Hand management

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  1. Why must hand wounds be fully explored and function assessed
    To identify full or partial tendon lacerations
  2. When should hand tendons NOT be assessed through movement
    • Glass thought to be in wound
    • High suspicion of a partial tendon tear
  3. How must any suspected tendon injury be managed
  4. How would a hand injury with normal X-ray but lack of full function be managed
    Follow up
  5. What discharge advice should be given following a hand injury
    Come straight back if your finger gets droopy or twisted
  6. What must be done BEFORE giving a local anaesthetic for a hand injury
    • Assessment of sensory nerves
    • Resisted tests of muscles for pain and weakness
  7. When do finger fractures through the joint need referring
    Greater than 1/3 of the joint surface
  8. What additional treatment do compound distal phalanx fractures need
    • Antibiotics
    • ED or ENP review
  9. What is the management of partial amputation of digits, inc distal phalanx
    Refer to plastics
  10. What is the management of displaced or angulated finger fractures
    Refer to plastics
  11. What is the general management of uncomplicated finger fractures
    • Neighbour strap
    • Elevate
    • Fracture clinic
  12. When do metacarpal fractures need referral
    • Rotational deformity
    • Volar angulation
    • Open fracture
    • Displaced fracture
    • Multiple metacarpals involved
  13. What sort of X-ray needs requesting for base of metacarpal fractures
    • True lateral
    • Fractures and dislocations are difficult to see on oblique
  14. What injuries are associated with finger hyperextension
    • Sprain at the PIPJ
    • avulsion fracture of the volar plate
  15. When must flake fractures of the finger be referred to fracture clinic
    If flake is >2mm from the bone
  16. Which finger fractures need fracture clinic follow up?
    • Flakes over 2mm from bone
    • Avulsion fractures involving over 1/3 articular surface
    • Shaft fractures
    • Any fractures needing manipulation in the department
  17. Which finger fractures should be referred to orthos
    Displaced fractures involving the articular surface
  18. If it is not possible to assess finger function fully, what is the management
    5-7 day review
  19. What is mallet finger commonly caused by
    Avulsion of the extensor tendon from the base of the distal phalanx
  20. How does mallet finger present
    Inability to extend at the DIPJ
  21. Why should mallet fingers be xrayed
    To check for dorsal avulsion fracture from the distal phalanx
  22. What is the treatment for mallet finger
    • Mallet splint
    • Keep extended at all times
    • ENP review at 3 and 6 weeks
  23. What advice should be given for mallet finger
    • Keep extended at all times
    • Keep skin clean and dry
    • A residual deformity may remain
  24. What is the management of a mallet finger associated with a small avulsion fracture
    • Mallet splint
    • Next fracture clinic
  25. What is a swan neck deformity caused by
    • Disease
    • Injury to the volar plate of the PIPJ
    • long standing mallet injury
  26. What is the management of mallet finger with a large avulsion involving >1/3 of the articular surface
    Refer to plastics
  27. What takes place at the 3 week mallet finger review
    • Remove splint - maintain extension
    • Check skin integrity
    • Change splint for a smaller size if needed
    • Re emphasise cleaning and maintaining splint at all times
  28. What is the 6 week mallet finger review for
    • Remove splint
    • Check finger function
    • Advise that residual deformity may be permanent
    • Use splint for 2 weeks at night
    • Use splint for 2 weeks if heavy work or sport
  29. What is the mechanism of injury for boutonnieres
    Sharp blow to dorsum of the PIPJ
  30. How does the patient with boutonnieres present
    Inability to flex the DIPJ
  31. What is the management for a boutonnière
    • Splint in extension
    • Refer to ED, discuss with plastics
  32. What ruptures to cause a boutonnière
    • The central slip of the extensor tendon
    • Puts the PIPJ into flexion
    • DIPJ into extension
  33. Why may a boutonnieres be missed initially
    • The lateral bands of the extensor mechanism disguise the injury
    • They then slip towards the palm causing fixed flexion deformity at the PIPJ, hyperextension at the DIPJ
  34. Which joints of the hand are most commonly dislocated
    IPJs of the fingers
  35. After reduction, what's the management of finger dislocations
    • Xray
    • Neighbour strap
    • Fracture clinic
  36. What is the management for MCPJ dislocations if unable to reduce
    • Refer immediately to ED or plastics
    • Neighbour strapping
  37. When may metacarpal neck fractures be managed by the ED
    • Involves 1 metacarpal
    • Not thumb MC
    • buckle or green stick
    • No rotational deformity or finger
    • Minimal loss of extension
  38. What is the finger position with a boutonnière
    • Fixed flexion at PIPJ
    • hyperextension at DIPJ
  39. What is the MOI for a Bennets fracture
    • Punch
    • Forced abduction
  40. What is a bennets fracture
    • Fracture of base of thumb metacarpal
    • Divides base from bone
    • Force of the APL dislocates the rest of the bone proximally
  41. What is the management for a bennets fracture
    • Bennets style backslab
    • Fracture clinic
    • If displaced, refer for MUA
  42. What is a boxers fracture
    • Angulated fracture of the 5 th MC
    • close to the head of the bone
    • Definition of the knuckle is lost
    • Exyension of the MCPJ is lost
    • Swelling over the ulna side of the dorsal hand
  43. What must be remembered when examining a boxer type fracture
    Inspect any wounds for teeth
  44. What overuse injury is common in the wrist and thumb
    • Tenosynovitis
    • In the combinedpassage of the APL and EPL
  45. What are the symptoms of tenosynovitis
    • Pain on movement
    • Crepitations
    • Pain on the finkelsteins test
  46. What is the finkelsteins test and what does it show
    • Patient makes a fist with the thumb inside
    • Apply passive ulna deviation
    • Painindicates tenosynovitis
  47. What is the treatment for tenosynovitis
    • Rest
    • Thumb extension splint may help
  48. What is the management for a 5th metacarpal fracture
    • Manipulation if needed
    • Neighbour strapping
  49. What is the mechanism of injury for ulna collateral ligament rupture
    • Hypeextension or abduction
    • Gamekeepers thumb
    • Skiing
  50. What is the treatment for UCL injury with ligament stability
    • 1/52 thumb spica
    • Then mobilise
  51. What is the treatment if UCL is too painful to assess
    • Thumb spica
    • Review in 1/52
  52. What is the management if the UCL is completely ruptured
    Refer to plastics
  53. How is UCL rupture ascertained
    Painfree and marked laxity on stress
  54. what should be part of the assessment of human and animal bites to hands
    • Xray if bony tenderness
    • Explore wounds for tendon damage
  55. Why should bites over the MCPJ be reviewed in 48 hours
    Increased risk of infection
  56. What is the management of all animal bites
  57. When should hand bites be referred or discussed with plastics
    • Tendon damage
    • Nerve damage
    • Infection
    • Open fracture
    • Wounds needing closure
  58. How do tendon sheath infections present
    • Red hot swollen hand
    • Ascending lymphangitis
    • Extreme pain on tendon movement ESP passive extension
  59. What is the management of tendon sheath infection
    Refer to plastics
  60. What should be tested when assessing hand wounds
    • Resisted tendon function
    • Nerves
  61. What should hand wounds be explored for
    • Depth
    • Tendon damage
  62. What is the management of hand wounds if tendons intact but visible
    • Close
    • Dress
  63. Which hand wounds should be sutured
    • Lacerations palmer aspect
    • Deep wounds over joints
  64. Which hand wounds should be steri stripped
    • Superficial
    • Distal phalanx crush injuries
  65. Which hand wounds should have a 2 day review
    • Sutured wounds
    • Deep steri stripped wounds
    • Any possible nerve damage
    • Nerve involvement at the distal phalanx
  66. When should hand wounds be referred to plastics
    • Tendon damage
    • Functional weakness
    • Nerve involvement
    • Longitudinal lacs over PIPJ and DIPJ
    • skin loss over 1cm x 1cm
  67. How do early stage paronychia present
    • Erythema only
    • No pus
  68. What is the treatment for early stage paronychia
    • Flucloxacillin or erythromycin 250mg QDS for 5 days
    • Warm saline soaks
  69. How do late stage paronychia present
    Visible or palpable pus
  70. What it the treatment for late stage paronychia
    • I and D
    • Clean nail fold
    • Cold spray
    • Scalpel sweep the nail edge
    • Express pus
    • Irrigate wound
    • Dry dressing
    • DO NOT close
  71. What may chronic paronychia be caused by
    • Fungal
    • Dont drain
    • Refer to GP
  72. How do herpetic paronychia present
    • Erythaema
    • Clear blisters of fluid
    • Refer to the GP
  73. What is the management of infection under the nail
    • Trim nail
    • Drain pus
    • ABS flucloxacillin or erythromycin 250mg QDS for 5 days
    • GP review
  74. What is the management of a splinter under the nail
    • Digital nerve block
    • Remove FB with forceps
    • Dry dressing
    • Xray if possible glass or metal
    • Refer if unable to remove
  75. What is the management of deep splinter in finger nail
    • Digital nerve block
    • Trim 'V' shaped wedge in nail
    • Remove FB
    • dry dressing
  76. what is the mechanism if injury for subungual haematoma
  77. What is the management of subungual haematoma
    • Assess
    • Trephine
    • Xray if needed
  78. What is the management of subungual haematoma without a fracture
    • Trephine
    • Neighbour strap
    • Elevate
    • Mobilise
  79. What is the management of a subungual haematoma with a fracture
    • If distal phalanx fracture - ED review
    • If joint involving >1/3 articular surface - fracture clinic
    • ABS - flucloxacillin or erythromycin 250mg QDS for 3 days
    • Elevate
    • Analgesia
Card Set:
Hand management
2012-01-27 11:49:03

Hand management
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