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Flashcards in Hand injuries Deck (33):
1

What are important general aspects of a history to cover with regard to hand injuries?

Left or right handed
Diabetes
Arthritis
Occupation
Hobbies (musical instruments, etc)

2

Which aspects of the history in terms of the injury itself are important to cover?

Type (crush, sharp, burn)
Degloving
Whether any protective items were worn
Timing (particularly in amputation)
Energy level

3

Which aspects of the history in terms of symptoms are important to cover?

Pain
Weakness
Sensory deficit

4

What should be examined with regard to hand injuries?

Wound itself
Nails (important for function!)
Point of tenderness
Deformity
Swelling
Movement
Neurological

5

What is important to look for on examination of the wound?

Position
Length
Depth
Visible structures
Clean vs dirty
Skin loss

6

What is a subungual haematoma? How and when is it treated? What must the patient be warned about?

A collection of blood under the nail
If causing pain it can be treated with a trephine (to relieve pressure)
The nail may fall off but it should grow back

7

How can nail/bed injuries/amputations be classified?

Type I - soft tissue only
Type II - soft tissue & nail
Type III - soft tissue & nail & bone
Type IV - proximal 1/3 phalanx
Type V - proximal to distal interphalangeal joint

8

How are nail/bed injuries/amputations treated?

Type I & II - dressing only
Type III - repair nail bed & stabilise bone
Type IV - as above unless ablate

9

How should nail/bed injuries/amputations be treated if the finger tip is not available?

Terminalise (finger)
Use V-Y flap

10

What is the aim with nail/bed injuries?

To preserve the nail

11

Where is the most common site for a sigmoid bone on the hand?

Metacarpal phalangeal joint of the thumb

12

What is the most important thing to differentiate when dealing with a hand fracture?

Extra or intra-articular

13

How does a boxers fracture typically appear on x-ray?

Extra-articular fracture of distal end of metacarpal of the little finger

14

How is a boxers fracture treated?

Buddy strap
Early mobilisation

15

How might the boxers fracture appear clinically?

Absent knuckle at the little finger
May or may not be a rotational deformity

16

How can you differentiate between a soft tissue and bony mallet finger?

X-ray

17

What type of fracture causes mallet finger?

Intra-articular avulsion fracture of the proximal end of the distal phalanx (causes subluxation of the joint)

18

What will be found on clinical examination of a patient with mallet finger?

Resistance to extension
Brusing
Tenderness

19

How is a mallet finger managed?

Mallet splint for six weeks 24/7
Wire fixation for large avulsion fractures
Dermatotenodesis if chronic

20

How common is proximal interphalangeal joint dislocation?

Common

21

How is PIP joint dislocation treated?

Acutely reduced and buddy strapped

22

How likely are delayed presentations of PIP joint dislocation to be reduced?

Unlikely

23

How are delayed presentations of PIP joint dislocation managed?

Cannot be reduced
Fusion is an option

24

How is a PIP joint dislocation and fracture managed?

Fixation and stabilisation

25

What is a bennet's fracture?

Intra-articular fracture of the base of the thumb metacarpal bone

26

How is a bennet's fracture managed?

Fixation

27

How should tendon injuries be examined?

Check all PIP and DIP joints and tendons to determine which are involved

28

How are tendon injuries managed?

Surgically
Early mobilisation + specialised splinting

29

What is the most common cause of a severe mutilating injury of the hand? Which types of injuries are these?

Industrial work
Degloving or amputation

30

What are the principles of management with regard to mutilating injuries?

Preserve amputated parts on ice
Early debridement of dirty wounds
Establish bony support
Establish blood supply
Repair damaged structures (nerves, tendons, etc)
Establish skin cover
Prevent or treat infection
Aggressively mobilise
Amputation may be necessary if unreconstructable or no nerve supply

31

How should burns be managed in general?

Respiratory support
Infection prevention
Dehydration management
Pain relief

32

How should burns to the hands be specifically managed?

Excision of damaged skin + split grafting
Aggressive mobilisation to prevent stiffness
Escharotomy

33

What is eschar?

Thick, inelastic skin that can form following burns and prevents movement

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