Hand Injuries - Introduction and Management

Hand Injuries - Introduction

• Hand injury defined as any pathological change distal to the wrist resulting from energy exchange between an individual and environment
• Injuries are not uncommon and can be isolated, or part of multiple injuries
• Injuries vary, including soft tissue and bony/skeletal
• Initial management is usually definitive or temporary in the first clinical setting

Hand Injuries - Learning Objectives

• Understanding of important anatomical features of the hand
• Appreciation of the spectrum of hand injuries
• Understanding principles of hand injury management

Hand Injuries - Relevant Anatomy

• Diagrams and labels outlining key anatomical structures, like the thenar and hypothenar eminence, distal palmar crease, and distal wrist crease

Hand Anatomy Schematic

• Diagram illustrating skeletal anatomy (carpals, metacarpals, phalanges)
• Diagram highlighting soft tissue, muscles and tendons, and neurovascular elements
• Including extrinsic and intrinsic muscles, tendons, and ligaments

Hand Anatomy - Pulley System

• Diagram illustrating pulley system details, key components and locations

Hand Anatomy - Extensor Compartment of the Wrist

• Diagram illustrating the extensor muscles and their functions in the wrist and hand

Biomechanics

• Hand has 7 primary functions, described as maneuvers
• The precision/terminal pinch (details on thumb and index finger flexion)
• The description and location of oppositional pinch, key pinch, chuck grip, hook grip, power grasp, and span grasp are detailed using associated image diagrams.

Types of Hand Injuries

• Soft tissue injuries, such as lacerations and burns, are mentioned
• Degloving injuries are also mentioned.
• Tendon injuries
• Ligamental and neurovascular injuries
• Skeletal injuries, such as fractures and dislocations, are described
• Vascular injuries are identified as a type that is not uncommon, and includes Radial or ulnar arteries as well as digital branches and associated veins
• Nerve injury classification, including the different types of injury, are included

Specific Injuries - Tendons

• Tendon injuries account for 17% of all hand injuries
• Describes specific flexor tendons: flexor digitorum superficialis, and profundus, extensor digitorum communis
• Flexor Tendon Injuries classified by zone (diagram provided)

Tendon Repair Techniques

• Diagrams and description of various tendon repair techniques (Kessler, Bunnell, modified Kessler, Pulervtaft)

Pulley Systems - Flexor

• Diagram of the flexor pulley system components
• Detailed description of the flexor pulley system, including zones.

Zones of Extensor Tendon Injuries

• Diagram illustrating the different zones of extensor tendon injuries

Vascular Injuries

• Vascular injuries are not uncommon
• They involve Radial or ulnar arteries and digital branches + associated veins

Nerve Injuries

• Nerve injuries and classifications, including Neurapraxia, Axonotmesis, and Neurotmesis, are described
• Sunderland's Classification is also included (Grades 1-V)

Nerve Injury Treatment

• Repair in 72 hours, delayed primary repair (72 hours-14 days), secondary repair
• Debridement of edges
• Material use in gap repair (nylon 8-0, collagen tubes)
• Nerve grafting, for larger gaps

Skeletal Injuries

• Listing of 27 bones and complex articulations amenable to fractures and dislocations
• Description of specific examples: Carpal (scaphoid, perilunate dislocations), metacarpal fractures, phalangeal fractures

Fracture Management Principles

• AO Guiding principles, including restoration of articular anatomy and correcting deformities
• Fracture stabilization methods
• Surgical approach, and compromising hand function considerations are given
• Rapid mobilization
• Open fractures have the same management principles as closed fractures.

Immobilization Position

• Diagram explaining proper hand and wrist immobilization techniques

Fixation Types

• Open Reduction and Internal Fixation (ORIF)
• CRPP and other Fixation methods (k-wires, screws, plates, arthroscopy)

Specific Examples of Fixation - Case Studies

• Diagrams of surgical repair (Bennett and Rolando procedures)
• ORIF described in diagram, with plate repair image

Prognostic Factors

• Severity of injury
• Time of presentation
• Other associated hand injuries
• Surgeon's skill and patient expertise
• Availability of skilled hand surgeons
• Adequately focused physiotherapy

Conclusion

• Discussion of the importance of hand structure in relation to function
• Consideration of the musculoskeletal integration of the hand for function
• Need for surgeon meticulousness and functional physiotherapy

This quiz explores the definition, types, and management of hand injuries. It also includes essential anatomical features and principles for effective treatment. Understand the complexities of hand injuries ranging from soft tissue to skeletal issues.