Referral to a hand specialist is required if a fracture is unstable, involves a large portion (greater than 30 percent) of the intra-articular surface, or has significant rotation. Treatment with sling immobilization is indicated for minimally displaced fractures with surgical fixation versus arthroplasty. Diagnosis is made with orthogonal radiographs of the shoulder. A boxers knuckle is a separate entity, which is a tear of the metacarpophalangeal joint sagittal band that causes subluxation of the associated extensor tendon. Some common finger fractures can be treated conservatively with appropriate reduction and immobilization. Proximal humerus fractures are common fractures often seen in older patients with osteoporotic bone following a ground-level fall on an outstretched arm. Boxer fractures are minimally comminuted, transverse fractures of the 5 th metacarpal neck, and are the most common type of metacarpal fracture. Referral to a hand specialist is needed if a dislocation cannot be reduced is unstable following reduction or involves significant ligament, tendon, or soft tissue injury. Finger dislocations should be reduced as quickly as possible and concurrent soft tissue injuries treated appropriately. Dorsal dislocation of the proximal interphalangeal joint is the most common type of finger dislocation. Radiography (commonly anteroposterior, true lateral, and oblique views) is required in the evaluation of finger fractures and dislocations. A systematic physical examination is imperative to avoid complications and poor outcomes following these injuries. Finger fractures and dislocations are common injuries that are often managed by family physicians.
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