Hand Injuries Dr Mark Putland MBBS FACEM Emergency Physician Bendigo Health Care Group 22/9/2011

Basics History – AMPLE – Handedness – Occupation – Leisure

Basics Exam – Position – Posture – Wound – Bones and Joints – Tendons – Vascularity and bleeding – Nerves – Function

Basics Digital Nerve Block

Fingers Tuft Fracture Closed Open Subungual haematoma Nail bed laceration Only one of these is a tuft fracture. Which?

Fingers Transverse Fracture of the Distal Phallanx Distal to the DFP insertion so stable – Reduce and splint – Occasionally need a K-wire Watch for mallet finger deformity with the more proximal ones

Fingers Mallet Finger Avulsion of the insertion of FDP (central band)

Fingers Mallet Finger Avulsion of the insertion of FDP (central band) ORIF if – >2mm # – >⅓ joint surface – Penetrating injury

Fingers Mallet Finger Avulsion of the insertion of FDP (central band) ORIF if – >2mm # – >⅓ joint surface – Penetrating injury Otherwise splint 24-7 for 6 weeks and then use night splinting and sports protection

Fingers Middle Phalanx Fracture Transverse or commminuted need fixation Spiral tend to be stable (splinted by tendons – Splint (MCP at 90° and wrist at 45° extension) – Clinic – Early protected motion

Fingers Intra-articular middle phalangeal fracture <30% of joint surface – Soft tissue injury >30% of joint surface – fixation Avulsion? Of what? What soft tissues might be injured?