Hand Injuries

Question 1

what are some important aspects of hand history?

Answer 1

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

Question 2

hand injury examination?

Answer 2

wound
nails
deformity
swelling
point of tenderness
movement
neurological

Question 3

give an example of point tenderness which indicates a diagnosis

Answer 3

snuff box tenderness = scaphoid fracture

Question 4

important features of a wound?

Answer 4

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

Question 5

incised wound vs laceration?

Answer 5

incised = sharp object injury
laceration = blunt injury, skin torn open

Question 6

give examples of types of injury?

Answer 6

crush
sharp
burn
laceration
incised
degloving
amputation
etc

Question 7

what is a subungual haematoma?

Answer 7

blunt trauma to the nail

can cause nail to eventually fall off but will grow back

Question 8

how is subungual haematoma treated if pressure causing pain?

Answer 8

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

Question 9

how are nail/nailbed injuries classified?

Answer 9

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

Question 10

how is level 1 and 2 nail injury treated?

Answer 10

dressing only

Question 11

how is level 3 nail injury treated?

Answer 11

repair nail bed

stabilise bone

Question 12

how is level 4 and 5 nail injury treated?

Answer 12

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

Question 13

what treatment is used if finger tip amputated?

Answer 13

terminalize or V-Y flap

Question 14

how do you describe a fracture?

Answer 14

which bones
joint involvement
deformity
stability

Question 15

what can affect the stability of a fracture?

Answer 15

the presence of soft tissues around it

if it is displaced

Question 16

what is a boxers fracture?

Answer 16

neck of middle finger?

usually due to a swinging punch

Question 17

what are the features of a boxers fracture?

Answer 17

minimal displacement
no rotation
more distal

Question 18

how is boxers fracture managed>

Answer 18

buddy strap

early mobilisation

Question 19

how can a rotational injury be identified?

Answer 19

can be seen in a closed hand

- finger crosses over others

Question 20

how is a rotational injury managed?

Answer 20

must be repaired as causes problems with grip

Question 21

what causes mallet finger?

Answer 21

can be due to a tendon injury or an avulsion injury

Question 22

what is mallet finger?

Answer 22

hyperflexion of DIP joint

Question 23

what are the features of mallet finger on examination?

Answer 23

resisted finger extension

tenderness/bruising

Question 24

how is mallet finger managed?

Answer 24

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

Question 25

how is a PIP joint dislocation managed?

Answer 25

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

Question 26

what is a bennets fracture?

Answer 26

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

Question 27

how can you tell if a tendon is ruptured?

Answer 27

if the finger remains straight when the hand is relaxed

Question 28

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

Answer 28

zone 2 "no mans land" | as both tendons present in a sheath

Question 29

how do you examine flexor digitorum profundus?

Answer 29

hold finger straight and flex PIP

Question 30

how do you test flexor digitorum superficialis?

Answer 30

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

Question 31

how is tendon injury treated?

Answer 31

physio? rehab? surgery to repair rupture?

Question 32

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

Answer 32

industrial

Question 33

what are the main principles of mutilating injuries treatment?

Answer 33

``` 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 ```

Question 34

standard general treatment of burns?

Answer 34

respiratory aid manage infection risk treat dehydration pain relief

Question 35

specific hand burns treatment?

Answer 35

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

Question 36

what is eschar?

Answer 36

thick, leathery, inelastic skin which can form after burns | may require surgical release to allow movement