10: Hand injuries Flashcards
What do you need to know about a patient with a hand injury?
Right or left-handed
General health - diabetes, arthritis, cardio/resp stuff
Occupation, hobbies and sports
What symptoms may a patient have following hand trauma?
Pain
Muscle weakness
Sensory problems - anaesthesia, paraesthesia
What condition classically follows a crush injury?
Compartment syndrome
Name four general types of hand injury?
Crush
Burn
Sharp
Degloving
What is degloving?
Avulsion of an extensive area of skin
What is a subungual haematoma?
Bleeding under the nail
What is the main symptom of subungual haematoma?
Pain
Due to pressure build-up
What eventually happens to the nail in subungual haematoma?
Falls off and grows back
levels of nailbed injury
higher number increases chance of amputation
slide 15 - unstable fractures, k wire to stabilise and allow mobility asap
slide 16 - angulation fracture of thumb, stabilised
slide 17 - unstable, flexor tendons want to pull it downwards
stabilise - plates, screws or wires
totally immobilised fractures actually heal slower due to lack of callus formation
micromobility is good
slide 18 - intraarticular fracture which may cause post-traumatic arthritis if not fixed
rotational deformities hard to identify in flat hands - FLEX FINGERS
mallet finger - avulsion of distal phalanx from extensor tendon
Bennett’s fracture - fracture-dislocation of 1st carpo-metacarpal joint
zone II is important - tendons adhere to one another within the sheathe, predicting course is difficult
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
tendons repaired by suture and hand splinted to prevent re-rupture
dealing with severe mutilation:
wash
remove clearly infected or necrotic tissue
assess vasculature
rest on slides
eschar
