Hand Injuries Flashcards
general questions to ask in a hand history
right/left handed
health -diabetes, arthritis, cardio/resp problems
occupation
hobbies/sports
hand trauma history questions
crush, sharp, burn gloves/protective items timing of injury/complete amputation devolving (separation of skin and underlying tissue) estimate level of energy
things to look at in hand injury examination
wound nails deformity swelling point of tenderness movement neurological
things to think about with wounds
where how long how deep clean/dirty skin loss obvious structures in wound eg. bone, tendon, foreign bodies, dirt/grit
diffraction between laceration and incised wound
incised- maid with sharp object
laceration - blunt trauma, skins burst
what is a sublingual haematoma
blunt force to fingertip leads to bleeding underneath the nail
v painful due to build up of pressure, nail will eventually fall off (will grow back)
treatment for severe sublingual haematoma
heat up the tip of a paper clip and press it gently to the nail
makes a little hope which allows a release of pressure
what is a type one nail bed injury
soft tissue damage only
what is a type 2 nail bed injury
soft tissue and nail
what is a type 3 nail bed injury
soft tissue + nail + bone
what is a type 4 nail bed injury
proximal 1/3 of phalanx
what is a type 5 nail bed injury
proximal to DIPjt
how to you treat level 1 +2 nail amputation
dressing only
how to teat level 3 nail amputation
repair nail bed and stabilise bone
how to treat level 4 nail amputation
repair nail bed and stabilise bone (<5cm of nail bed - ablate)
what do you do if theres no fingertip to put back on
terminals or V-Y flap
how to describe a fracture
which bone
does it involve a joint
deformity
stability
what makes a fracture stable
lots of soft tissues on either side
what makes a fracture unstable
large zone of injury
large displacement
what are boxer’s fractures
neck of the middle finger fracture
minimal displacement
no rotation
more distal
what is rotational deformity
fingers crossed over others
can be seen in a closed hand
how do you manage a rotational deformity
most be repaired as causes problems with grip
what is a mallet finger
can be soft tissue injury.tendon injury or an avulsion injury
how to manage a mallet finger
straighten out and splint
keep splint on for 6 weeks and do not take it off
if a late presentation or chronic case do dermatotenodesis (surgery)
how does PIPjt dislocation present
common injury
vital to be treated acutely
-pull to reduce, buddy strap
delayed presentation is a disaster bc its impossible to reduce and may require fusion
what is Bennett’s fracture
fracture from the base of the first metacarpal that extends to the CMC joint
how can you tell if a tendon is ruptures
if the finger remains straight when relaxed
most dangerous zone of the hand do get a tendon injury
zone 2 ‘no mans land’ as both tendons present in a sheath
how to test the flexor digitorium profundus
how finger straight and flex PIP
how to test the flexor digitorum superficialis
hold middle 3 fingers straight and flex the middle one
should only get DIP flexion
how to treat severe mutilating injures
take a picture
remove everything that is contaminated/dirty (early debridement)
establish bony support
establish vascularity
repair all tissues (nerves, tendons)
establish skin cover (graft)
prevent/treat infection
aggressive mobilisation
what is standard burns treatment for hands
excise damaged skin and perform split skin graft
aggressive mobilisation to prevent finger stiffness
escharotomy
what is a eschar
tick leathery inelastic skin which can form after burns
may require surgical release to allow movement
