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Hand injuries

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Hand injuries Powered By Docstoc
					   Vascular Injuries
   Ligament Injuries
   Dislocations
   Fractures
   Vessel divisions
   Compartment syndrome
         Following crush injuries and the
    fractures of the forearm and hand, pressure
    within the facial compartments rises, Occlude
    the microcirculation
 Carpal instability
   Damage to the ligaments interconnecting
  intercalated segment
    Following outstretched hand
   Rx- early repair and stabilization with wires
 Thumb ulnar collateral ligament
       Can be torn when thumb is wrenched
  radially or with chronic over use
  Rx – relatively stable injury is splinted for 3
  weeks
        Unstable- need repair
   Triangular fibro cartilage complex
       attach ulnar styloid to the ulnar side of the
    distal radius and stabilize distal radio ulnar
    joint
   Can be torn leading to instability of the distal
    radio ulnar joint and ulnar sided wrist pain
   Rx- repair
 Dislocation of the lunate bone
    Following fall on to the hand
    Lunate bone lies at the front of the wrist
  rotated 90 degrees
 Rx- early-manipulation under anesthesia
       Late- open reduction
Complications
        Avascular necrosis
        Osteoarthritis
        Median nerve injury
   Perilunate dislocation
      Compress median nerve
      Painful and swollen wrist
      Radiograph – usually normal
    Rx- ligament repair
         Temporally Kirschner wires
   Distal radioulnar joint
    Can occur in isolation or in association with
    radial head or shaft fracture
    Rx- Perfect fixation of the radius and stable
    reduction of the joint is essential
Bennett’s fracture-dislocation
   Intra-articular fracture of the thumb
carpometacarpal joint
  Rx- Closed reduction and percutaneous
wire fixation
Inter phalangeal joints
          Easy to reduce and are stable
   Sudden passive flexion of the distal
    interphalangeal joint may rupture the
    extensor tendon at the point of its insertion
    into the base of the distal phalanx
   Clinically the distal IP joint rests in moderate
    flexion and can not be actively extended.
   Management : Tendon avulsion without a
    bone fragment is treated by uninterrupted
    splintage in the fully straight position for 6
    weeks.
   Flexor tendon division
   Extensor tendon division
       - Cut over proximal interphalangeal joint
        buttonhole deformity
       - Cut over MCP joints from opponents'
    tooth can leads to septic arthritis
   Many heal when left alone
   If > 1cm2 is lost, may need skin graft
   If bone is exposed,shortning should be
    considered in manual workers
   Replantation of digits may lead to stiffness

				
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