HandSurgeryforTrauma

《HandSurgeryforTrauma》由会员分享，可在线阅读，更多相关《HandSurgeryforTrauma（59页珍藏版）》请在装配图网上搜索。

1、Hand Surgery for TraumaMr CW Oliver FRCS(Tr&Orth)DMTypes of handNormal hand positionPosition of restHand-oedemaPosition of immobilisationHand functional positionsElevation?Missed Upper Limb InjuriesHand incisionsHand incisionsNormal alignment and rotational deformityHand FracturesMetacarpal fracture

2、:transverseHand Fracture TreatmentMetacarpal fracture:obliqueBoxers fractureInter articular FractureBlade Plate Fixation Phalanx Epiphyseal fractureBennetts fractureRolando fractureScaphoid waist fractureUnstable scaphoid non-unionHook of Hamate FractureLunate dislocationScapholunate dissociationPIP

3、J dislocationVolar avulsionMCPJ dislocationUCL sprainUCL ruptureBony UCLMallet deformityFlexor tendon injuryZones for tendon repairMethods of tendon repairProfundus AvulsionOpen fractures-classificationzType Itidy wound 2cm;soiledzType IIIBIIIA+periosteal strippingzType IIICneurovascular damageSever

4、e hand injury surveyzBlood supplyzStable skeletonzViable skin coverzBasic functionzOccupationSerious hand trauma-after debridementzLongitudinal/extensile exposureszCompartment decompressionzSkeletal alignment/fixationzMusculo-tendon repairzVessel repair/graftzNerve repairReplantation-indicationszAll

5、 amputations at the level of the arm,forearm,carpus and metacarpuszAll amputations of thumb prox to mid distal phalanxzIn multiple digits replant as many as possiblezMost digits amputated distal to prox phalanxzChildrenzThink about avulsed digits and crushed distal partsHand Replantationz7 months of

6、f workz50%get only protective sensationz50%range of movementz60%need 2 operationszMedical cost 5-15 times amputationNerve RepairzPartial nervezFull nervezRegrow at 1mm per dayzSplintagezrehabilitationHand InfectionzBacterialzViralzFungalzProtozoalz64%grow multiple organismsHand Infection:anatomical

7、compartmentszNail fold(paronychia)zPulp spacezTendon sheathzWeb spacezDeep palmar spacezSeptic arthritisInfection:historyzOccupationdentists/nurses(H Simplex)barbers(pilonidal sinus)water(m.marinum)zSystemic diseaseHIV,diabetes,immunocompromisezPrevious injury(human)bite,needle stickInfection:histor

8、yzTime lapsecellulitis24 hours tendon sheath48 hours web space deep palmdays paronychia pulp space4-5 days septic arthritis2 weeksWeb space infectionDeep palmar infectionCollar stud abscessInfection:tendon sheathzFinger in slight flexionzUniformly red and swollenzIntense pain on attempted extensionz

9、Tenderness along line of sheathDrainage of tendon sheathDrainage of mid-palmar spaceInfection:septic arthritiszUsually secondary to human bitezSwelling out of proportion to inflammationzRestricted motionzInstabilityzDischarging sinuszX-ray changes(2/52)ParonychiaPulp space infectionHerpetic whitlowHand trauma and IV Drug Abuse