Hand injury assessment

Hand Injuries

Richard Hay

Overview of upper limb anatomy Assessment of upper limb injuries affecting the

hand Common injuries seen in ED

◦ Soft tissue◦ Bones

Other considerations

Hand Injuries

Anatomical terminology◦ Surfaces◦ Movements

Flexor and extensor compartments of the forearm Flexor and extensor retinaculum

◦ Carpal tunnel Hand

Upper limb – forearm and hand

Carpal Tunnel

Extensor retinaculum

Dorsal expansion

History◦ Hand dominence / ischaemic time / ADT / occupation /

hobbies / conditions affecting peripheral circulation Look Feel Move

◦ Functional assessment of all muscles / tendons◦ Assessment of neural function

Sensory and motor Anaesthetise and explore wounds only after

completing neurological assessment◦ Digital blocks◦ Wrist blocks

Assessment

Lacerations◦ Irrigation with either N/S or tap water

Tendon injuries◦ Surgical repair if >50% (?75% if no triggering)

FB◦ XR / US / CT

Bite wounds◦ Good evidence for the use of prophylactic Abx

Soft tissue injuries

Nerve injuries◦ All motor branches◦ Digital nerves proximal to DIP

Radial aspect IF / MF Ulnar aspect LF Both sides of thumb

Fingertip amputations◦ Different classification systems


Nail bed injuries◦ Subungual haematoma

Trephination If significant pain Antibacterial soaking / dressing

◦ When to explore / repair nail bed If nail fold disrupted If nail plate is dislodged from nail bed If nail plate adherent to nail bed then probably does not

require exploration


Management primarily non-operative◦ Closed reduction and splinting

<2mm articular congruity Accept angulation and rotation that does not interfere with

function or cause significant cosmetic deformity Shaft #s

◦ Acceptable angulation varies with MC involved and location of # Greater deformity acceptable in 4th/5th MC

10° for 2nd/3rd

20° for 4th

30° for 5th

Less angulation if # closer to CMC jts

Metacarpal fractures

Neck #s◦ Acceptable angulation

10-15° for 2nd/3rd

45° for 5th

Immobilisation◦ Forearm based extending to the PIP dorsally and distal

palmar crease on volar aspect (ie allow motion of IP jts) Wrist at 20-30 degrees MCP jts at 70-90 degrees

◦ Can buddy strap for rotational control

Metacarpal fractures

Hand injury assessment

Health & Medicine

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