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Hand injuries

Hand injuries. Vascular Injuries Ligament Injuries Dislocations Fractures. 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.

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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

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