Hand injuries are common and can invlove a variety of structures such as the skin, tendons, nerves, blood vessels, bones and joints.
These are common in the Emergency Department.
Preservation & restoration of maximal normal function is essential.
Identify & document all injuries, vascular, tendon & nerve deficits & refer appropriately.
1. Analgesia with digital block, local infiltration, nerve blocks, Bier’s block or IV analgesia,
2. X-Ray if there is possible bony injury or foreign body (consider USS),
3. Clean open injuries & remove all debris,
4. Suture with a 5-0 non-absorbable material,
5. Antibiotics if extensive wounds or “open” fractures,
6. Splinting in neutral position with arm elevated,
7. All wound should be reviewed by medical officer within a couple of days,
8. Sutures should be removed after 5-7 days, longer if over extensor surface of joint.
Fingertip skin loss:
If small, treat with non-adherent dressings, changed every couple of days.
Larger areas of skin loss,or where there is none exposure, should be referred to general surgical
or plastics specialists.
Remember failure to flex at the;
· DIPJ = Divided flexor digitorum profundus,
· PIPJ = Divided flexor digitorum superficial &
· The IPJ of the thumb = Divided flexor pollicus longus.
Tendon injuries should generally all be repaired by a Plastic/orthopaedic surgeon, preferably within
24 hours. Partial extensor tendon division (up to 80%) may be treated by splinting after discussion
with medical officer/ “Plastics”.
Digital Nerve injury:
Operative repair for thumb, ulna border of hand, distal index finger & digits of dominant hand unless
distal to the DIPJ.
Palmar surface infections & tendon sheath infection: Elevate, splint, Flucloxacillin with early review
as might need incision for drainage