Rotational deformity Fractures of the bones of the hand account for 10% of all fractures. In children, the majority of these are phalangeal fractures. It is important to recognise that even minor, minimally displaced phalangeal or metacarpal fractures can cause significant functional impairment if they lead to overlap of the fingers when attempting to grip. This is otherwise known as a rotational deformity. How do we test for it? Ask the patient to flex the fingers as if making a fist. In the normal hand the fingers should sit next to each other, without overlap. In the presence of a rotational deformity the axis of the affected finger will deviate from the rest, causing finger overlap. Note that rotation of the fifth finger in towards and beneath the fourth finger can be a normal variant. Rotational deformity due to a fracture in the hand - MSD manual (www.msdmanuals.com) These injuries typically require operative intervention and so all children who have a rotational deformity should be discussed with the local Hand/Orthopaedic team using usual referral processes. Dr Danielle Scarfe
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October 2021
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