Hand Injuries - 01/11/18 Flashcards
What are important aspects of the history in hand injury?
Hand dominance Health DM Arthritis Cardio-reso Occupation Hobbies Sports
What important aspects of the injury should be asked?
Crush, sharp, burn Gloves Protective items Timing Degloving Estimate level of energy Pain Weakness Sensory
What are important aspects of the examination with hand injuries?
Wound Nails Deformity Swelling Point of tenderness Movement Neurological
What questions should be asked for a wound?
Where How long How deep Clean Dirty Skin less Obvious structures (Bone, tendon, foreign bodies, dirt, grit)
What is the difference between a laceration and an incised wound?
Incised wound - sharp object
Laceration - blunt trauma
What causes a subungual haematoma?
Blunt trauma to the nail
Bleeds under the nail bed
Builds up pressure
If a subungual haematoma is causing pain what can be done?
Trephine
What happens if a subungual haematoma is left alone?
Nail may fall off
Will grow back
What are the 5 types of injury to the nail?
Soft tissue only Soft tissue and nail Soft tissue and nail and bone Proxiaml 1/3rd of phalynx Droximal to DIPjt
What are the 4 levels of repair for nail injuries?
Level 1 and 2 - dressing only
Level 3 - Repair nail bad + stabilise bone
Level 4 - As above unless <5mm nail bed = ablate
What is important in the diagnosis of fractures?
Which bones
Joint involvement
Deformity
Stability
What are the characteristics of a boxers fracture?
Minimal displacement
No rotation
More distal
How is a boxers fracture managed?
Buddy strap
Early mobilisation
What is looked for on examination of mallet finger?
Resisted finger extension
Tenderness/bruising
How is mallet finger managed?
Mallet splint for 6 weeks
24/7
Wire?
Dermatotenodesis in chronic cases
