9. • A thorough exam can diagnose most
injuries. Try to avoid wound exploration
• Apply direct pressure to bleeders rather
than blindly clamping or tying off vessels
12. • Assess active motion
– Flexor digitorum
profundus (FDP)
• Ask patient to flex DIP
while examiner
stabilizes the PIP and
MCP in extension
– Flexor digitorum
sublimus (FDS)
• Hold all fingers
extended except
affected finger, then
ask the patient to flex
affected finger
13. • Assess digital perfusion
– Color
– Turgor
– Capillary refill < 2 seconds
– Digital Allen’s test
• Nerves
– Radial digital nerve
– Ulnar digital nerve
14. Treatment
• Thorough I&D
• Tetanus
– Booster if > 5 years
– Immunoglobulin
• >10 year since last immunization
• Manure, puncture wounds, wounds >6 hours old
• Antibiotics
– 1stgeneration cephalosporin for complex
wounds (Cefadroxil, Cephalexin)
– 3 – 5 day course
15. • Suture of simple superficial lacerations
• Surgical repair of complex deep wounds
16. Mammalian Bites
• 80-90% of all bites are dog bites
• I&D and then loose closure
• Debride puncture wounds (cats) – do not suture
• Consider tetanus and rabies prophylaxis
• Antibiotic goal is to cover:
– Staphylococci, Streptococci, anaerobes, and
Pasteurella species.
– Augmentin 875 BID
– 3 - 5 day course
• Human bites
– Fight bite – I&D in OR
17. • Dog bites
– Staphylococcus species
– Streptococcus species
– Eikenella species
– Pasteurella species
– Proteus species
– Klebsiella species
– Haemophilus species
– Enterobacter species
– DF-2 or Capnocytophaga
canimorsus
– Bacteroides species
– Moraxella species
– Corynebacterium species
– Neisseria species
– Fusobacterium species
– Prevotella species
– Porphyromonas species
• Cat bites
– Pasteurella species
– Actinomyces species
– Propionibacterium
species
– Bacteroides species
– Fusobacterium species
– Clostridium species
– Wolinella species
– Peptostreptococcus
species
– Staphylococcus species
– Streptococcus species
19. • Assess neurovascular status
• Reduce dislocations/deformity urgently
• Open fractures
– Emergency operative care for I&D, IV abx
– Not the same operative urgency as lower
extremity injuries
• Splint for comfort and stability
20. Phalanx fractures
• Deforming forces
– Flexor tendons
– Extensor tendons
– Difficult to maintain
reduction
– Operative
management often
required for displaced
fractures – CRPP vs.
ORIF
• Rotational deformity
25. Carpal fractures
• Scaphoid
– TTP in “snuff box”
• Thumb spica even if
normal x-rays
– Poor vascularity
• Slow to heal
• Non-unions common
– MRI can help to
diagnose acute non-
displaced fractures
26. Distal radius fractures
• “Colles fracture”
• Fall onto outstretched
hand
• Closed reduction
required for displaced
fractures
• Beware of open
fracture – open ulnar
puncture
27. • Operative intervention for unstable
fractures
– ORIF now more common than ex fix
– Locking technology
30. Ganglion
•
•
•
•
•
60% of hand lesions
Benign fluid filled sac
– Not a true cyst – lacks epithelial
lining
– Glucosamine, albumin,
hyaluronic acid, globulin
Communicates with joint or
tendon sheath
Women > men = 3:1
Soft, mobile, transilluminates
31. Treatment
• Observation – up to 50% spontaneous
resolution
• Aspiration
– +/- steroid injection
– >50% recurrence
– Avoid aspiration for volar ganglion
• Surgical excision
– <5% recurrence
– Open or arthroscopic
32. Basal Joint Arthritis
• Symptoms
– Pain at base of thumb
at carpo-metacarpal
joint
– Pain with heavy grip
and pinch
• Lifting pots
• Turning keys
• X-rays
– Spurs/osteophytes
– Collapsed joint space
