Hand Injury Assessment

Question 1

Why may you not want to suture a hand laceration?

Answer 1

Tissue swelling

Question 2

What are the principles of management for the patient who presents with a hand injury?

Answer 2

ABC
General medical Hx
Age
Occupation
Hand dominance
Pain management

Question 3

What are the principles of management for the hand when someone presents with a hand injury?

Answer 3

Timing
Mechanism of injury
Examination
Investigations
- X-ray
- US
Treatment
- Splint in intrinsic plus position
- Elevation
- Compression
- Clean wounds
- +/- Abx
- Tetanus status
- Analgesia
Referral/discharge/follow-up

Question 4

What is the intrinsic plus position?

Answer 4

Safe position for hand

• Wrist extended to <10 degrees max
• MCP joints at 60-70 degrees of flexion
• IP joints fully extended

Question 5

What should you examine in a hand injury?

Answer 5

Blood supply
- Nailbed blancing
Tendons
Nerves
- Compare to other side if there's any doubt
Bone and joint

Question 6

What are the considerations to be made in a complex hand injury?

Answer 6

Compartment syndrome
Composite injury
Open/closed injury
Clean/contaminated

Question 7

How do you examine the vascular supply of the hand when it’s injured?

Answer 7

Colour
- Look
Temperature
- Feel
- Compare
Capillary refill
- Blanch time
- Compare
Allen's test

Question 8

What is the antibiotic prophylaxis for a human bite?

Answer 8

First generation cephalosporin

Metronidazole to cover Gram +ve anaerobes

Question 9

What is the management for a cut injury?

Answer 9

Irrigation
Repair of deep structures
Direct closure
Healing by primary intention

Question 10

What is the management for a crush injury?

Answer 10

Remove all non-viable tissue to ward off infection

Question 11

What skin is likely to survive in a shear injury?

Answer 11

Only skin freely bleeding from cut edge

Question 12

What is the management for puncture wounds?

Answer 12

Carry organisms deep into tissue > thorough cleaning difficult without extensive exploration
Excise and irrigate wound
Abx

Question 13

What is tenosynovitis?

Answer 13

Infection within tendon sheath

Question 14

What is the clinical presentation of tenosynovitis?

Answer 14

Fusiform swelling of digit
Partially flexed posture
Tender along sheath
Pain with passive extension

Question 15

What is the treatment for tenosynovitis?

Answer 15

Splint
Elevation
Compression
Clean any wounds
IV Abx
Tetanus status
Analgesia
Urgent referral