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HAND INJURIES

Writer's picture: EditorEditor

Updated: Sep 22, 2024

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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