Wrist and Hand trauma Flashcards
Crush injury sequelae
- hemorrhagge
- intra/extracellular fluid loss
- complicated by multiple problems (need to triage what will be treated first)
- need to understand injury to manage
Crush injury management phases
- inflammatory/fibroplasia phase
- edema control phase
inflammatory/fibroplasia phase goal with crush injuries
- minimize pain
- reduce edema
- provide wound care
- rest and mobilize healing tissues
- specific technique dependent on mode of medical management
- Elevation and compression are best ways to get rid of swelling in the hand
Crush injuries
Edema Control goal
- Treatment
- pain mamagement
- wound management
- exercise and activity
Resting splint for crush injuries
- thumb placed in abduction
- MCP flexed
- wrist neutral
- IPs extended
- direct opposite of claw deformity (ulnar and median nerve damage)
- volar plate can get tight and its hard to treat easier to prevent
Nerve arterial supply in the hand and how to test
- Allens test
- occlude the blood supply and have them pump their hand
- watch for it to blanch then let go of one side and watch how it fills
Flexors zones fingers: zone 1
- Zone 1: from the insertion of the FDP on the distal phalanx to just distal of the FDS insertion on the middle phalanx
Flexer zones on finger Zone 2
- Zone 2: from the distal insertion of the FDS tendon to the level of the distal palmar crease
Flexer zones on finger Zone 3
From the neck of the metacarpals, proximally along the metacarpals to the distal border of the carpal tunnel
Flexer zones on finger Zone 4
the carpal tunnel
Flexer zones on finger Zone 5
- area just proximal to the wrist
- to the musculotendinous junction of the extrinsic flexors in the distal flexor
Zones of the thumb
a) zone 1
b) zone 2
c) zone 3
a) from the distal insertion of the FPL on the distal phalanx of the thumb to the neck of the proximal phalanx
b) from the proximal phalanx, across the MCP joint to the neck of the wrist metacarpal
c) from the first metacarpal to the proximal margin of the carpal ligament
Kleinert splint
- flexor tendon repair
- Keeps them from extending too far
- rubber band will be attached the nail to passive flex
- use extensors and then passively flex
Dorsal blocking tenodesis splint
- Prevents wrist extension with digital extension
- get some early isometrics with a place and hold
- maintain gliding
- controlled stress with place and hold can reorient collagen
Extensor zones of the fingers
a) zone 1
b) zone 2
c) zone 3
d) zone 4
e) zone 5
f) zone 6
g) zone 7
h) zone 8
a) zone 1 - DIP joint region
b) zone 2 - middle phalanx
c) zone 3 - PIP joint region
d) zone 4 - proximal phalanx
e) zone 5 - Apex of the MCP joint region
f) zone 6 - dorm of the hand
g) zone 7 - wrist region/dorsal retinaculum
h) zone 8 - distal and middle forearm
