trauma_hand
the injured hand
see also:
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 127.0.0.1