MANUAL MINORS
Hand injuries are common in emergency departments, potentially involving superficial tissues such as the skin, as well as deeper structures including tendons, nerves, blood vessels, and bones. These injuries often occur due to trauma mechanisms such as cuts, crush injuries, bites, or burns. Due to the anatomical complexity of the hand, even seemingly simple wounds can significantly compromise function if not treated properly.
Diagnosis
The evaluation of hand wounds begins with a visual inspection of the injury, determining its depth, location, and the potential involvement of important structures. A neurological examination is performed to assess sensation and motor function, as well as a vascular examination to ensure that blood supply remains intact.
It is essential to rule out tendon injuries by testing active and passive movements of the fingers. In certain cases, imaging studies such as X-rays may be required to identify fractures or foreign bodies.
Differential Diagnosis
Condition | Main Clinical Characteristics | Key Differentiation |
Simple Laceration | Superficial cuts without involvement of deep structures | Absence of neurological or functional deficits |
Tendon Injury | Inability to flex or extend the fingers | Specific motor deficit depending on the affected tendon |
Nerve Injury | Loss of sensation in the area distal to the wound | Paresthesia or anaesthesia in areas innervated by the damaged nerve |
Vascular Injury | Pulsatile bleeding, distal pallor | Absence of distal pulse or signs of ischaemia |
Fracture or Dislocation | Severe pain, visible deformity | Confirmation by X-ray |
Infected Bite | Erythema, pain, swelling, purulent discharge | History of bite, signs of infection |
Emergency Management
Initial management includes controlling bleeding through direct compression and immobilising the affected hand. The wound should be cleaned with sterile saline and, if necessary, non-viable tissue should be debrided. Administration of analgesics and local anaesthesia may be required for more accurate evaluation and to facilitate treatment.
If tendon, nerve, or vascular injury is suspected, it is crucial to avoid excessive movement until a specialist has assessed the patient. In cases of bite wounds, antibiotic prophylaxis should be initiated, and tetanus vaccination status updated.
Definitive Treatment
Definitive treatment may include primary wound closure, surgical repairs of tendons, nerves, or blood vessels, or reduction and stabilisation of fractures. Wounds at high risk of infection, such as human or animal bites, may require delayed closure and close follow-up to ensure proper healing. Postoperative physiotherapy is essential for complete rehabilitation and the restoration of hand functionality.
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