Hand Injuries Flashcards

1
Q

what are some important aspects of hand history?

A

hand dominance
occupation
hobbies/sports
health - Diabetes, arthritis, cardio-resp
description of injury (mechanism of injury, how it happened)
symptoms

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2
Q

hand injury examination?

A
wound
nails
deformity
swelling
point of tenderness
movement
neurological
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3
Q

give an example of point tenderness which indicates a diagnosis

A

snuff box tenderness = scaphoid fracture

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4
Q

important features of a wound?

A
where
how long
how deep
clean/dirty
skin loss
obvious structures in wound (bone, tendon, foreign bodies, dirt etc)
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5
Q

incised wound vs laceration?

A
incised = sharp object injury
laceration = blunt injury, skin torn open
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6
Q

give examples of types of injury?

A
crush
sharp
burn
laceration
incised
degloving
amputation
etc
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7
Q

what is a subungual haematoma?

A

blunt trauma to the nail

can cause nail to eventually fall off but will grow back

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8
Q

how is subungual haematoma treated if pressure causing pain?

A

trephine - create a hole in the nail to relieve the pressure

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9
Q

how are nail/nailbed injuries classified?

A
type 1 = soft tissue only
type 2 = soft tissue and nail
type 3 = soft tissue and nail and bone
type 4 = proximal 1/3rd of phalanx
type 5 = proximal to DIP joint
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10
Q

how is level 1 and 2 nail injury treated?

A

dressing only

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11
Q

how is level 3 nail injury treated?

A

repair nail bed

stabilise bone

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12
Q

how is level 4 and 5 nail injury treated?

A

as above unless <5mm of nail bed in which case ablation is used

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13
Q

what treatment is used if finger tip amputated?

A

terminalize or V-Y flap

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14
Q

how do you describe a fracture?

A

which bones
joint involvement
deformity
stability

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15
Q

what can affect the stability of a fracture?

A

the presence of soft tissues around it

if it is displaced

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16
Q

what is a boxers fracture?

A

neck of middle finger?

usually due to a swinging punch

17
Q

what are the features of a boxers fracture?

A

minimal displacement
no rotation
more distal

18
Q

how is boxers fracture managed>

A

buddy strap

early mobilisation

19
Q

how can a rotational injury be identified?

A

can be seen in a closed hand

- finger crosses over others

20
Q

how is a rotational injury managed?

A

must be repaired as causes problems with grip

21
Q

what causes mallet finger?

A

can be due to a tendon injury or an avulsion injury

22
Q

what is mallet finger?

A

hyperflexion of DIP joint

23
Q

what are the features of mallet finger on examination?

A

resisted finger extension

tenderness/bruising

24
Q

how is mallet finger managed?

A

mallet splint for 6 weeks (24 hrs a day)
Occasionally fix large avulsion fragment (wire)
dermatotenodesis

25
Q

how is a PIP joint dislocation managed?

A

must be treated acutely
- pull to reduce, buddy strap
delayed presentation is a disaster as impossible to reduce and may require fusion

26
Q

what is a bennets fracture?

A

fracture at the base of the 1st metatarsal (thumb) which extends into 1st CMC joint

27
Q

how can you tell if a tendon is ruptured?

A

if the finger remains straight when the hand is relaxed

28
Q

what is the most dangerous zone of the hand in which to sustain a tendon injury?

A

zone 2 “no mans land”

as both tendons present in a sheath

29
Q

how do you examine flexor digitorum profundus?

A

hold finger straight and flex PIP

30
Q

how do you test flexor digitorum superficialis?

A

hold index, ring, and little finger straight (to remove FDP) and bend middle finger - only get PIP flexion, not DIP

31
Q

how is tendon injury treated?

A

physio?
rehab?
surgery to repair rupture?

32
Q

what is the most common cause of severe mutilating hand injuries (degloving, amputation etc)?

A

industrial

33
Q

what are the main principles of mutilating injuries treatment?

A
preserve amputated parts on ice
early debridement of dead tissue
establish stable bony support and vascularity
repair all tissues - nerves, tendons etc
establish skin cover (grafts etc)
prevent/treat infection
aggressive mobilisation
early involvement with plastics
flaps to cover exposed bone
formal amputation if needed
later use of prosthetics
34
Q

standard general treatment of burns?

A

respiratory aid
manage infection risk
treat dehydration
pain relief

35
Q

specific hand burns treatment?

A

excise damaged skin and perform split skin grafts early
aggressive mobilisation to prevent finger stiffness
escharotomy

36
Q

what is eschar?

A

thick, leathery, inelastic skin which can form after burns

may require surgical release to allow movement