Hand Injuries Flashcards
Hx to question in hand injury case?
Right or left-handed
PMH (DM, arthritis, cardio-resp for general anaesthetic guidance)
Occupation
Hobbies/sports that require functional requirements above that of a normal patient
Detailed description of the injury:
• Crush, sharp or burn
• Were they wearing gloves/protective items, esp. in industry
• Timing of injury (esp. if there is partial/complete amputation)
• Degloving
• Estimate of the level of energy of the injury (high or low)
Symptoms of hand injuries?
Pain, weakness and sensory impairment (
Examination of a hand injury?
Examine the wound and nails
Look for deformities and swelling
Palpate/find a point of tenderness
Movement
Neuological examination
Describe the examination of the wound
Where is the wound/ how long and how deep is it
Clean/dirty
Skin loss
Obvious visible structures in the wound:
• Bone, tendon, foreign bodies, dirt/grit
What is a subungual haematoma?
Bleeding from the nail bed results in increased pressure under the nail and this pressure can cause pain
The nail may eventually fall off but will grow back (unless the germinal matrix is damaged)
Treatment of subungual haematoma?
If the pressure causes pain, trephine can be attempted (heat allows a paperclip to pass through the nail and bleeding to occur, which relieves pressure)
General rules of treating nail/nail bed injuries?
Keep the nail, if possible:
• As a splint
• To maintain the nail fold
Repair the nail fold
Types of nail/nail bed injuries?
Type 1 - soft tissue only Type 2 - soft tissue + nail Type 3 - soft tissue + nail + bone Type 4 - proximal ⅓ of phalanx Type 5 - proximal to DIPJ
ADD NAIL BED PICTURE
Treatment of the different types of nail/nail bed injuries?
Level 1+2 - dressing only
Level 3 - repair nail bed + stabilise bone
Level 4 - as above unless <5mm of nail bed ➞ ablate
If tip not available, terminalise or V-Y flap
What is a Boxer’s fracture?
Fracture of one of the metacarpal bones, classically, occuring transversely across the neck of the bone, after the patient strikes an object with a closed fist
Treatment of Boxer’s fracture?
“Buddy strap” (two fingers strapped together)
Early mobilisation
How to identify a rotation deformity?
Ask patient to flex fingers; they should all point to the scaphoid tubercle but, if there is a rotational deformity, one will be bent
What is a mallet finger?
Injury of the extensor digitorum tendon of the fingers at the DIPJ
It results from hyperflexion of the extensor digitorum tendon, and usually occurs when a ball is being caught, hits an outstretched finger and jams it, creating a ruptured/stretched extensor digitorum tendon
The tendon can either rupture alone or it can rupture and pull a fragment of bone with it (avulsion fracture)
DIPJ is flexed
Examination of mallet finger?
Resisted finger extension
Tenderness/bruising
Management of mallet finger?
Mallet splint
Can fix a large displaced avulsion fragment with a wire
In chronic cases, dermatotenodesis can be used
Treatment of PIPJ dislocation?
Must be TREATED ACUTELY; if treatment is delayed, the dislocation will be impossible to reduce and may require fusion
What is Bennett’s fracture?
Fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint.
Examination of the tendons of the middle finger?
FDP and FDS are in the same sheath in the middle finger
To test FDP only, hold the PIPJ (this hold FDS in place) and try to bend
To test FDS only, hold the other fingers straight and try to bend the finger
Scenarios of severe mutilating injuries?
Usually industrial and tend to be degloving and amputation
Principles of treating mutilating injuries?
Preserve amputated parts of ice
Early debridement
Establish stable bony support and vascularity
Repair all tissues (nerves, tendons)
Establish skin cover, e.g: grafts or flaps
Prevent/treat infection
Aggressive mobilisation
Standard burns treatment?
Respiratory
Infection control
Dehydration
Pain relief
Specific treatments for hand burns?
Excise damaged skin and perform split skin grafts early
Aggressive mobilisation to prevent finger stiffness
Escharotomy (remove eschar skin)
What is eschar?
Thick, leathery, INELASTIC skin which can form after burns
May require surgical release to allow movement
