MANUAL MINORS
From the perspective of an emergency physician in a department, hand injuries are common and can range in severity from superficial wounds to complex traumas that may compromise long-term hand function. Below are the main categories of hand injuries and their management in an emergency setting:
Type of Injury | Description | Evaluation | Management |
---|---|---|---|
1. Lacerations and Open Wounds | Cuts or tears in the skin that may affect tendons, nerves, or blood vessels. | Inspect the wound, assess tendon and nerve function, evaluate distal vascularity. | - Hemorrhage control - Wound cleaning and debridement - Wound suturing - Antibiotics and tetanus prophylaxis |
2. Fractures | Fractures of metacarpal bones or phalanges. | Physical and radiographic evaluation, determine displacement, angulation, or abnormal rotation. | - Closed reduction (if necessary) - Splint or cast immobilisation - Orthopaedic consultation for follow-up |
3. Dislocations | Displacement of hand joints. | Assess joint stability and neurovascular involvement. | - Closed reduction under local anaesthesia - Immobilisation of the affected joint - Radiographic assessment pre- and post-reduction |
4. Tendon Injuries | Cuts or ruptures of hand tendons. | Specific function tests for each tendon, such as flexion or extension against resistance. | - Surgical repair - Postoperative immobilisation - Hand surgery consultation for follow-up |
5. Nerve Injuries | Injury to nerves such as median, ulnar, or radial nerves. | Assess sensation and motor function to identify neurological deficits. | - Surgical repair if nerve is transected - Postoperative therapy to maximise functional recovery |
6. Crush Injuries | Extensive damage to soft tissues, bones, and neurovascular structures. | Assess tissue viability and integrity of vital structures. | - Debridement of necrotic tissue - Surgical repair and reconstruction - Pain management and wound care |
7. Partial or Complete Amputations | Loss of parts of the hand, such as fingers. | Assess extent of amputation and possibility of replantation. | - Surgical replantation (if possible) - Care of the amputated part - Plastic or hand surgery consultation |
Additional Considerations
Pain Management: Critical to treatment, may involve oral analgesics, nerve blocks, or sedation for painful procedures.
Early Rehabilitation: Important to optimise functional recovery and prevent joint stiffness or muscle atrophy.
Goal in the Emergency Department: Stabilise the injury, minimise further damage, and prepare the patient for appropriate follow-up, either outpatient or surgical.
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