10: Hand injuries

Question 1

What do you need to know about a patient with a hand injury?

Answer 1

Right or left-handed

General health - diabetes, arthritis, cardio/resp stuff

Occupation, hobbies and sports

Question 2

What symptoms may a patient have following hand trauma?

Answer 2

Pain

Muscle weakness

Sensory problems - anaesthesia, paraesthesia

Question 3

What condition classically follows a crush injury?

Answer 3

Compartment syndrome

Question 4

Name four general types of hand injury?

Answer 4

Crush

Burn

Sharp

Degloving

Question 5

What is degloving?

Answer 5

Avulsion of an extensive area of skin

Question 6

What is a subungual haematoma?

Answer 6

Bleeding under the nail

Question 7

What is the main symptom of subungual haematoma?

Answer 7

Pain

Due to pressure build-up

Question 8

What eventually happens to the nail in subungual haematoma?

Answer 8

Falls off and grows back

Question 9

levels of nailbed injury

higher number increases chance of amputation

Question 10

slide 15 - unstable fractures, k wire to stabilise and allow mobility asap

Question 11

slide 16 - angulation fracture of thumb, stabilised

Question 12

slide 17 - unstable, flexor tendons want to pull it downwards

stabilise - plates, screws or wires

Question 13

totally immobilised fractures actually heal slower due to lack of callus formation

micromobility is good

Question 14

slide 18 - intraarticular fracture which may cause post-traumatic arthritis if not fixed

Question 15

rotational deformities hard to identify in flat hands - FLEX FINGERS

Question 16

mallet finger - avulsion of distal phalanx from extensor tendon

Question 17

Bennett’s fracture - fracture-dislocation of 1st carpo-metacarpal joint

Question 18

zone II is important - tendons adhere to one another within the sheathe, predicting course is difficult

Question 19

FDP attaches to distal phalanx

FDS to middle and proximal

to demonstrate FDP function, hold PIP straight and flex finger

to demonstrate FDS function, hold all other fingers straight and flex finger

Question 20

tendons repaired by suture and hand splinted to prevent re-rupture

Question 21

dealing with severe mutilation:

wash

remove clearly infected or necrotic tissue

assess vasculature

rest on slides

Question 22

eschar