Pathology brush

Congenital malformations brush diverse. The complete absence of a brush (ahairy) is rare. Much more often there is a polydactyl - Megaplast (Fig. 4). Congenital reduced the number of fingers called oligodactylia. In the absence of one or more fingers with relevant metacarpal bones formed forked split brush "claw cancer." Fingers in congenital deformities of the hand may have a normal form, in some cases they are underdeveloped or ugly. Abnormally short fingers are called microdactila, excessively long - macrodactylia. Not uncommon congenital fusion fingers - syndactylia (Fig. 5). Fingers can be connected only skin jumper (webbed form of syndactyly), covered General skin case (skin form) or may be bone fusion of the bones (bone form). There is also a congenital clubhand (see). Treatment of syndactyly, and some other deformities of the fingers and hand surgical.

polydactyly


Fig. 4. (left) Polydactyly.
Fig. 5. Syndactylia with macrodactylia.

When the hand trauma occur as isolated and combined injuries of bones, tendons, muscles. Dislocations of bones of the wrist are rare. The most frequently encountered perilunate dislocations, which are sometimes combined with the scaphoid fractures that is detected on the radiograph. Defined clinically insignificant deviation brush elbow in the side; 2, 3, and 4 fingers bent, straighten them painfully. In the early stages able bloodless reduction of dislocation. After reduction impose a plaster of Paris splint is placed. At dislocations big old resetting is done through surgery. Mayhem I finger - see Dislocations.
Fracture of the wrist is rare, most frequently encountered scaphoid fracture that occurs mainly in the fall on an outstretched hand.
Clinical signs to suspect a fracture,a pain when pressure on the scaphoid bone and passive movements in the wrist joint, swelling in the area of the joint. Diagnosis is only on the basis of x-ray studies. When the scaphoid fracture impose a plaster cast, fixing the wrist joint 3-6 months.
Non-consolidation of the scaphoid fracture treated promptly. Fractures of other bones of the wrist treatment similar.
The broken edge of the base 1 metacarpal bone is usually combined with a dislocated in this joint (broken Bennett). Clinically defined bringing 1 finger bone ledge at the base 1 metacarpal bones, pain during feeling, and when the movement 1 finger. The diagnosis is established radiographically. Lumbar fracture performed by a physician by stretching for 1 finger and lead it along with 1 metacarpal bone. In this position, put a plaster cast on his forearm, wrist joint, brush and 1 finger for a period of 4 weeks. Body fractures metacarpal bones and phalanges offset arise from direct attack, sometimes dropping on the front part folded brush. Symptoms: pain during feeling, sudden tenderness effleurage on the head metacarpal bones bent in the fist.


Fig. 6. Skeletal traction with a broken finger.

Treatment: simultaneous reposition of fragments and the imposition of a plaster bandage or skeletal traction nail phalanx (Fig. 6). Nevprawima fractures are treated promptly.
In open fractures and gunshot injuries of the hand may be damaged skin, tendons, bones, joints, blood vessels and nerves. The main danger of such damage is a complication of infection. Treatment: urgent thorough surgical treatment. If there is evidence used osteosynthesis. To restore the function of the hand and fingers necessary medical gymnastics.
It is a common disease brushes, due to Andrey rebirth Palmar aponeurosis and expressed in the gradual development of flexion contractures of the fingers (dupuitrena contracture). Treatment initially conservative: baths, therapeutic exercises, lotions from randasi or local injections lidzi. In the later stages - excision of Palmar aponeurosis followed physiotherapy and gymnastics.
Of acute inflammatory diseases very dangerous deep abscess palm. It develops mainly as a complication of the running of the tendon felon (see), or from surface interdigital phlegmon. The reason for the latter is most often festering wash hands ("water corn"), where the infection penetrates the skin interdigital period. Inflammatory infiltrate pulls interdigital space, pushing the adjacent fingers (hence the common name "respironics"). Unopened interdigital cellulitis spreading in deep tissues of the palm. When the abscess most dangerous defeat of the tendon sheath, which pus quickly fills in the area of the wrist joint, and then on the forearm. The process results in severe contractures brush, and sometimes sepsis. Treatment phlegmon brush - only emergency operation. The patient must urgently be sent to the surgeon. Attempts conservative treatment (warm baths, and so on) is invalid. Prevention consists in timely and proper treatment of panaritiums, boils and minor injuries brush.