Trauma - Hand & Finger Injuries

Hand & Finger injuries



Thumb MC #bennetts

Fractures of the base of the thumb metacarpal not involving the joint need to be differentiated from fracture dislocations or subluxation (Bennett's #)


Ruptured Ulnar Collateral Ligament (UCL) thumb MCPJ  (Gamekeeper's thumb) 

See link above or Here


Index - Ring metacarpal fractures

Usually undisplaced. Treat with bandage and a sling and refer to the Fracture Clinic. If displaced, ask for advice.


Punch Injuries

Infected punch injury

Little metacarpal fractures


Proximal metacarpal injuries

Most are stable injuries if sustained with a clenched fist (no rotation at the time of injury) butDislocated CMC Joint

Beware of a proximal (carpometacarpal) dislocation.

Dislocation of PIP and DIP joints  

Volar plate injuries


Phalangeal fracturesProx phanyngeal fixation

Spiral rotating fracture


Mallet finger

mallet finger 1

Boutonnière finger

Middle slip deformity 1middle slip test 1middle slip 1Finger extensor tendon normally has two lateral slips (inserting into distal phalanx) and a middle slip inserting into the base of the intermediate phalanx. If this middle slip ruptures the patient may have point tenderness as the site of the rupture and a "button hole" or Boutonniere deformity ensues. Patients will be unable to extend the PIPJ flexed over the edge of a table (and will have hyperextension of the DIPJ). Apply splint to hold the PIPJ straight and refer to the next CUH fracture clinic Referral Form.


Ruptured or lacerated extensor or flexor tendons or digital nerve injury


Spreading or deep hand infections



Trapped fingers and amputated finger-tipsNail Anatomy

Trapped finger tips with partial avulsion should rarely be sutured:


Guillotine amputations of finger tips

Terminal amputations of the finger tips in young children do extremely well with conservative treatment only. Even if the bones protrude slightly it should be left alone:

There should be regrowth of the tip and nail and complete restoration of function with an excellent cosmetic result eventually (look at series of photographs in the ED). As long as the amputation is distal to the distal interphalangeal crease the result should be very good.


Pulp / fingertip incisionspulp suture 1

Analgesia


Hand lacerations


Subungal haematoma

Subungal haematoma inage


Paronychia / Felon#

Acute paronychia develops over a few hours when a nail fold becomes painful, red and swollen.

Throbbing pain indicated presence of pus

Location of paronychia pus

Paronychia DDx includes


Herpetic whitlow / felon

Felon


Hand injury referrals:

Severe hand injuries have very long-term implications for patients. Efficient management and referral are of paramount importance. In this ED service the following referral protocol should be followed:

Referral CUH fracture clinic:

You MUST discuss the case with the your Duty Doc before discussing with the plastics team.


Preservation of amputated parts


Content by Dr Íomhar O' Sullivan 17/02/2004. Reviewed by Dr ÍOS 02/03/2004, 19/05/2005, 28/01/2007.Last review Dr ÍOS 19/01/14.