Hand injuries Flashcards
What are important general aspects of a history to cover with regard to hand injuries?
Left or right handed Diabetes Arthritis Occupation Hobbies (musical instruments, etc)
Which aspects of the history in terms of the injury itself are important to cover?
Type (crush, sharp, burn) Degloving Whether any protective items were worn Timing (particularly in amputation) Energy level
Which aspects of the history in terms of symptoms are important to cover?
Pain
Weakness
Sensory deficit
What should be examined with regard to hand injuries?
Wound itself Nails (important for function!) Point of tenderness Deformity Swelling Movement Neurological
What is important to look for on examination of the wound?
Position Length Depth Visible structures Clean vs dirty Skin loss
What is a subungual haematoma? How and when is it treated? What must the patient be warned about?
A collection of blood under the nail
If causing pain it can be treated with a trephine (to relieve pressure)
The nail may fall off but it should grow back
How can nail/bed injuries/amputations be classified?
Type I - soft tissue only
Type II - soft tissue & nail
Type III - soft tissue & nail & bone
Type IV - proximal 1/3 phalanx
Type V - proximal to distal interphalangeal joint
How are nail/bed injuries/amputations treated?
Type I & II - dressing only
Type III - repair nail bed & stabilise bone
Type IV - as above unless ablate
How should nail/bed injuries/amputations be treated if the finger tip is not available?
Terminalise (finger)
Use V-Y flap
What is the aim with nail/bed injuries?
To preserve the nail
Where is the most common site for a sigmoid bone on the hand?
Metacarpal phalangeal joint of the thumb
What is the most important thing to differentiate when dealing with a hand fracture?
Extra or intra-articular
How does a boxers fracture typically appear on x-ray?
Extra-articular fracture of distal end of metacarpal of the little finger
How is a boxers fracture treated?
Buddy strap
Early mobilisation
How might the boxers fracture appear clinically?
Absent knuckle at the little finger
May or may not be a rotational deformity
How can you differentiate between a soft tissue and bony mallet finger?
X-ray
What type of fracture causes mallet finger?
Intra-articular avulsion fracture of the proximal end of the distal phalanx (causes subluxation of the joint)
What will be found on clinical examination of a patient with mallet finger?
Resistance to extension
Brusing
Tenderness
How is a mallet finger managed?
Mallet splint for six weeks 24/7
Wire fixation for large avulsion fractures
Dermatotenodesis if chronic
How common is proximal interphalangeal joint dislocation?
Common
How is PIP joint dislocation treated?
Acutely reduced and buddy strapped
How likely are delayed presentations of PIP joint dislocation to be reduced?
Unlikely
How are delayed presentations of PIP joint dislocation managed?
Cannot be reduced
Fusion is an option
How is a PIP joint dislocation and fracture managed?
Fixation and stabilisation
What is a bennet’s fracture?
Intra-articular fracture of the base of the thumb metacarpal bone
How is a bennet’s fracture managed?
Fixation
How should tendon injuries be examined?
Check all PIP and DIP joints and tendons to determine which are involved
How are tendon injuries managed?
Surgically
Early mobilisation + specialised splinting
What is the most common cause of a severe mutilating injury of the hand? Which types of injuries are these?
Industrial work
Degloving or amputation
What are the principles of management with regard to mutilating injuries?
Preserve amputated parts on ice Early debridement of dirty wounds Establish bony support Establish blood supply Repair damaged structures (nerves, tendons, etc) Establish skin cover Prevent or treat infection Aggressively mobilise Amputation may be necessary if unreconstructable or no nerve supply
How should burns be managed in general?
Respiratory support
Infection prevention
Dehydration management
Pain relief
How should burns to the hands be specifically managed?
Excision of damaged skin + split grafting
Aggressive mobilisation to prevent stiffness
Escharotomy
What is eschar?
Thick, inelastic skin that can form following burns and prevents movement
