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 Deformity Angulation Rotational malalignment

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