Hand injuries

Priorities

Function, Function, Function! Must be able to test sensory, motor and

tendon function. Should be able to draw a cross-section of wrist. If tendon, nerve or vascular injury, consult.

Know the location of all important deep structures

Priorities

Adequate coverage of important structures Consider if simple repair of laceratons

crossing joint will lead to limiting contracture

Must know proper bandaging and splinting

Method for sterile field and exsanguination of digit

Why a “fight bite”, even seen early needs exploration. Hidden tendon injury and joint violation

Anatomy of finger nail

“Trap door” will have associated nail bed injury and probable open fracture

Remove nail with blunt dissection with iris scissors then pull with clamp

Use cleaned whole nail as dressing, base under cuticle to prevent nail matrix to eponychium adhesion. If nail not possible, adaptic or foil from suture package

After nail removal

Irrigate open wound carefully, remove foreign material,

Debride conservatively if at all, very little excess tissue for repair

Close nail bed laceration with 6-0 absorbable (eccentric hand guys would use 8-0 and loops, If you try this you will need very fine instruments, such as castro-viejo driver and tying forceps)