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trauma_hand

the injured hand

referring patients to the plastics registrar

  • first indicate what YOU think is the diagnosis as this helps set a framework for the receiving doctor's thought processes
  • patient's age, fasting status, occupation and dominant handedness
  • mechanism and timing of injury
  • whether or not the injury is covered by an insurance scheme such as TAC, WorkCare as this may allow other options of referral for definitive management
  • examination findings, in particular:
    • xray findings - most patients with a hand injury severe enough for plastics referral warrant an Xray to exclude fracture or FB
    • if fracture, describe it and whether it is open (associated wound nearby) or closed
    • describe fingers by their name not number, ie. thumb, index, middle, ring, little
    • describe phalanges by their name (proximal, middle or distal), or by number (P1,P2 or P3 respectively)
    • describe joints by their name (eg. MCP, PIP, DIP joints, or on the thumb, just interphalangeal joint)
    • extent of open wound including any visible structures in its base
    • assessment of:
      • tendons
      • nerve supply
        • if digital artery is bleeding then digital nerve is also likely to be injured and will generally require exploration in theatre
        • if possible ulnar nerve injury, test Froment's sign (adduction power of the thumb)
        • if possible median nerve injury, test abduction of the thumb (this is NOT extension!)
        • if possible radial nerve injury, test extension of fingers and sensation over dorsum of hand
      • arterial supply (consider Allen's test)
    • if partial amputation, viability of amputated part
    • if full amputation, is the amputated part available and has it been placed in a plastic bag which is inside a plastic bag containing ice to reduce risk of ischaemic necrosis
trauma_hand.txt · Last modified: 2013/07/03 04:01 by gary1