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Hand Injuries

Hand injuries are common in the emergency department. Common types of injury may include puncture wounds or blunt trauma. Diagnosis is normally based on individual patient history, examination and imaging such as X-Rays or Ultrasound.

Plastic surgeons usually manage the following conditions:

Nail injuries
Nailbed injuries can be repaired so that the nail can grow properly, and re-adhere to the nailbed.

Flexor and Extensor Tendon Injury
Repair of flexor tendon would be followed by careful hand therapy for about 6 to 8 weeks. Initially, the patient would be in a splint to rest the hand. Too much movement impair the recovery, whereas too little movement would cause the tendons to become adherent. Hence, hand therapy is essential after tendon repairs.

Hand infections often don’t respond to oral antibiotics, so would need admission for intravenous antibiotics. In addition to that, the hand would need to be splinted and elevated until the redness and swelling subsides.

Animal bites
Dog bites, cat bites and scratches can cause deep punctures, and sometimes involve a joint. It is imperative to debride the wound, and irrigate the wound, followed by intravenous antibiotics, elevation and a resting splint for the hand.

Closed Fractures
Fractures may be simple or complex. When the fracture is minor and stable, a plaster may be adequate. However, if the break is unstable, then excision and an internal repair with plates and screws would be the next step. Closed fractures usually heal in about 8 weeks.

Compound Fractures
In addition to the treatment of closed fractures, compound fractures need to be flushed clean and antibiotics prescribed to the patient as there is a risk of infection.

Foreign Bodies in the Hand
Imaging for foreign bodies could be diagnosed by X-Ray if the object is a metallic or radioopaque foreign body. If the foreign body is of plant or wood origin, an ultrasound would be required to define the size and location of the foreign body.

The patient is instructed to elevate the hand in a sling or on to elevate the hand on pillows for a few days. Antibiotics are given to the patient on discharge from hospital and follow up is arranged for the following week.

Hand therapy is commenced at the appropriate time, utilising appropriate exercises and on occasion enlisting the help of hand therapists.
A plastic bag is used to protect the dressing for showers. Some bruising is normal.
Driving is not possible due to bandages and/or plaster dressings.
The sutures are usually removed between 2 & 3 weeks after surgery.
Scar management, and desensitisation continue for months after the surgery.


The Risks

Early sequelae include bleeding, wound infection, swelling and stiffness, abnormal scarring, slow healing, wound dehiscence, damage to a nerve, persistent numbness, and complex regional hand syndrome. Later complications include prolonged swelling and stiffness, complex regional hand syndrome, and recurrence.

Image by Sincerely Media
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