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PHTY APPB > HT: Trauma Management > Flashcards

HT: Trauma Management Flashcards

1
Q

What are ways hand trauma can occur?

A
  • Laceration
  • Crush
  • Burn
  • High pressure injury
  • Fall
  • Contact with other objects
  • Gunshot
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2
Q

What is the general principle of management

A
  • Understanding anatomy
  • Balance between protection of healing and regaining ROM and function
  • wound management
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3
Q

What are the 3 stages of wound and tissue healing?

A
  • Inflammatory stage, 0-4/5 days
  • Proliferative phase 4-27 days
  • Remodelling phase day 25-18 months
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4
Q

What happens during inflammatory stage?

A
  • Blood vessels in wound contract - clot formation
  • Blood vessels dilate to allow cells, growth
  • 72 hours
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5
Q

What may cause prolonged inflammatory phase?

A
  • Severe tissue trauma
  • Poor tissue handling at time of surgery
  • Aggressive therapy
  • Inappropriate splint/dress
  • Infection
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6
Q

What happens due to proliferative/regenerative phase?

A
  • Fibroblastic ativity: rapid collagen synthesis
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7
Q

What happens during remodelling phase?

A
  • Collagen fibres become organised

- Peak tensile strength of scar 60-90 days

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8
Q

What are factors affecting wound healing?

A
  • Diabetes
  • Peripheral vascular disease
  • Anemia
  • Oedema
  • Malnutrition
  • Steroids
  • Patient compliance
  • Anti- inflammatory
  • Infection
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9
Q

What are the flexor tendon zones?

A 
Recall this 
Zone 1: FDP only 
Zone 2: most commonly injured 
	- Laceration to both FDS AND FDP
	- Prone to scar tissue 
	- Prone to PIP joint contracture 
	- Be mindful of tendon adhesion
Zone 3
Zone 4: area of carpal tunnel +/- median and ulnar nerve injuries 
Zone 5: proximal to CT, +/- nerve and artery
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10
Q

How does a flexor tendon injury occur?

A

Pulling on something- forced into extension
Like a rugby player
Can occur in zone 1,2,3
Flexor tendon injuries need surgical repair

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11
Q

What are the goals of therapy post op of tendon repair?

A
  • Protect tendon rupture

- Prevent secondary joint contracture

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12
Q

Summarise post op therapy for flexor tendon injury?

A
  • Dorsal blocking splint or cast/ prevent extension
  • Immobilisation for unreliable patients
  • Early passive mobilisation OR early active mobilisation
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13
Q

Recall days 3-21 post op for flexor tendon repair?

A
  • Avoid wrist/MP extension
  • Splint/cast worn full time
  • Begin early controlled mobilisation
  • Passive IPJ flexion Active IP joint ext
  • Gentle active flexion within splint
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14
Q

Recall weeks 4-6 post op

A
  • Progress exercises according to scar density and motion
  • Gentle active wrist ROM/ avoid forceful ext
  • 5/52 light ADL
  • Tendon gliding week 5
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15
Q

Recall

  • week 6-8
  • week 8-10
  • week 12
A

6-8: DIP flexion, increase ADL, splint for sleep and travel

8-10: discard splint, increase resisted grip exercise, PIP ext splint still required

12: no restriction

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16
Q

Recall the zones and injuries of extensor tendons?

A

Zone 1- Mallet
Zone 3: central slip
Zone 5-8 laceration

17
Q

Which zones can be treated conservatively with extensor tendon injuries

A

Zones 1-3

18
Q

How do you manage a central slip injury?

A
  • conservative or surgical
  • Early Active Mobilisation
  • Splint full PIP joint extension, except for exercsies
  • 2nd splint to allow for gradually more flexion
  • PIP joint flexion progressed 30-70 1-5weeks post op

MAKE sure full active extension present at all stages

19
Q

How do you manage extensor tendon injuries zones V-VI

A
  • Immobilisation
  • Controlled passive
  • Active
20
Q

What is relative early active motion- for extensor repair?

A
  • Injured tendon placed 15-20 deg less relative motion than adjacent tendons at MP joints
  • Interconnections will keep tendon safe- more extended than adjacent fingers
21
Q

Describe nerve regeneration

A
  • Degeneration of nerve distal to injured segment

- Regeneration of axons 1mm/day

22
Q

What happens to muscles without nerve innervation?

A
  • moderate to servere atrophy within 3 months

- Fibrosis after 1 year

23
Q

What happens to sensory and sympathetic supply without nerve innervation?

A
  • Loss of sweating
  • Skin atrophy
  • Loss of protection pain sensation
  • May be reinnervated years later
24
Q

What muscles do radial nerves mainly innervate?

A

Extensors

25
Q

What are factors affecting nerve regeneration?

A
  • Age
  • Level of injury
  • Associated tissue injury
26
Q

What are post op aims for nerve repair

A
  • Protection
  • Scar management
  • Patient education
  • Desensitisation
  • PRevent secondary deformity
  • sensory retraining
  • Monitor recovery
  • Strengthen as recovery occurs
27
Q

How long to splint from post op for nerve repair?

A

3/52

- Patient education from hot or sharp objects

28
Q

What are the aims of splinting post nerve injury?

A
  • Compensate for weak or absent muscles

- Prevent or treat join contracture

29
Q

What is the management of median nerve injury?

A
  • Maintain palmar abduction

- Night splint to prevent 1st web space contracture

30
Q

What is the management of ulnar nerve injury?

A

Prevent MP joint ext contracture

  • prevent PIP joint extension contracture
  • Passive stretch
  • POSI splint night
  • Anti claw splint
31
Q

What is the management of radial nerve injury?

A
  • Prevent long finger and thumb flexor tightness
  • Prevent wrist flexion contracture
  • Wrist extension splint
  • Tenodesis splint
32
Q

What is the management of radial nerve injury?

A
  • Prevent long finger and thumb flexor tightness
  • Prevent wrist flexion contracture
  • Wrist extension splint
  • Tenodesis splint
33
Q

Outline treatment of fingertip injury?

A
  • Surgery
  • HT
    wound care, splint, scar, desensitisation, mobilisation, early functional use

PHTY APPB (10 decks)

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