Hand Injuries Flashcards
What is important in the history taking of a trauma patient?
Detailed description of injury: crush, sharp, burn. Gloves. Timing (esp if amputation). Degloving. Level of energy
Symptoms: pain, weakness, sensory
What needs to be included in the examination of a traumatic hand wound?
Wound Nails Deformity Swellling Point of tenderness Movement Neurological
What needs to be examined in particularly the wound in acute trauma?
Where How long How deep Clean/ dirty Skin loss Obvious structures in the wound
What can fingertip injuries cause?
Subungual haematoma
If pressure causing pain - trephine
Nail may eventually fall off but it will grow back
What are the different types of nail bed injuries?
Type 1: soft tissue only Type 2: soft tissue and nail Type 3: soft tissue and nail and bone Type 4: proximal 1/3 of phalanx Type 5: proximal to DIP
How are the different grades of nail bed injuries treated?
Type 1 +2 = dressing
Type 3 =repair nail bed and stabilise bone
Type 4 +5 = as above unless more than 5mm of nail bed then ablate
What is a boxers fracture?
Minimal displacement
No rotation
Fracture of neck of little finger
How is a boxers fracture treated?
Buddy strap
What is a mallet finger?
A mallet finger is a deformity of the finger caused when the extensor tendon is damaged
How is a mallet finger managed?
Mallet splint for 6 weeks 24/7
Occasionalyl fix if there is a large displaced avulsion fragment
How is a PIP dislocation treated?
Pull to reduce then buddy strap
How will a PIP dislocate?
Twisting injruy
What is a bennetts fracture?
Fracture dislocation at the thumb base
How can you tell if there has been a tendon injury?
A straight finger is pathognomic of tendon injuries
What are the different zones of the hand?
Zone 1 = only FDP Zone 2 = both tendons within the sheath Zone 3 = both tendons with no sheath, lumbrical origin Zone 4 = carpal tunnel Zone 5 = muscle tendon junction
What area is the worst to have a tendon injury in?
Zone 2, known as no mans land
How can you just flex the FDP?
DIP joins - hold the PIP and MCP and flex the DIP
How can you flex just the FDS?
Hold the index, ring and little finger straight and flex the middle finger
What are the principles of treating mutilating injuries?
Preserve amputated parts on ice Early debridement Establish stable bony support Establish vascularity Repair all tissues - nerves tendons Establish skin cover - grafts, flaps Prevent infection Aggressive mobilisation
What are the standard principles in burn treatment?
Resp
Infection
Dehydration
Pain relief
What are the specifics for hand burns treatment?
Exicse damaged skin and perform split skin grafts early
Aggressive moblisation to prevent finger stiffness
Escharotomy
What is eschar?
Thick, leathery, inelastic skin which can form after burns
May require surgical removal
