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Hand Surgery Trauma Collection

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Hand Surgery Trauma Collection Powered By Docstoc
					Hand Surgery for Trauma


             Mr CW Oliver
             FRCS (Tr & Orth) DM
Types of hand
Normal hand position
Position of rest
Hand - oedema
Position of immobilisation
Hand functional positions
Elevation?
Missed Upper Limb Injuries
Hand incisions
Hand incisions
Normal alignment and rotational
deformity
Hand Fractures
Metacarpal fracture: transverse
Hand Fracture Treatment
Metacarpal fracture: oblique
Boxer’s fracture
Inter articular Fracture
Blade Plate Fixation Phalanx
Epiphyseal fracture
Bennett’s fracture
Rolando fracture
Scaphoid waist fracture
Unstable scaphoid non-union
Hook of Hamate Fracture
Lunate dislocation
Scapholunate dissociation
PIPJ dislocation
Volar avulsion
MCPJ dislocation
UCL sprain
UCL rupture
‘Bony’ UCL
Mallet deformity
Flexor tendon injury
Zones for tendon repair
Methods of tendon repair
Profundus Avulsion
Open fractures - classification

Type   I      tidy wound < 1cm
Type   II     tidy wound 1-2 cm
Type   IIIA   >2cm; soiled
Type   IIIB   IIIA + periosteal stripping
Type   IIIC   neurovascular damage
Severe hand injury survey

Blood supply
Stable skeleton
Viable skin cover
Basic function
Occupation
Serious hand trauma
-after debridement

Longitudinal/ extensile exposures
Compartment decompression
Skeletal alignment/ fixation
Musculo-tendon repair
Vessel repair/ graft
Nerve repair
Replantation - indications

All amputations at the level of the arm, forearm,
 carpus and metacarpus
All amputations of thumb prox to mid distal phalanx
In multiple digits replant as many as possible
Most digits amputated distal to prox phalanx
Children
Think about avulsed digits and crushed distal parts
Hand Replantation

7 months off work
50% get only protective sensation
50% range of movement
60% need > 2 operations
Medical cost 5-15 times amputation
Nerve Repair

Partial nerve
Full nerve
Regrow at 1mm per day
Splintage
rehabilitation
Hand Infection

Bacterial
Viral
Fungal
Protozoal
64% grow multiple
 organisms
Hand Infection:
anatomical compartments

Nail fold (paronychia)
Pulp space
Tendon sheath
Web space
Deep palmar space
Septic arthritis
Infection: history

Occupation      dentists/nurses (H Simplex)
                 barbers (pilonidal sinus)
                 water (m. marinum)

Systemic disease     HIV, diabetes,
                      immunocompromise

Previous injury (human) bite, needle stick
Infection: history

Time lapse   cellulitis         24 hours
              tendon sheath      48 hours
              web space
              deep palm          days
              paronychia
              pulp space         4-5 days
              septic arthritis   <2 weeks
Web space infection
Deep palmar infection
Collar stud abscess
Infection: tendon sheath

Finger in slight flexion
Uniformly red and
 swollen
Intense pain on
 attempted extension
Tenderness along line
 of sheath
Drainage of tendon sheath
Drainage of mid-palmar space
Infection: septic arthritis

Usually secondary to human bite
Swelling out of proportion to inflammation
Restricted motion
Instability
Discharging sinus
X-ray changes (2/52)
Paronychia
Pulp space infection
Herpetic whitlow
Hand trauma and IV Drug
Abuse