hand injuries. priorities 4 function, function, function! 4 must be able to test sensory, motor and...
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Hand injuries
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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.
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Know the location of all important deep structures
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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
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Method for sterile field and exsanguination of digit
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Why a “fight bite”, even seen early needs exploration. Hidden tendon injury and joint violation
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Anatomy of finger nail
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“Trap door” will have associated nail bed injury and probable open fracture
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Remove nail with blunt dissection with iris scissors then pull with clamp
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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
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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)