What do you need to know about a patient with a hand injury?
Right or left-handed
General health - diabetes, arthritis, cardio/resp stuff
Occupation, hobbies and sports
What symptoms may a patient have following hand trauma?
Sensory problems - anaesthesia, paraesthesia
What condition classically follows a crush injury?
Name four general types of hand injury?
What is degloving?
Avulsion of an extensive area of skin
What is a subungual haematoma?
Bleeding under the nail
What is the main symptom of subungual haematoma?
Due to pressure build-up
What eventually happens to the nail in subungual haematoma?
Falls off and grows back
levels of nailbed injury
higher number increases chance of amputation
how would you treat an unstable fracture?
k wires to stabilise
slide 16 - angulation fracture of thumb, stabilised
slide 17 - unstable, flexor tendons want to pull it downwards
stabilise - plates, screws or wires
why do totally immobilised fractures heal slower?
what should be encouraged?
lack of callus formation
what may happen if an intraarticular fracture isnt fixed?
post traumatic arthritis
how to identify rotational deformities?
hard in flat hands
what is a mallet finger?
avulsion of distal phalanx from extensor tendon
fracture -> dislocation of 1st carpo-metacarpal joint
zone II is important - tendons adhere to one another within the sheathe, predicting course is difficult
FDP attaches to distal phalanx
FDS to middle and proximal
to demonstrate FDP function, hold PIP straight and flex finger
to demonstrate FDS function, hold all other fingers straight and flex finger
how are tendons repaired?
by suture and hand splinted to prevent re-rupture
dealing with severe mutilation
remove clearly infected or necrotic tissue
rest on slides
a dry, dark scab or falling away of dead skin