Hand Injuries

Question 1

general questions to ask in a hand history

Answer 1

right/left handed
health -diabetes, arthritis, cardio/resp problems
occupation
hobbies/sports

Question 2

hand trauma history questions

Answer 2

crush, sharp, burn 
gloves/protective items 
timing of injury/complete amputation 
devolving (separation of skin and underlying tissue) 
estimate level of energy

Question 3

things to look at in hand injury examination

Answer 3

wound 
nails 
deformity 
swelling 
point of tenderness 
movement 
neurological

Question 4

things to think about with wounds

Answer 4

where 
how long 
how deep 
clean/dirty 
skin loss 
obvious structures in wound eg. bone, tendon, foreign bodies, dirt/grit

Question 5

diffraction between laceration and incised wound

Answer 5

incised- maid with sharp object

laceration - blunt trauma, skins burst

Question 6

what is a sublingual haematoma

Answer 6

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)

Question 7

treatment for severe sublingual haematoma

Answer 7

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

Question 8

what is a type one nail bed injury

Answer 8

soft tissue damage only

Question 9

what is a type 2 nail bed injury

Answer 9

soft tissue and nail

Question 10

what is a type 3 nail bed injury

Answer 10

soft tissue + nail + bone

Question 11

what is a type 4 nail bed injury

Answer 11

proximal 1/3 of phalanx

Question 12

what is a type 5 nail bed injury

Answer 12

proximal to DIPjt

Question 13

how to you treat level 1 +2 nail amputation

Answer 13

dressing only

Question 14

how to teat level 3 nail amputation

Answer 14

repair nail bed and stabilise bone

Question 15

how to treat level 4 nail amputation

Answer 15

repair nail bed and stabilise bone (<5cm of nail bed - ablate)

Question 16

what do you do if theres no fingertip to put back on

Answer 16

terminals or V-Y flap

Question 17

how to describe a fracture

Answer 17

which bone
does it involve a joint
deformity
stability

Question 18

what makes a fracture stable

Answer 18

lots of soft tissues on either side

Question 19

what makes a fracture unstable

Answer 19

large zone of injury

large displacement

Question 20

what are boxer’s fractures

Answer 20

neck of the middle finger fracture
minimal displacement
no rotation
more distal

Question 21

what is rotational deformity

Answer 21

fingers crossed over others

can be seen in a closed hand

Question 22

how do you manage a rotational deformity

Answer 22

most be repaired as causes problems with grip

Question 23

what is a mallet finger

Answer 23

can be soft tissue injury.tendon injury or an avulsion injury

Question 24

how to manage a mallet finger

Answer 24

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)

Question 25

how does PIPjt dislocation present

Answer 25

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

Question 26

what is Bennett’s fracture

Answer 26

fracture from the base of the first metacarpal that extends to the CMC joint

Question 27

how can you tell if a tendon is ruptures

Answer 27

if the finger remains straight when relaxed

Question 28

most dangerous zone of the hand do get a tendon injury

Answer 28

zone 2 ‘no mans land’ as both tendons present in a sheath

Question 29

how to test the flexor digitorium profundus

Answer 29

how finger straight and flex PIP

Question 30

how to test the flexor digitorum superficialis

Answer 30

hold middle 3 fingers straight and flex the middle one

should only get DIP flexion

Question 31

how to treat severe mutilating injures

Answer 31

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

Question 32

what is standard burns treatment for hands

Answer 32

excise damaged skin and perform split skin graft

aggressive mobilisation to prevent finger stiffness

escharotomy

Question 33

what is a eschar

Answer 33

tick leathery inelastic skin which can form after burns

may require surgical release to allow movement