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Hand injuries

Hand injuries

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Hand injuries

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  1. Hand injuries

  2. Vascular Injuries • Ligament Injuries • Dislocations • Fractures

  3. Vascular Injuries • Vessel divisions • Compartment syndrome Following crush injuries and the fractures of the forearm and hand, pressure within the facial compartments rises, Occlude the microcirculation

  4. Ligaments • Carpal instability Damage to the ligaments interconnecting intercalated segment Following outstretched hand Rx- early repair and stabilization with wires • Thumb ulnar collateral ligament Can be torn when thumb is wrenched radially or with chronic over use Rx – relatively stable injury is splinted for 3 weeks Unstable- need repair

  5. Triangular fibro cartilage complex attach ulnarstyloid to the ulnar side of the distal radius and stabilize distal radio ulnar joint • Can be torn leading to instability of the distal radio ulnar joint and ulnar sided wrist pain • Rx- repair

  6. Dislocations • Dislocation of the lunate bone Following fall on to the hand Lunate bone lies at the front of the wrist rotated 90 degrees • Rx- early-manipulation under anesthesia Late- open reduction Complications Avascular necrosis Osteoarthritis Median nerve injury

  7. Perilunate dislocation Compress median nerve Painful and swollen wrist Radiograph – usually normal Rx- ligament repair Temporally Kirschner wires

  8. Distal radioulnar joint Can occur in isolation or in association with radial head or shaft fracture Rx- Perfect fixation of the radius and stable reduction of the joint is essential

  9. Bennett’s fracture-dislocation Intra-articular fracture of the thumb carpometacarpal joint Rx- Closed reduction and percutaneous wire fixation Inter phalangeal joints Easy to reduce and are stable

  10. Tendons

  11. Mallet finger (baseball finger) • Sudden passive flexion of the distal interphalangeal joint may rupture the extensor tendon at the point of its insertion into the base of the distal phalanx • Clinically the distal IP joint rests in moderate flexion and can not be actively extended. • Management : Tendon avulsion without a bone fragment is treated by uninterrupted splintage in the fully straight position for 6 weeks.

  12. Flexor tendon division • Extensor tendon division - Cut over proximal interphalangeal joint buttonhole deformity - Cut over MCP joints from opponents' tooth can leads to septic arthritis

  13. Finger tip injuries • Many heal when left alone • If > 1cm2 is lost, may need skin graft • If bone is exposed,shortning should be considered in manual workers • Replantation of digits may lead to stiffness