Hand injuries Flashcards
What should be asked about in hand trauma?
- Type of injury - Crush, Sharp, Burn
- Protection - Gloves
- Timing of injury - How long (Esp. in amputation)
- Seriousness - De-gloving?
What questions are required in cases of wounds to the hand?
- Where
- How long?
- How deep?
- Clean or dirty
- Skin loss
- Exposed structures?
What is a subungual haematoma?
This is pooling of blood beneath the nail at the proximal end
What are some causes of subungual haematoma?
This is usually caused by quick, blunt trauma to the nail, such as hammering or slamming in a door
What can happen to the nail in subungual haematoma?
It may fall off, however, it will grow back
How can subungual haematoma present?
Visible blood pooling under nail
Pain if blood exerts pressure
How can pressure be released in cases of subungual haematoma?
Trephine - Heated needle placed through the nail
What are the 5 types of nailed injury?
- Type I - Soft tissue only (Very end of finger)
- Type II - Soft tissue + Nail
- Type III - Soft tissue + Nail + Bone
- Type IV - Proximal 1/3rd of distal phalynx
- Type V - Proximal to DIPJ
How are type I and II nailed injuries managed?
Dressing
How are type III nailed injuries managed?
Nailed repair + Bone stabilisation
How are type IV and V nailed injuries managed?
If >5mm nailbed then nailed repair + bone stabilisation
If <5mm nailbed then ablate
What should be performed in cases of a missing fingertip?
If the tip of the finger is missing, the finger should be terminalised or V-Y flapped, in which a V is cut into the finger and the skin is sewn back up into a Y shape
How do flexor tendon injuries most commonly occur?
Injuries to the flexor tendons commonly result from volar lacerations
How are flexor tendon injuries classified?
By zone of injury:
Zone I → Finger tips
Zone II → No mans land (Difficult to treat)
Zone III → Lumbrical origin
Zone IV → Carpal tunnel
Zone V → Muscle-tendon junction
How will flexor tendon injuries present?
These tendon injuries will lead to loss of active flexion strength or motion of the involved digits
What investigations are used in flexor tendon injury?
X-ray (For associated fractures)
USS (To assess lacerations)
How are flexor tendon injuries managed?
Management can be conservative, involving wound care and early movement, or surgical, with flexor tendon repair or reconstruction
What are some conditions associated with extensor tendon injury?
Mallet finger
Extensor pollucis longus rupture
What is mallet finger?
This is an injury in which extensor tendon rupture or an avulsion fracture to the distal phalanx by the extensor tendon leads to resistance to finger extension
How will mallet finger present?
Resistance to finger extension
Tenderness
Bruising
How is mallet finger managed?
Mallet splinting for 6 weeks (24/7) to keep the finger straight
Avulsion fractures may require surgical wire fixing
How is chronic mallet finger managed?
Dermatotenodesis
What are some possible causes of extensor pollucis longus rupture?
Rheumatoid arthritis
Colles fracture
How can rheumatoid arthritis cause extensor pollucis longus rupture?
An autoimmune attack on the synovium, leads to tendon degeneration and rupture
How can extensor pollucis longus present?
Patients will present with loss of function, in which the patient cant extend the thumb at the MCP or IPJ
How is a rupture extensor pollucis longus managed?
Tendon transfer
How can preceding synovitis be managed in rheumatoid arthritis to prevent tendon rupture?
Synovectomy
What is standard burn treatment (Non-finger specific)?
- Respiratory care
- Manage infection
- Rehydrate
- Pain relief
What are some hand specific burn treatments?
- Excise damaged skin and perform split skin grafts early
- Aggressive mobilisation to prevent finger stiffness
- Escharotomy - Surgical release of eschar (Thick leathery, ineslastic skin which forms after burns)
What is the most common cause of severe mutilating injury?
Industrial accidents causing de-gloving or partial amputation
How should severe mutilating injuries be managed initially?
- Preservation of amputated parts in moist gauze and ice
- Early debridement
- Establish bony support
- Establish vascularity
- Repair all tssue
- Establish skin grafts and flaps
- Prevent infection
- Aggressive mobilisation
What are soem further management strategies used in severe mutilating injury?
Early involvement with plastics, microsurgery, split skin grafting, possible formal amputation and possible use of prosthetics
