Hand Injuries Flashcards
What kind of things do you want to learn in a patient’s history?
Handedness, occupation, hobbies (musical instruments, art/crafts) and sports
Health = diabetes, arthritis, resp/cardio (may affect anaesthetic)
What details about an injury do you want to know?
Crush/sharp/burn, gloves/protective clothing worn, timing (especially if amputation), de-gloving, estimate of level of energy, symptoms (pain, weakness, sensory)
What are some important things to examine?
Nails, deformity, swelling, point of tenderness, movement, neurological
How should wounds be examined?
Where, how long, how deep, clean/dirty, skin loss, any exposed structures (bone, tendon, foreign bodies), structures at risk (nerves, tendons, bones)
What is an example of an injury to the nail?
Subungual haematoma
What may be done to relive pain caused by the pressure of a subungual haematoma?
Use a trephine
What should be done to the damaged nail?
Nail will eventually fall off (will grow back eventually)
Keep nail if possible = acts as splint, maintains nail bed
What are the levels of nail injuries?
1 = soft tissue only 2 = soft tissue and nail 3 = soft tissue, nail and bone 4 = proximal 1/2 of phalanx 5 = proximal to DIP joint
How should nail injuries be treated?
Level 1 or 2 = dressing only
Level 3 = repair nail bed and stabilise bone
Level 4 = as above unless < 5mm of nail bed, then ablate
What should be done to repair a nail injury if the tip of the finger isn’t available?
Terminalise or perform V-Y flap
What are important things to know when assessing a fracture?
Which bones are involved, joint involvement, deformity/rotation, stability
What is a Boxer’s fracture?
Fracture of the 5th metacarpal bone near the knuckle = minimal displacement, no rotation, more distal
How are Boxer’s fractures treated?
Early mobilisation, buddy strap (tape finger to functioning ajoining finger)
What causes Mallet finger?
Injury to thin tendon that straightens the end joint of finger/thumb = resisted finger extension, tenderness, bruising
How is Mallet finger treated?
Mallet splint for 24 hrs a day for 6 weeks, occasionally fix large displaced avulsion fragment with wire, dermatotenodesis in chronic cases
What are some features of PIP dislocations?
Common injury, vital to be treated quickly
How are PIP dislocations treated?
Pull to reduce, buddy strap
Delayed presentation = impossible to reduce, may need fusion
Associated fractures = fixation/stabilisation
What is a Bennett’s fracture?
Fracture of the base of the first metacarpal bone which extends into the CMC joint = most common fracture of thumb
What are almost always present alongside Bennett’s fractures?
Subluxation or dislocation of the CMC
How are Bennett’s fractures treated?
Closed reduction and thumb spica cast immobilisation
What are some features of tendon injuries?
Usually caused by penetrating injury, can result in severe loss of function, can be to extensor tendons (back of hand) or flexor tendons (palm of hand)
How are tendon injuries treated?
Extensors = may be fixed without open surgery Flexors = need to be fixed in operating theatre under anaesthetic
How do tendon injuries present?
Pain, swelling, unable to bend/flex fingers
What are some features of severe mutilating injuries?
Usually industrial, de-gloving and amputation occur
What are the principles of treating severe mutilating injuries?
Preserve amputated part on ice
Establish stable bony support and vascularity
Early debridement and repair all tissues (e.g nerves)
Establish skin cover and prevent/treat infection
Aggressive mobilisation
How are severe injuries treated?
Early involvement with plastics, microsurgery to repair nerves and vessels, split skin grafts on to healthy tissue, flaps to cover exposed bone
When should amputations be considered in severe mutilating injuries?
If injury unreconstructable or if unable to re-establish nerve supply = will need later use of prosthetics
What is the standard treatment for burns?
Respiratory support, avoid infection, rehydrate, give pain relief
What is the specific treatment for burns on the hands?
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 (escharotomy)
