Overview
• Introduction
• Hand Assessment
• Treatment principles
• Specific injuries
General Principles
• Initial evaluation and primary care of the
injured hand are critical
• Accurate assessment
• Restore altered anatomy
• Return to normal function
Complications
• Stiffness
• Pain
• Loss of function
AIM: AVOID THE BAD HAND
Swelling Reduction
• Elevation
• Initial splinting
• Hand therapy
HISTORY
• Age
• Hand Dominance
• Occupation
Injury Details
• Mechanism
• Where did injury occur?
• When?
• Treatment?
Examination
• Local swelling
• Tenderness
QuickTime™ and a
decompressor
are needed to see this picture.
• Deformity
• Angulation
• Rotational malalignment
Rotational malalignment
QuickTime™ and a
decompressor
are needed to see this picture.
Investigations
• Radiographs
– PA, Lateral and Oblique
• Referral to Hand Fracture Clinic
Finger Tip
Distal Phalanx
• Most # require only splinting
• Warning:
– Subungual haematoma
– Nail avulsion
= ? NAIL BED INJURY
Mallet Injury
• Extensor insertion disruption
• Tendinous versus bony
SPLINT
• Warning:
– >50% articular surface
– Joint subluxation
FDP avulsion
• HISTORY!!!!!
• EXAMINATION
• Ring finger involved in 75% of cases
Examination
PIPJ Dislocations
PIPJ dislocations
• Dorsal
• Lateral
• Volar
• Fracture-dislocation
Dorsal Dislocation
• Most common
• Easily reduced
• Stable
• Dorsal blocking splint
Lateral Dislocation
• Rupture of lateral ligaments
• Often volar plate involved
• Reduction
• Assessment of stability
Volar Dislocation
• Less common
• Central Slip Injury
• Referral < 1 week
Ulnar Collateral Ligament
Injury
Assessment
Stener Lesion