt objects [dissertation abstract]. Barnaul; 2005. 23 р. (In Russ).

[43] Shadymov A.B. Establishment of the mechanisms of fractures of the tubular bones of the hands. In: Topical issues of forensic medicine and expert practice: Collection of articles. Issue 14. Barnaul-Novosibirsk; 2008. P. 380–385. (In Russ).

[44] Шадымов А.Б. Установление механизмов переломов трубчатых костей кистей рук // Актуальные вопросы судебной медицины и экспертной практики: сборник статей. Вып. 14. Барнаул-Новосибирск, 2008. С. 380–385.

[45] Shadymov A.B. Establishment of the mechanisms of fractures of the tubular bones of the hands. In: Topical issues of forensic medicine and expert practice: Collection of articles. Issue 14. Barnaul-Novosibirsk; 2008. P. 380–385. (In Russ).

[46] Clinical reports in the field of traumatology and orthopedics, standards of diagnosis and treatment of the Ministry of Health of the Republic of Uzbekistan dated 30.11.2021 No. 273. Tashkent; 2007. 436 p. (In Russ).

[47] Клинические отчеты в области травматологии и ортопедии, стандарты диагностики и лечения Минздрава Республики Узбекистан от 30.11.2021 № 273. Ташкент, 2007. 436 с.

[48] Clinical reports in the field of traumatology and orthopedics, standards of diagnosis and treatment of the Ministry of Health of the Republic of Uzbekistan dated 30.11.2021 No. 273. Tashkent; 2007. 436 p. (In Russ).

[49] On judicial practice in cases of intentional bodily injury: Resolution of the Plenum of the Supreme Court of the Republic of Uzbekistan, No. 6 of 27.06.2007. (In Russ). Available from: https://lex.uz/docs/1592421. Accessed: 15.12.2022.

[50] О судебной практике по делам о причинении умышленного телесного повреждения: Постановление Пленума Верховного суда Республики Узбекистан, № 6 от 27.06.2007. Режим доступа: https://lex.uz/docs/1592421. Дата обращения: 15.12.2022.

[51] On judicial practice in cases of intentional bodily injury: Resolution of the Plenum of the Supreme Court of the Republic of Uzbekistan, No. 6 of 27.06.2007. (In Russ). Available from: https://lex.uz/docs/1592421. Accessed: 15.12.2022.

[52] Parkinson RW, Hodgkinson JP, Hargadon EJ. Symptomatic non-union of the carpal scaphoid: Matti-Russe bone grafting versus Herbert screw fixation. Injury. 1989;20(3):164–166. (In Russ). doi: 10.1016/0020-1383(89)90090-9

[53] Parkinson R.W., Hodgkinson J.P., Hargadon E.J. Symptomatic non-union of the carpal scaphoid: Matti-Russe bone grafting versus Herbert screw fixation // Injury. 1989. Vol. 20, N 3. Р. 164–166. doi: 10.1016/0020-1383(89)90090-9

[54] Parkinson RW, Hodgkinson JP, Hargadon EJ. Symptomatic non-union of the carpal scaphoid: Matti-Russe bone grafting versus Herbert screw fixation. Injury. 1989;20(3):164–166. (In Russ). doi: 10.1016/0020-1383(89)90090-9

[55] Matsukatov FA, Gerasimov DV. On the factors influencing the timing of fracture consolidation. Bulletin of Traumatology and Orthopedics. N.N. Pirogov. 2016;(2):50–57.

[56] Мацукатов Ф.А., Герасимов Д.В. О факторах, влияющих на сроки консолидации переломов // Вестник травматологии и ортопедии им. Н.Н. Пирогова. 2016. № 2. С. 50–57.

[57] Matsukatov FA, Gerasimov DV. On the factors influencing the timing of fracture consolidation. Bulletin of Traumatology and Orthopedics. N.N. Pirogov. 2016;(2):50–57.

[58] Boyer MI, von Schroeder LP, Axelrod TS. Nonunion of the scaphoid with avascular necrosis of the proximal pole. Treatment with vascularized bone graft from the dorsal part of the distal radius. J Hand Surg Br. 1998;23(5):686–690. doi: 10.1016/s0266-7681(98)80029-6

[59] Boyer M.I., von Schroeder L.P., Axelrod T.S. Nonunion of the scaphoid with avascular necrosis of the proximal pole. Treatment with vascularized bone graft from the dorsal part of the distal radius // J Hand Surg Br. 1998. Vol. 23, N 5. Р. 686–690. doi: 10.1016/s0266-7681(98)80029-6

[60] Boyer MI, von Schroeder LP, Axelrod TS. Nonunion of the scaphoid with avascular necrosis of the proximal pole. Treatment with vascularized bone graft from the dorsal part of the distal radius. J Hand Surg Br. 1998;23(5):686–690. doi: 10.1016/s0266-7681(98)80029-6

[61] Indiaminov SI, Shopulatov IB, Ernazarov MB. On the issue of establishing the prescription of fractures of the bones of the hands. Problems Biol Med. 2020;(5.1):181–185. (In Russ).

[62] Индиаминов С.И., Шопулатов И.Б., Эрназаров М.Б. К вопросу установления давности переломов костей кисти рук // Проблемы биологии и медицины. 2020. № 5.1. С. 181–185.

[63] Indiaminov SI, Shopulatov IB, Ernazarov MB. On the issue of establishing the prescription of fractures of the bones of the hands. Problems Biol Med. 2020;(5.1):181–185. (In Russ).

[64] A workshop on forensic medicine. Ed. 3. Forensic medical examination in cases of transport injury and falling from a height: A textbook. Ed. by V.N. Kryukov, I.V. Buromsky. Moscow: Svetoton LTD; 2007. 24 p. (In Russ).

[65] Практикум по судебной медицине. Изд. 3. Судебно-медицинская экспертиза в случаях транспортной травмы и падения с высоты: учебное пособие / под ред. В.Н. Крюкова, И.В. Буромского. Москва: Светотон ЛТД, 2007. 24 с.

[66] A workshop on forensic medicine. Ed. 3. Forensic medical examination in cases of transport injury and falling from a height: A textbook. Ed. by V.N. Kryukov, I.V. Buromsky. Moscow: Svetoton LTD; 2007. 24 p. (In Russ).

RIGHTS & PERMISSIONS

Eco-Vector