Hand Injuries

Question 1

What is important in the history taking of a trauma patient?

Answer 1

Detailed description of injury: crush, sharp, burn. Gloves. Timing (esp if amputation). Degloving. Level of energy
Symptoms: pain, weakness, sensory

Question 2

What needs to be included in the examination of a traumatic hand wound?

Answer 2

Wound
Nails 
Deformity
Swellling
Point of tenderness
Movement
Neurological

Question 3

What needs to be examined in particularly the wound in acute trauma?

Answer 3

Where
How long
How deep
Clean/ dirty
Skin loss
Obvious structures in the wound

Question 4

What can fingertip injuries cause?

Answer 4

Subungual haematoma
If pressure causing pain - trephine
Nail may eventually fall off but it will grow back

Question 5

What are the different types of nail bed injuries?

Answer 5

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

Question 6

How are the different grades of nail bed injuries treated?

Answer 6

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

Question 7

What is a boxers fracture?

Answer 7

Minimal displacement
No rotation
Fracture of neck of little finger

Question 8

How is a boxers fracture treated?

Answer 8

Buddy strap

Question 9

What is a mallet finger?

Answer 9

A mallet finger is a deformity of the finger caused when the extensor tendon is damaged

Question 10

How is a mallet finger managed?

Answer 10

Mallet splint for 6 weeks 24/7

Occasionalyl fix if there is a large displaced avulsion fragment

Question 11

How is a PIP dislocation treated?

Answer 11

Pull to reduce then buddy strap

Question 12

How will a PIP dislocate?

Answer 12

Twisting injruy

Question 13

What is a bennetts fracture?

Answer 13

Fracture dislocation at the thumb base

Question 14

How can you tell if there has been a tendon injury?

Answer 14

A straight finger is pathognomic of tendon injuries

Question 15

What are the different zones of the hand?

Answer 15

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

Question 16

What area is the worst to have a tendon injury in?

Answer 16

Zone 2, known as no mans land

Question 17

How can you just flex the FDP?

Answer 17

DIP joins - hold the PIP and MCP and flex the DIP

Question 18

How can you flex just the FDS?

Answer 18

Hold the index, ring and little finger straight and flex the middle finger

Question 19

What are the principles of treating mutilating injuries?

Answer 19

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

Question 20

What are the standard principles in burn treatment?

Answer 20

Resp
Infection
Dehydration
Pain relief

Question 21

What are the specifics for hand burns treatment?

Answer 21

Exicse damaged skin and perform split skin grafts early
Aggressive moblisation to prevent finger stiffness
Escharotomy

Question 22

What is eschar?

Answer 22

Thick, leathery, inelastic skin which can form after burns

May require surgical removal