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Hand injuries (Hand wounds (Types (Crush Burst injury fingertip wounds,…

- - - - Surgical repair
        Indication: nerve/tendon/compound injury, nailbed laceration
        MOA: repair then immobilise POP
      - Amputation repair
        Indication: injuries without crush
        MOA: reimplantation, flap surgery etc.
      - Exploration under anaesthesia
        Indication: suspected FB, injection injury
        CI: evidence of functional impairment e.g. nerve/tendon damage
        MOA: remove FBs and dirt etc; fine forceps
      - Skin grafts
        Indication: large finger pad amputation, degloving
        MOA: grafts, advancement flaps
      - Nail removal and replacement
        Indication: extensive nailbed laceration
      - Haematoma I+D
        Indication: nailbed haematoma
        MOA: hot clip, drill
- - - - Clinical presentation
        Tenderness on thumb MCPJ
        Thumb instability
      - Diagnosis
        
        Examination
        Tender over thumb MCPJ
        Thumb instability in abduction
        
        Investigations
        Imaging: X-ray if suspect fracture
        
        History
        Mechanism of injury
      - Pathophysiology
        Hyperabduction injury ruptures ulnar collateral ligament
      - Management
        Conservative: Elevation, strapping/POP
        Medical: analgesia
        Surgical: surgical repair if full rupture
    - - Pathophysiology
        Repetitive use or trauma
      - Management
        Medical: steroid injection to tendon sheath
        Surgical: repair
    - - Clinical presentation
        Bowstring effect on flexion
      - Diagnosis
        
        History
        HPC: mechanism, assoc injury
        
        Examination
        Bowstring effect on flexion
      - Pathophysiology
        Tendon cuts through pulley at PIPJ
        Common in rock climbers
        Can also have tendon injury
      - Management
        Conservative: buddy strap/splint, elevation
    - - Pathophysiology
        Extensor tendon injury at DIPJ
        Forced flexion of DIPJ, blow/fall
      - Clinical presentation
        Fixed flexion at DIPJ
      - Diagnosis
        History: mechanism, PMH
        Examination: fixed flex DIPJ
        Investigations: X-ray (exclude fracture)
      - Management
        Conservative: splinting
    - - Pathophysiology
        Rupture of central slip finger extensor tendon
        Blunt or penetrating trauma
      - Management
        Conservative: splinting
        Surgical: repair
    - - Pathophysiology
        Often in patients with joint pathology e.g. OA
        Osteophytes catch on tendon shealth/pulley system
      - Clinical presentation
        Fixed flexion deformity (cant extend)
      - Management
        Conservative: treat OA
        Surgical: repair
  - - - Flexor
        tenosynovitis
        
        Clinical presentation
        Kanavel's signs: tender flexor tendon, symmetrical finger swelling, finger held in flexion, pain on passive extension
        
        Management
        Medical: tetanus prophylaxis, abx
        Surgical: exploration, irrigation
        
        Pathophysiology
        Infection of finger flexor tendon shealth
        after a penetrating injury to the finger
      - Palmar space
        infections
    - - Septic arthritis
    - - Pulp
        infection
        
        Management
        Dressing
        Abx (flucloxacillin)
        
        Diagnosis
        Swabs MCS
        X-ray (FBs, osteomyelitis)
        
        Pathophysiology
        Infection of pulp space
      - Paronychia
        
        Diagnosis: swabs MCS, X-ray (osteomyelitis)
        
        Pathophysiology
        Infection of nail fold adjacent to nail
        
        Management
        Conservative: dressing
        Medical: abx
        Surgical: I+D