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Hand Assessment

Hand Assessment

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Chapter from Book with permission

UNDERSTANDING HAND SURGERY: A GUIDE FOR JUNIOR DOCTORS
by Vaikunthan Rajaratnam Mubashir Cheema Syed Nadir Ali

ISBN: 978-0-9558489-1-9 Publisher: PIMO Ltd Copyright: © 2008 V Rajaratnam Standard Copyright License
Language: English Country: United Kingdom Edition: First Edition

A primer in hand trauma for junior doctors. It is intended as a quick reference for doctors new to hand surgery as well as an 'aide memoire' for the more experienced ones. It provides evidence base from several important papers from hand surgery literature. There is an extensive reference section to help the reader.
To purchase - http://www.lulu.com/content/paperback-book/understanding-hand-surgery-a-guide-for-junior-doctors/3127570
Paperback £37.31 Download pdf £10
Chapter from Book with permission

UNDERSTANDING HAND SURGERY: A GUIDE FOR JUNIOR DOCTORS
by Vaikunthan Rajaratnam Mubashir Cheema Syed Nadir Ali

ISBN: 978-0-9558489-1-9 Publisher: PIMO Ltd Copyright: © 2008 V Rajaratnam Standard Copyright License
Language: English Country: United Kingdom Edition: First Edition

A primer in hand trauma for junior doctors. It is intended as a quick reference for doctors new to hand surgery as well as an 'aide memoire' for the more experienced ones. It provides evidence base from several important papers from hand surgery literature. There is an extensive reference section to help the reader.
To purchase - http://www.lulu.com/content/paperback-book/understanding-hand-surgery-a-guide-for-junior-doctors/3127570
Paperback £37.31 Download pdf £10

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Published by: Vaikunthan Rajaratnam on Oct 14, 2013
Copyright:Attribution Non-commercial

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11/26/2013

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History taking
L H Tan, V. Rajaratnam
COMFORT AND ANALGESIA 
Ensure that the patient is as comfortable as possible and thatadequate analgesia has been given even before the history -taking and full evaluation.
Patient‟s conce
rns:
 
 What effect will his injury have on his/her everyday life, bothimmediately and in the long term, and
 
 What treatment options are available? You must also be aware that the patient requires sufficientinformation, assurance and confidence to be in the sur
geon‟s
hands.
HISTORY 
 The following information must be obtained in any hand injury patients:1.
 
Name2.
 
Gender3.
 
 Age4.
 
Dominant-hand5.
 
Occupation6.
 
Hobbies/recreational activities7.
 
Smoker / non-smokerOther general points in history:
 The patient‟s current health
status, past medical history, previousanaesthetic experiences, bleeding disorders, current medications,allergies, tetanus immunisation status and time of last meal shouldall be recorded.
 
Understanding Hand Surgery 2
Date, time and type of injury 
It can potentially have medico-legal implications. The time of injury should be noted as certain injuries requireurgent management and should be treated as soon as they arerecognized; in order of urgency:1.
 
Uncontrolled haemorrhage secondary to vascular injury 2.
 
Complicated fracture or dislocation compromising major vascular injury or producing doubtful viability 3.
 
Compartment syndrome4.
 
Macro-replantation, that is when the amputated partcontains significant muscle bulk 5.
 
Hydrofluoric acid burns6.
 
Pressure gas injuriesIf left untreated, the hand will undergo certain changes, which willinfluence its eventual recovery of function:
 
Necrosis and contractures may result from vessel occlusionsecondary to unstable fractures. (Due to irreversiblepermanent intimal changes or irreversible ischemia in the areaof blood supply)
 
Contamination of the tissue causing infection.
 
Progressive edema, leading to:a)
 
Compartment syndromeb)
 
 Joint contracturec)
 
Friability of tissues, which may complicate tendon, nerve,and vessel repairsd)
 
Difficulty in skin closure, to the point of compromising skin circulation
Place of injury 
 
Home
 
 Work 
 
Understanding Hand Surgery 3
 
Outdoor
Mode of injury 
 
 Accident
 
RTA (Are there other injuries which may takeprecedence?)
 
Self-inflicted (Is the patient likely to re-injure / be non-compliant?)
 
 Assault
Mechanism of injury 
1.
 
 What happened to your hand?2.
 
 Which part of your hand is injured?3.
 
How was it injured?
 
Roller
 
Punch Pressure
 
Saw 
 
Laceration
 
Penetrating 
 
Blunt
 
Pressure gun
 
Gunshot wound
 
Others e.g. lawn mower
Roller injuries 
 
Does it have a roller?Roller injuries commonly produce avulsion flaps, whereby thedistal part may not be viable and hence amputation would be theonly treatment option.
 
 What is the size of the gap?If the gap is small, distal crush may be so severe thatrevascularisation may not be successful.

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