MANUAL MINORS
Compound hand injuries are complex lesions that involve multiple types of damage simultaneously, such as deep lacerations, bone fractures, tendon, nerve, and vascular damage. These injuries are often the result of severe trauma such as work-related accidents, crush injuries, or machinery wounds, and can seriously compromise both the structure and functionality of the hand. Due to the delicate anatomy of the hand, these wounds require a detailed assessment and comprehensive management to prevent permanent sequelae.
Diagnosis
The diagnosis of a compound hand injury is made through visual inspection of the lesion, assessing the extent of damage to the skin, muscles, tendons, nerves, bones, and blood vessels.
It is crucial to perform a neurological evaluation to determine if there is any loss of sensation or motor function, as well as a vascular exam to check for blood flow distal to the injury. Imaging studies such as X-rays or CT scans are useful to identify fractures and bone displacements, while ultrasound can help assess the integrity of tendons and vessels.
Differential Diagnosis
Condition | Main Clinical Characteristics | Key Differentiation |
|---|---|---|
Simple compound wound | Damage to skin and superficial tissues | Absence of damage to deep structures (tendons, nerves, bones) |
Associated tendon injury | Inability to actively move affected fingers | Motor deficit in extension or flexion, depending on the injured tendon |
Associated nerve injury | Loss of sensation distal to the injury | Paresthesia or anaesthesia in specific areas |
Associated vascular injury | Heavy bleeding or distal ischaemia | Absence of pulse or signs of distal pallor and coldness |
Open fracture | Deformity, crepitus, and bone exposure | Radiographic confirmation of fracture |
Emergency Management
The initial management of compound hand injuries begins with controlling bleeding through direct compression and, in cases of significant haemorrhage, temporary use of a tourniquet. It is essential to stabilise the patient, ensuring there are no other serious injuries, and to provide adequate analgesia. The wound should be cleaned with sterile saline solution and protected with a moist sterile dressing.
The next step is careful exploration of the wound to identify damage to deep structures such as tendons, nerves, and vessels. If there is suspicion of a fracture or tendon or nerve injury, the hand should be immobilised, and the patient referred to a specialised surgeon as soon as possible. Antibiotic prophylaxis is essential in open wounds to prevent infection, and tetanus vaccination should be updated if necessary.
Definitive Treatment
Definitive treatment of a compound hand injury generally requires surgical intervention. This may include the reduction and fixation of fractures, tendon or nerve repair, vascular reconstruction, and soft tissue coverage with grafts or flaps. The priority in surgery is to restore hand function while preserving the maximum amount of viable tissue.
Post-surgery, rehabilitation is a crucial part of the treatment, as it allows for the recovery of both mobility and strength in the hand. Physiotherapy and occupational therapy programmes are aimed at maximising functional recovery and preventing complications such as stiffness or loss of movement.
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