Hand Injuries PDF

‫ميحرلا نمحرلا هللا‬ ‫بسم‬ ‫اللهم إنى ظلمت نفسى ظلما كثيرا‬ ‫وال يغفر الذنوب إال أنت‬ ‫فاغفر لى مغفرة من عندك‬ ‫وارحمنى إنك أنت الغفور الرحيم‬  Hand injuries By Prof. Dr. Mohamed Abdelhamid Professor of Orthopedics and Traumato...

‫ميحرلا نمحرلا هللا‬ ‫بسم‬ ‫اللهم إنى ظلمت نفسى ظلما كثيرا‬ ‫وال يغفر الذنوب إال أنت‬ ‫فاغفر لى مغفرة من عندك‬ ‫وارحمنى إنك أنت الغفور الرحيم‬  Hand injuries By Prof. Dr. Mohamed Abdelhamid Professor of Orthopedics and Traumatology Learning Objectives… To understand important anatomical features of the hand To appreciate the spectrum of injuries to the hand To understand principles of management of hand injuries INTRODUCTION A prehensile organ with structural adaptations to functions Injuries to the hand are not uncommon present as isolated injury or component of multiple injuries. Injury can be soft tissue or bony/skeletal These injuries can be definitively/temporarily managed in the first clinical setting. RELEVANT ANATOMY  HAND ANATOMY SKELETAL SOFT ANATOMY TISSUE Carpals, metacarpals, phalanges, joints MUSCLES & NEUROVASCUL TENDONS AR Extrinsic & intrinsic Extensors & muscles + flexors tendon ligaments & pulley Schematic by R. Mulbah systems Flexor pulley system BIOMECHANICS  The hand has 7 maneuvers that make up most hand functions. 1. The precision pinch ( terminal pinch,):  flexion of the interphalangeal (IP) joint of the thumb and the distal IP (DIP) joint of the index finger. The fingernail tips are brought together so that a small item, such as a pen, can be picked up. Precision/terminal pinch oppositional pinch ( subterminal pinch) Key pinch The chuck grip (directional grip) The hook grip power grasp span grasp HAND INJURIES Hand injury: any pathological change occurring in the part of the upper limb distal to the wrist as a result of exchange of energy between an individual and his environment (Bashiru et al ) SKELETAL SOFT TISSUE INJURIES INJURIES SEVERITY OF INJURIES CATEGORIES OF INJURIES SOFT TISSUE INJURIES  Lacerations  Burns  Degloving injuries  Tendon Injury Extensor tendons Flexor tendons  Ligamental & neurovascular injuries SKELETAL INJURIES  Fractures  Dislocations TENDON INJURIES  17% reported among Hand injuries @ KNH (Kaisha 2006)  Flexor digitorum superficialis and profundus + extensor digitorum communis commonly injured  Flexor Tendon Injuries volar lacerations plus/minus concomitant neurovascular injury Classified by the zone of injury Courte of orthobullet Tendon repair techniques Flexor pulley system Zones of Extensor Tendon Injuries VASCULAR INJURIES Are not uncommon Can involve Radial or ulnar arteries and digital branches + associated veins NERVE INJURIES Nerve injury Classification by Sedon: Neurapraxia Axonotmesis Neurotmesis Sunderland’s classification: Grade 1 : neurapraxia Grade 11 : axonotmesis Grade 111 : Neurotmesis (intact peri & epineurium) Grade 1V : Neurotmesis (intact epineurium only) Grade V : Complete transection (not recoverable) … Primary nerve repair in 72 hours of injury Delayed primary repair 72 hours to 14 days Secondary nerve repairs 14 days or longer after injury. Adequate debridement of edges May use nylon 8-0 collagen tubes for gaps or nerve grafts for large gaps SKELETAL INJURIES 27 bones & complex articulations amenable to fractures and dislocations Fractures & dislocations Carpal: Scaphoid, perilunate dislocation Metacarpal FX, MCP dislocation Phalanx FX Principles of hand fracture management AO Guiding principles of hand fracture (FX) management I. restoration of articular anatomy; II. correction of angular or rotational deformity; III. stabilization of fractures; IV. surgical approach not compromising hand function; V. rapid mobilization Open Hand fractures…management principle remains the same Position of safe immobilization Types of fixation CRPP ORIF K-WIRES, SCREWS, PLATES ARTHROSCOPY (also described) ORIF by plate PROGNOSTIC FACTORS  Severity of injury  Time of presentation  Other associated injuries  Skill of the surgeon  Availability of skilled hand surgeon  Adequate physiotherapy  CONCLUSION “Nowhere in the body does function follow form as closely as in the hand. The stability of its small articulations, the balance between its extrinsic and intrinsic muscles, and the complexity of the tendon systems require a stable and well aligned supporting skeleton. The outcome of skeletal injuries in the hand may be judged more on the return of function of the soft-tissue structures rather than on skeletal union.” AO Principle of fracture management vol 2 Therefore, surgeons have to be meticulous in managing hand injuries & functional physiotherapy is very important. THE END