Approach to traumatic hand injuries for primary care physicians

Abstract

Objective: To review the initial management of common traumatic hand injuries seen by primary care physicians.

Sources of information: Current clinical evidence and literature identified through MEDLINE electronic database searches was reviewed. Expert opinion was used to supplement recommendations for areas with little evidence.

Main message: Primary care physicians must routinely manage patients with acute traumatic hand injuries. In the context of a clinical case, we review the assessment, diagnosis, and initial management of common traumatic hand injuries. The presentation and management of nail bed injuries, fingertip amputations, mallet fingers, hand fractures, tendon lacerations, bite injuries, and infectious tenosynovitis will also be discussed. The principles of managing traumatic hand injuries involve the reduction and immobilization of fractures, obtaining post-reduction x-ray scans, obtaining soft tissue coverage, preventing and treating infection, and ensuring tetanus prophylaxis.

Conclusion: Proper assessment and management of traumatic hand injuries is essential to prevent substantial long-term morbidity in this generally otherwise healthy population. Early recognition of injuries that require urgent or emergent referral to a hand surgeon is critical.

Figures

Figure 1

Right middle finger injury following an accident with a paint gun.

Figure 2

Fingertip injury:A) Dorsal view; healing might occur by secondary intention. B) Healed fingertip 3 months later.

Figure 3

Mallet finger deformity with associated avulsion fracture:Clinical photo (left) and lateral x-ray scan (right).

Figure 4

Unicondylar fracture of the proximal phalanx

Figure 5

Oblique fracture of the proximal phalanx:Anterior-posterior (left) and lateral (right) views.

Figure 6

High-pressure injection injury to middle finger:A) Intraoperative. B) Under magnification.