1. Overview Introduction Hand Assessment Treatment principles Specific injuries

2. General Principles Initial evaluation and primary care of the injured hand are critical Accurate assessment Restore altered anatomy Return to normal function

3. Complications Stiffness Pain Loss of function AIM: AVOID THE BAD HAND

4. Swelling Reduction Elevation Initial splinting Hand therapy

5. HISTORY Age Hand Dominance Occupation

6. Injury Details Mechanism Where did injury occur? When? Treatment?

7. Examination Local swelling Tenderness Deformity Angulation Rotational malalignment

9. Investigations Radiographs –PA, Lateral and Oblique Referral to Hand Fracture Clinic

10. Finger Tip

11. Distal Phalanx Most # require only splinting Warning: –Subungual haematoma –Nail avulsion = ? NAIL BED INJURY

12. Mallet Injury Extensor insertion disruption Tendinous versus bony

13. SPLINT

14. Warning: –>50% articular surface –Joint subluxation

15. FDP avulsion HISTORY!!!!! EXAMINATION Ring finger involved in 75% of cases

16. Examination

17. PIPJ Dislocations

18. PIPJ dislocations Dorsal Lateral Volar Fracture-dislocation

19. Dorsal Dislocation Most common Easily reduced Stable Dorsal blocking splint

20. Lateral Dislocation Rupture of lateral ligaments Often volar plate involved Reduction Assessment of stability

21. Volar Dislocation Less common Central Slip Injury Referral < 1 week

22. Ulnar Collateral Ligament Injury

23. Assessment

24. Stener Lesion