the injured hand

see also:

• animal bites
• cellulitis
• removal of embedded fish hooks
• burns
• paediatric lacerations
• local anaesthetic agents
• fractures of the metacarpal
• fractures and dislocations of the fingers
• high pressure fluid spray / hydraulic injury

• 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