Hand Injuries Flashcards
what are some important aspects of hand history?
hand dominance
occupation
hobbies/sports
health - Diabetes, arthritis, cardio-resp
description of injury (mechanism of injury, how it happened)
symptoms
hand injury examination?
wound nails deformity swelling point of tenderness movement neurological
give an example of point tenderness which indicates a diagnosis
snuff box tenderness = scaphoid fracture
important features of a wound?
where how long how deep clean/dirty skin loss obvious structures in wound (bone, tendon, foreign bodies, dirt etc)
incised wound vs laceration?
incised = sharp object injury laceration = blunt injury, skin torn open
give examples of types of injury?
crush sharp burn laceration incised degloving amputation etc
what is a subungual haematoma?
blunt trauma to the nail
can cause nail to eventually fall off but will grow back
how is subungual haematoma treated if pressure causing pain?
trephine - create a hole in the nail to relieve the pressure
how are nail/nailbed injuries classified?
type 1 = soft tissue only type 2 = soft tissue and nail type 3 = soft tissue and nail and bone type 4 = proximal 1/3rd of phalanx type 5 = proximal to DIP joint
how is level 1 and 2 nail injury treated?
dressing only
how is level 3 nail injury treated?
repair nail bed
stabilise bone
how is level 4 and 5 nail injury treated?
as above unless <5mm of nail bed in which case ablation is used
what treatment is used if finger tip amputated?
terminalize or V-Y flap
how do you describe a fracture?
which bones
joint involvement
deformity
stability
what can affect the stability of a fracture?
the presence of soft tissues around it
if it is displaced
what is a boxers fracture?
neck of middle finger?
usually due to a swinging punch
what are the features of a boxers fracture?
minimal displacement
no rotation
more distal
how is boxers fracture managed>
buddy strap
early mobilisation
how can a rotational injury be identified?
can be seen in a closed hand
- finger crosses over others
how is a rotational injury managed?
must be repaired as causes problems with grip
what causes mallet finger?
can be due to a tendon injury or an avulsion injury
what is mallet finger?
hyperflexion of DIP joint
what are the features of mallet finger on examination?
resisted finger extension
tenderness/bruising
how is mallet finger managed?
mallet splint for 6 weeks (24 hrs a day)
Occasionally fix large avulsion fragment (wire)
dermatotenodesis
how is a PIP joint dislocation managed?
must be treated acutely
- pull to reduce, buddy strap
delayed presentation is a disaster as impossible to reduce and may require fusion
what is a bennets fracture?
fracture at the base of the 1st metatarsal (thumb) which extends into 1st CMC joint
how can you tell if a tendon is ruptured?
if the finger remains straight when the hand is relaxed
what is the most dangerous zone of the hand in which to sustain a tendon injury?
zone 2 “no mans land”
as both tendons present in a sheath
how do you examine flexor digitorum profundus?
hold finger straight and flex PIP
how do you test flexor digitorum superficialis?
hold index, ring, and little finger straight (to remove FDP) and bend middle finger - only get PIP flexion, not DIP
how is tendon injury treated?
physio?
rehab?
surgery to repair rupture?
what is the most common cause of severe mutilating hand injuries (degloving, amputation etc)?
industrial
what are the main principles of mutilating injuries treatment?
preserve amputated parts on ice early debridement of dead tissue establish stable bony support and vascularity repair all tissues - nerves, tendons etc establish skin cover (grafts etc) prevent/treat infection aggressive mobilisation early involvement with plastics flaps to cover exposed bone formal amputation if needed later use of prosthetics
standard general treatment of burns?
respiratory aid
manage infection risk
treat dehydration
pain relief
specific hand burns treatment?
excise damaged skin and perform split skin grafts early
aggressive mobilisation to prevent finger stiffness
escharotomy
what is eschar?
thick, leathery, inelastic skin which can form after burns
may require surgical release to allow movement
