Hand Infections iy In the management of hand infection take care: SS, gl Salers u 4- General and local rest to the hand in the elevated position. 2- Early administration of antibiotics. 3- Early drainage of infection i.e. dant wait for fluctuation. 4- Incision must be planned and under general or regional anesthesia. 5- Incision is done under tourniquet to have a dry field to be able to explore the abscess. 6 The hand must be maintained in the elevated position to prevent edema & congestion. 7- Position of immobilization is that of function of the hand. 8- Early restoration of function by movement. Pulp Space Infection 4- Don’t wait for fluctuation. 2+ The incision is sited directly over the most tender point and in direction lines. 3- Other technique: 2 incisions-on sities of tre paim to divide all septa + drain. of Langer’s Web Space infection Management: ékin incision is made over the point of maximum tenderness or fluctuatio 1- Atransvel and then an artery of a sinus forceps is opened in & longitudinal direction (to avoid damage to the digital nerves and vessels), through the subcutaneous tissue to enter the abscess cavity. i 2- Vertical dorsal incision.Take care, and don’ aD G Hulton, ‘t reach the edge of the web. ‘a jal Spaces ~~ Lateral SN Hi oe in et S fen Midpalmar space Sie } ‘Thenar Eminence Medial Hypothenar > fy [ eminence Vo esy Medial Border of 5 Dorsal incision on lateral border of metacarpal 2" metacarpal bonespaceJ Hybothenar Space infection Management + Avvertical incision at the site of maximal tenderness or along the medial border of the fifth metacarpal bone is done. The space is entered by a sinus forceps i.e. Hilton’s method, $ Thenar Space Infection jan ent a + Transverse incisior-at the: web then the. space is open by a sinus forceps (Hilton's method) OR * Vertical incision:on,the lateral-aspect of the back of the 2™4 metacarpal bone, this is the commonly used-incision, fecti Mid Palmar Space Management Te ~ Incision when pus is formed: either: © If there is a collar-stud abscess, incise along one of the hand creases, draining the subcutaneous abscess. The hole in the aponeurosis is explored and is enlarged to drain subaponeurotic collection. * A transverse incision is done like that of the web ‘Space and by Hilton's method a sinus forceps is Introduced into the retrotendenous space to drain. 3 incisions Of the Hand Dorsum Palmer eva (UY aN 1 ~ > ™ 1+ Thenar 4+ Thenar 2+ Web (Vertical.incision) 2-.Web (Hilton) & mid palmar space 3- Mypothenar 3+ Palp Space: a. 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Thoracic or Abd injuries incase of MaliTrauma pt pope In Case of MultiTreuma Patient <<oppe> In Case of MutT rama Patient << + Xray (Discuss) T T T = Inv Sor compliations 0g Subelavian A> Doppler y Y Suspectng ate inory > Paeamathorax > cest x ay Doppler Inv for posible ass injaies F-Conmpleatons: = General “Barly local ‘skin Vascular Nerve ‘Tendon Infetion vascular newrosis Visceral | fate ical Malurion Deleyed union Sudel’s atrophy Myesstisossificans Volkmann's Joint stfhess ‘Grovch dsurbance complications of TTT: Fctvestment ABCDE in A) General: b) Specific: Reduction Fixation Indication of ORIF Rehabilitation (aftercare) 6) tt of compound tm of complications o) tof ss injres 2/5/2007 Yo compound compound Yeonpound Subelavion ev Brachial dtc) Rodi! ulnar Brachial plexus ‘Median , ulnar, radial Median ,carpat tunnel i Subelayino mossle a Feaying, Rupture = q v 8 Dome Apex, thorecicd SSSSSS550Re ebloinal US ih MaliTraunna patient < ‘(Discuss ) ae Véthow Elbow, shoulder, fingers 7 + Madelung > ie PAPEETE ere Ea] e ‘V analgesics ‘V UNdispinced & Displaced | V No attempt to reduce ORIF if ass vescular injury | ORIF if: ass vascular injury Only on broad arm sting | +8 ¥ under seat or lea 4 ea tio 2 (vata) tee ce y y a ‘losedreduetion | + dificult closed reduction for3 weeks | DD elbow dislocation Edited by Ehab Nawar after Dr. Dina Refaat 15ora au0q Acrorsarydon-omny (&sqo19 ayskous Aq ,poqeanay ) AL sowranesor2917) oforeqny. “3 ‘eunéd proe opaig Seah (41q) onseydiadAyy (once 411)) + 1109 ‘SoaSSQ) 10 [elAoUKg Arepuosas 79 Areunag aOVe (422) canwiea | poolg ap ydusd'y sodg ag Az A a, Mog. mog ' Az 10 Ax KaOTHET(e) ~poold “WI0g Poo], (anor Axz) wuny + poolg: “Wog poojg, ‘Pomoy} (ouog Gopperq Wog Por c “ovfpe woy ) peor] “100 woy)) yoayur Sutpusosy HH [e0T- wonse8mt :ay- | -ydurky 10 poo amnoy “gt + oo + a oe os TusyUReIQ"Y ‘AS|OE (2) i BOUTS Jerat1a8 a00d — oo +* +e a hat peg ydioard ts ” MOUPTD, unpe Bunox * ” ** ‘SWPP (1) HH aujog ouog Teuoy) spuopeg | sHoyUg | yrepeqdudy aLOl , joao am adn ree suoneorpuy3 Bepamy :Ax 7 eatua i ae ee a ae i: i: a ” anova, ” + a . 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