Hand injuries
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This document provides guidance on evaluating and treating various common hand and finger injuries. It discusses evaluating and repairing lacerations, treating tendon damage with either immediate closure or later repair, and immobilizing fractures and dislocations. It also outlines treating various infections like paronychia, felon, and cellulitis with incision and drainage or antibiotics. Burns are treated with wound cleaning and topical agents. Miscellaneous sections cover removing stuck rings and "ring avulsion."
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Hand injuries
- 8. Classification • Lacerations or cuts • Fractures and dislocations • Infections • Burns • Miscellaneous
- 10. Lacerations • Evaluation • Local anesthesia • Wound preparation - cleansing and irrigation, reexamination • Cleaning and removal of dead tissue • Wound repair or closure • Dressing and splinting • Pain medication • Antibiotics • Tetanus
- 11. Tendon Damage • Tendon Damage…..???? Close the wound @ the Immediate Care Defer the tendon repair at a later date
- 12. Modified Verdan zone system in hand
- 13. Testing the tendons • Flexor tendons • • • • Flexor carpi radialis Flexor carpi ulnaris Flexor digitorum superficialis Flexor digitorum profundus • Extensor tendons
- 14. Treatment • Primary repair • Reconstruction by tendon grafting • Palmaris longus • Tendon transfer
- 15. Bites…..?? Suture it or not……?????? Risk of infection Clean and leave it open……..
- 17. Fractures & Dislocations • Evaluation • Pain relief • X-ray • acute reduction • Reexamination • Immobilization by splinting or buddy taping • X-ray for confirmation of correct alignment • Follow-up
- 18. Scaphoid Fracture • Young adults • Fall on outstreched hand • Crack fracture or displaced fracture
- 19. Diagnosis….. • Tenderness in anatomical Snuff box • Xray- fracture line
- 20. Treatment • Scaphoid cast (3-4 months) • Dorsiflexion & radial deviation (glass holding position)
- 21. •Internal fixation • Herbert’s screw
- 22. Complications • Avascular necrosis • Delayed / non union • Wrist osteoarthritis
- 23. Lunate dislocations • Lunate dislocation perilunate dislocation • Open reduction • Avascular necrosis
- 24. Bennett’s fracture dislocation • Base of 1st metacarapal • Intra articular • Longitudinal force to thumb
- 25. Treatment • Closed manipulation and Plaster cast • Closed manipulation & percutaneous fixation • Open reduction and internal fixation
- 26. Fracture metacarpals • All ages – Fracture through the base – Fracture to the shaft – Fracture to the neck • Boxer’s fracture • Auto immobilisation • Dorsal slab
- 27. Fracture phalanges • Fall of heavy object or crush injury • Undisplaced Displaced • Strapping • Open reduction
- 28. Mallet finger
- 30. Infections • X-ray if indicated • extensive cleaning of the wound • Antibiotics`
- 31. Paronychia • infection of the finger that involves the tissue at the edges of the fingernail • superficial and localized to the soft tissue and skin • most common bacterial infection seen in the hand ( staph; strep).
- 32. Paronychia treatment • wound care alone. • collection of pus - drain. – a simple incision over the collection of pus to allow drainage. – scalpel may be inserted along the edge of the nail to allow drainage. – If the infection is large, a part of the nail may be removed. • oral antibiotic. • wound care at home.
- 33. Felon • infection of the fingertip. • This infection is located in the fingertip pad and soft tissue associated with it.
- 34. Felon treatment • incision and drainage » incision will be made on one or both sides of the fingertip. » break up the compartments » gauze will be placed into the wound to aid the initial drainage. » flush out with a sterile solution • antibiotics.
- 35. Herpetic whitlow • infection of the fingertip area caused by herpes simplex virus type I or II • This is the most common viral infection of the hand. • This infection is often misdiagnosed as a paronychia or felon.
- 36. Herpetic whitlow treatment • Antiviral drugs • Pain medication. • wound must be properly protected to prevent a secondary bacterial infection • Incision and drainage is not recommended.
- 37. Cellulitis • superficial infection of the skin and underlying tissue. • usually on the surface and does not involve deeper structures of the hand or finger. • Staph and strep.
- 38. Cellulitis treatment • oral antibiotics are sufficient. • If immunocomprised- i.v antibiotics
- 39. Infectious flexor tenosynovitis & Deep space infection • infection involves the tendon sheaths and deep spaces • penetrating trauma that introduces bacteria • surgical emergency and will require rapid treatment with IV antibiotics.
- 40. Kanavel’s cardinal signs • intense pain – along the course of tendon with extension – this is the earliest and most important sign • flexion posture • uniform swelling • percussion tenderness along the course of the tendon sheath
- 41. Burns • Local wound care • Blisters • Cleaning- chlorhexidine • Topical agents • Silver sulphadiazine • Dressing • • • • Decrease pain Improve healing time Decrease op visits Lower owerall costs • Healing • Infection • Itching • Traumatic blisters
- 42. Miscellaneous…
- 43. “ring”
- 44. Stuck finger !!!
- 45. Methods to remove • Lubricant method • Elevation method • Cold water method • Dental floss Method
- 46. Dental Floss Method • Slip one end of the dental floss under the ring
- 47. • Wrap the dental floss around your finger, up to your knuckle
- 48. • Unwind the dental floss, beginning at the bottom of the finger
- 49. Do’s & Don’ts Do’s Don’ts Examine hand carefully Do not incise every infected digit Think of other diagnosis Do not make puncture incisions Wait for abcess to localize Do not injure digital vessels or nerves Place adequate depth and length of incisions Do not place incisions crossing the creases Immobilise, elevate the hand Do not close bite wounds Antibiotics & proper dressings Do not forget pus culture and sensitivity
Editor's Notes
- Edward Hallaran Bennett (9 April 1837, Charlotte Quay, Cork – 21 June 1907, Dublin) was an Irish surgeon remembered for describing Bennett's fracture. He studied at Trinity College, Dublin of theUniversity of Dublin, graduating M.Ch. in 1859 and M.D. in 1864. He was professor of anatomy and surgery at Trinity College from 1873-1906. He studied fractures, dislocations and bone diseases, recording them at the Pathology Museum at Trinity College. He described his eponymous fracture at the British Medical Association meeting in Cork in 1880.[1] He is said to have introduced antiseptictechnique to Dublin, and became president of the Royal College of Surgeons in Ireland.[2]