Hand injury assessment

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Hand injury assessment

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Hand injury assessment

  1. 1. Richard Hay
  2. 2.  Overview of upper limb anatomy  Assessment of upper limb injuries affecting the hand  Common injuries seen in ED ◦ Soft tissue ◦ Bones  Other considerations
  3. 3.  Anatomical terminology ◦ Surfaces ◦ Movements  Flexor and extensor compartments of the forearm  Flexor and extensor retinaculum ◦ Carpal tunnel  Hand
  4. 4.  History ◦ Hand dominence / ischaemic time / ADT / occupation / hobbies / conditions affecting peripheral circulation  Look  Feel  Move ◦ Functional assessment of all muscles / tendons ◦ Assessment of neural function  Sensory and motor  Anaesthetise and explore wounds only after completing neurological assessment ◦ Digital blocks ◦ Wrist blocks
  5. 5.  Lacerations ◦ Irrigation with either N/S or tap water  Tendon injuries ◦ Surgical repair if >50% (?75% if no triggering)  FB ◦ XR / US / CT  Bite wounds ◦ Good evidence for the use of prophylactic Abx
  6. 6.  Nerve injuries ◦ All motor branches ◦ Digital nerves proximal to DIP  Radial aspect IF / MF  Ulnar aspect LF  Both sides of thumb  Fingertip amputations ◦ Different classification systems
  7. 7.  Nail bed injuries ◦ Subungualhaematoma  Trephination  If significant pain  Antibacterial soaking / dressing ◦ When to explore / repair nail bed  If nail fold disrupted  If nail plate is dislodged from nail bed  If nail plate adherent to nail bed then probably does not require exploration
  8. 8.  Management primarily non-operative ◦ Closed reduction and splinting  <2mm articular congruity  Accept angulation and rotation that does not interfere with function or cause significant cosmetic deformity  Shaft #s ◦ Acceptable angulation varies with MC involved and location of #  Greater deformity acceptable in 4th/5th MC  10° for 2nd/3rd  20° for 4th  30° for 5th  Less angulation if # closer to CMC jts
  9. 9.  Neck #s ◦ Acceptable angulation  10-15° for 2nd/3rd  45° for 5th  Immobilisation ◦ Forearm based extending to the PIP dorsally and distal palmar crease on volar aspect (ie allow motion of IP jts)  Wrist at 20-30 degrees  MCP jts at 70-90 degrees ◦ Can buddy strap for rotational control

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