Hand Injuries Overview- Plastic Surgery ppt

1. Hand Injury Overview
Dr Okoye
27/05/2019

2. Outline
 Introduction
– Epidemiology
– Relevant Anatomy
– Function of the Hand
 Aetiology
 Mechanism of injury
 Classification
 Management
– History
– Examination
– Investigations
– Treatment

3. Outline
 Complications
 Follow up
 Conclusion
 References

4. Introduction
• The hand is an essential participant for
activities of daily living, vocation and
recreation
• Hand injuries are one of the commonest
extremity injuries globally
• Commonly occurring in the young adult

5. Introduction
• Hand injuries can have major functional
implications
• Major injuries are seen in most tertiary
centers

6. Epidemiology
• Dafiewhare OR Ajibade A
• F;M- 5.6:1
• Mean age of patients was 25.69 +/-14.04
years
• Traumatic amputations and fractures were
the commonest injury types
• Occupational injuries, RTA, domestic accidents

7. Epidemiology

8. Relevant Anatomy (Bones)

9. Relevant Anatomy (Nerves)

10. Relevant Anatomy (arteries)

11. Relevant Anatomy
(muscles/tendons)

12. Functions of the Hand
• Fine jobs
– fine pinch, power grip, key grip, chuck grip, hook
grip
• Cosmesis
• Communication tool
• Sensory tool
• Defense tool

13. Aetiology
• Industrial injuries
• Assault
• Road traffic accidents
• Gunshot injuries
• Burns
• Explosive devices

14. Mechanisms of injury
• Injury
• Pattern

17. Classification
• Closed/Open
• Mechanisms of injury
• Tissue Component
• Degree of contamination
• Burns
• Anatomic zones

18. Classification
• Rank and Wakefield
– Tidy,
– Untidy,
– Indeterminate
• Mclain and Duncan classification of open hand fractures
– Type I tidy wound < 1cm
– Type II tidy wound 1-2 cm
– Type IIIA >2cm; soiled
– Type IIIB IIIA + periosteal stripping
– Type IIIC neurovascular damage

20. Management
– ATLS
– HISTORY
– EXAMINATION
– INVESTIGATION
– TREATMENT

21. Management
• History
– Time since injury
– Mechanism of injury
– Hand dominance
– Occupation /recreation
– Social economics/patient’s choice
– Relevant past medical history

22. Examination
LOOK FEEL MOVE
• LOOK
– Expose upper limb and remove rings
– Skin colour Swelling
– Asymmetry Shape
– Shrinkage scars
– Compare with contralateral limb

23. Examination
LOOK FEEL MOVE
• FEEL
– Tenderness
– Temperature
– Capillary refill
– 2PD
• MOVE
– ROM

24. Investigations
• Specific
• X-ray
• CT scan
• MRI
• Doppler USS
• General
• FBC
• Wound swab

25. Treatment
• Aims of treatment
– Restore the basic hand unit
– Provide a sensate mobile digit
– Provide a stable coverage
– Preserve function
– Preserve appearance

26. Treatment
• Pre-Op considerations
– Clinical photos
– Informed consent including for
graft(s)/amputation(s)
– Splint and elevate
– Hand surgery instruments
• Including tourniquet and magnification
– Appropriate sutures
– Analgesics/Antibiotics/Tetanus prophylaxis

27. Treatment
• Intra-Op considerations
– Adequate anaesthesia
– Good lighting
– Hand rest

28. Hand incisions

29. Treatment
• RECONSTRUCTIVE PRINCIPLES
• Restore circulation
• Obtain soft-tissue coverage
• Align and stabilize bony anatomy
• Restore nerve function
• Mobilize joints
• Restore tendon function

30. Treatment
• Post Op considerations
– Splint
– Elevate
– Early physiotherapy
– Prosthesis

31. Complications
• Non union/malunion
• Osteomyelitis
• Traumatic neuroma
• Contracture
• Adhesions/rupture

32. Follow Up
• There should be a definitive individualized
rehabilitation plan
• Begin immediately after surgery with elevation
• Splint
• Controlled ROM exercises
• Adequate wound care

33. Prognosis
• Depends on the variant of hand injury
– Difficult to compare because no two injuries or individuals are alike
• Factors influencing outcome include
- Injury related factors
- Age
- Motivation and compliance
– surgery (1O and 2O )
- Rehabilitation
- Co-morbid pathologies

34. Conclusion
• Hand injuries require a careful evaluation
• Individualizing the patient is important
• All reconstructions must be carried out with
long term function and a clear rehabilitation
plan in mind

35. •Thank you

36. References
• Rizvi M, Bille B, Holtom P, Schnall SB. The role of prophylactic
antibiotics in elective hand surgery. J Hand Surg.
2008;33(3):413-420.
• Ryu J, Cooney WP III, Askew LJ, An KN, Chao E. Functional
ranges of motion of the wrist joint. J Hand Surg.
1991;16(3):409-419.
• Wilgis E. Observations on the effects of tourniquet ischemia. J
Bone Joint Surg Am Vol. 1971;53(7):1343.