Evaluation and management

of Hand injuries
  Mechanism of injury – crush or
How to evaluate
sharp
a patient with  Clean vs dirty – dictates the time
an injury of the of repair
hand  Time since injury
 Vascularity of the digits
 Sensation – most sensitive test
 Fractures
 Tendon injuries
Sharp cut vs crush injury
 Evaluation and
management of skin
loss

If the defect is so large

that it cannot heal
even with granulation
then skin grafts or
flaps may be done to
ensure coverage
Neurovascular
supply to the
fingers
 Vascularity

 Allens finger test

 Capillary refill test
 Pin prick test
Sensation

 The two pint

discrimination test
is the most sensitive
and accurate test to
determine sensory
loss
Assess for
tendon
injuries
Assess for the tendon
injuries and decide the
zone of involvement of
the tendons
Anatomical zones
of hand

 Zone 2– no man’s land

because of the intricate
arrangement of pulleys and
the insertion of FDS.
 Zone 3 – zone of lumbricals
 Zone 4 – may injure the
median nerve
 Primary repair – clean cut injury with a
healthy bed and the tendon ends can be
approximated without tension.

Delayed repair – contaminated unhealthy

bed, delayed repair using a tendon graft can be
Tendon repair done

Tendon transfer – if the tendon cannot be

repaired even with a graft then trandfer of
another tendon to perfom its function can be
done
 Fracture and its
stabilization

 Assess and decide the

plan of management.
INJURY BY A GRINDER
Case

 CRUSH INJURY
 CLEAN WOUND
 VASCULARITY AND
SENSATION
 LUMBRICAL ZONE
 ASSESSMENT OF THE
TENDONS
 X RAY
Management of
fractures

 K wiring to stabilize the fracture

 Amputation of the 5th digit
Management of
tendon injury

 Debridement and repair of the

tendon was done
 Management of the
soft tissues

 Since primary closure could not be

achieved without tension
 Groin and superficial epigastric flap
was done
THANK EMAIL:

YOU ortho.prajwalgupta.2020 @gmail.co