Hand Injuries
NB Hand injuries are important. Closed hand fractures requiring surgery are referred to Ortho On-call. Open fractures with potential tendon and nerve injuries are referred to the Plastic surgeons. If you think a fracture may need surgery - ask advice.
Metacarpal injuries
Fracture dislocation base of 1st M.C.(Bennett's #, Rolando #)
Refer to Ortho On-call.
Fracture base 1st M.C. not involving joint
POP slab including thumb. Refer Virtual Fracture Clinic (VFC).
Fracture neck 5th M.C. (Boxer's #) (& less commonly of other M.C.'s)
Check for rotational deformity. Position usually acceptable.
Tubigrip/ Futura splint and buddy strapping. Encourage finger exercises.
If no rotational deformity D/C or ED review clinic 1-2 weeks.If rotational deformity refer to VFC. If angulation >45o refer Ortho On-call.
Other undisplaced MC fractures
Usually well splinted by neighbouring bones so: tubigrip/ Futura splint
Encourage finger exercises.
Refer VFC.
Severely displaced M.C. fractures
Multiple M.C. fractures
Refer Ortho On-call.
Metacarpophalangeal joint (MCPJ) injuries
Dislocation 1st MCPJ
Reduce, Check ulnar collateral ligament.
Thumb splint.
Refer VFC.
If irreducible - refer Ortho On-call.
Ruptured ulnar collateral ligament
Refer Ortho On-call.
Sprain 1st MCPJ
Exclude instability
Advise mobilise
Thumb spica if necessary for symptoms
Review clinic 2 weeks if follow up needed
Dislocation other MCPJ
Rare - ask advice
Fractures of the phalanges (PP)
Undisplaced fractures (Check for rotational deformity)
Neighbour strapping.
Refer VFC.
Displaced fracture
Refer Ortho On-call.
Epiphyseal fracture base PP
Reduce (local infiltration of LA)
Re-X-ray. Buddy strapping
Refer VFC.
Injuries of the PIP joints
Dislocation PIPJ
Ring block, reduce, check stability, Re-X-ray. Buddy strapping.
Refer VFC.
Sprain of PIPJ
Buddy strapping. Encourage mobilisation
Review Clinic 1-2 weeks if needed.
Volar plate injuries
Large fragment with significant intra-articular component refer Ortho On-calll.
Small avulsion, buddy strapping and refer Hand OT.
Finger tip injuries
Dislocated DIPJ
Reduce, test stability, re-X-ray
If stable - no splintage required. Refer VFC.
Epiphyseal fracture base D.P.
Undisplaced Mallet splint and refer VFC.
Displaced Reduce (digital nerve block)
Replace nail under nail fold.
DO NOT remove the nail unless absolutely necessary
If open wound give antibiotics
Mallet splint. Review clinic 5 days.
Other fractures of the D.P.
If subungual haematoma - trephine, and Flucloxacillin (as have made compound)
Mallet finger
X-ray
If no fracture or small avulsion Mallet splint and refer Hand OT
If intra-articular fracture >25% refer Ortho On-call.
Tendon & Nerve Injuries in the Hand
-- Closed tendon injuries --
Extensor tendon central slip rupture (Boutonnière deformity)
Splint
Refer Hand Surgery service
Closed rupture flexor tendons
Refer Hand Surgery service (usually FDP)
Closed EPL rupture
Refer Hand Surgery service
-- Open tendon injuries --
Extensor tendons PARTIAL division
If > 50% refer Hand Surgery service.
If < 50% ask advice
COMPLETE division
Refer Hand Surgery service
Flexor Tendon injuries
Refer Hand Surgery service
Open nerve injuries
Refer Plastic surgeons