Hand injuries Flashcards

1
Q

What should be asked about in hand trauma?

A
  • Type of injury - Crush, Sharp, Burn
  • Protection - Gloves
  • Timing of injury - How long (Esp. in amputation)
  • Seriousness - De-gloving?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What questions are required in cases of wounds to the hand?

A
  • Where
  • How long?
  • How deep?
  • Clean or dirty
  • Skin loss
  • Exposed structures?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a subungual haematoma?

A

This is pooling of blood beneath the nail at the proximal end

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some causes of subungual haematoma?

A

This is usually caused by quick, blunt trauma to the nail, such as hammering or slamming in a door

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can happen to the nail in subungual haematoma?

A

It may fall off, however, it will grow back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can subungual haematoma present?

A

Visible blood pooling under nail
Pain if blood exerts pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can pressure be released in cases of subungual haematoma?

A

Trephine - Heated needle placed through the nail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 5 types of nailed injury?

A
  • 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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are type I and II nailed injuries managed?

A

Dressing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How are type III nailed injuries managed?

A

Nailed repair + Bone stabilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are type IV and V nailed injuries managed?

A

If >5mm nailbed then nailed repair + bone stabilisation

If <5mm nailbed then ablate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be performed in cases of a missing fingertip?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do flexor tendon injuries most commonly occur?

A

Injuries to the flexor tendons commonly result from volar lacerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are flexor tendon injuries classified?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How will flexor tendon injuries present?

A

These tendon injuries will lead to loss of active flexion strength or motion of the involved digits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What investigations are used in flexor tendon injury?

A

X-ray (For associated fractures)
USS (To assess lacerations)

17
Q

How are flexor tendon injuries managed?

A

Management can be conservative, involving wound care and early movement, or surgical, with flexor tendon repair or reconstruction

18
Q

What are some conditions associated with extensor tendon injury?

A

Mallet finger
Extensor pollucis longus rupture

19
Q

What is mallet finger?

A

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

20
Q

How will mallet finger present?

A

Resistance to finger extension
Tenderness
Bruising

21
Q

How is mallet finger managed?

A

Mallet splinting for 6 weeks (24/7) to keep the finger straight
Avulsion fractures may require surgical wire fixing

22
Q

How is chronic mallet finger managed?

A

Dermatotenodesis

23
Q

What are some possible causes of extensor pollucis longus rupture?

A

Rheumatoid arthritis
Colles fracture

24
Q

How can rheumatoid arthritis cause extensor pollucis longus rupture?

A

An autoimmune attack on the synovium, leads to tendon degeneration and rupture

25
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
26
How is a rupture extensor pollucis longus managed?
Tendon transfer
27
How can preceding synovitis be managed in rheumatoid arthritis to prevent tendon rupture?
Synovectomy
28
What is standard burn treatment (Non-finger specific)?
- Respiratory care - Manage infection - Rehydrate - Pain relief
29
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)
30
What is the most common cause of severe mutilating injury?
Industrial accidents causing de-gloving or partial amputation
31
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
32
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
33