Lu IV March2014 combined ue and hand trauma principles2

0 %
100 %
Information about Lu IV March2014 combined ue and hand trauma principles2
Health & Medicine

Published on March 9, 2014

Author: docnats


Introduction to Trauma of the Hand and Upper Extremity Nathaniel S. Orillaza Jr., MD Leo Daniel Caro, MD Section of Hand and Micro Surgery Department of Orthopedics Philippine General Hospital

Scope • • • • Principles Unique Concerns Sample Cases NOT o Anatomy details o Comprehensive review of injuries

Upper Extremity • Motion and Precision

Upper Extremity • manipulate the environment and hold our tools

Upper Extremity • Prone to injury

The Hand 1. Complex anatomical unit

The Hand 2. Practical applied anatomy related to basic functions of the Hand.

The Hand • 1. Power grip / crude grasp • 2. Prehensile grip a. Lateral/ Key pinch b. Tip pinch c. Chuck pinch • 3. Tactile gnosis“Eye” of the hand

Burden • 1/3 all acute injuries seen in emergency rooms • 2/3 occur to individuals in their working years. • >1/4 of all disabling work injuries

Who you gonna call? Injured Hand (100%) GP – Tx 10% Residents/ GS – Tx 30% Refer 50% ER MD/ GS – Tx 40% Refer 20% ORTHOPOD– Tx 15% Refer 5% HAND SURGEON

Musculoskeletal Trauma Basics • Fracture o Soft tissue injury complicated by o a break in the bone

Musculoskeletal Trauma Basics • Fracture o Soft tissue injury complicated by o a break in the bone

Musculoskeletal Trauma Basics • Soft tissue injuries oIntegument (Laceration, Avulsion) oMuscle/tendons (Strain, Transection, Avulsion) oLigaments (Sprain, Transection, Avulsion) oVascular (Sharp/Blunt, Complete/Incomplete) oNeurologic (Neuroplraxia/Axonotmesis/ Neurotmesis, High/Low)

Musculoskeletal Trauma Basics • Soft tissue injuries oIntegument oMuscle/tendons oLigaments oVascular oNeurologic

History • Age/Sex, Handedness, Occupation • DOI, TOI o “Golden period” • POI o Environment • MOI o Anticipate degree of injury

History • Mechanism of Injury o FOOSH o Crushing (Doors, Machines) o Vehicular crash (Motorcycle!) o Sharp (Hacking, Industrial) o Gunshot

Physical Examination • Quick and Concise • Identify “big” problems • Detailed examination done when patient is more comfortable

Inspection • Swelling • Deformity • Discoloration o Red –Alive o White – Threatened o Blue – Congested

Inspection • Wounds o and anatomic correlation

(Gentle) Palpation • Masses • Tenderness • Crepitus • Irregular movements • Temperature

Sensory Evaluation • Light touch/“Autonomous Zones” • Non-cooperative o Sweat/Tactile Adherence o Wrinkling • 2-pt discrimination – not very helpful • NO Provocative tests in acute conditions eatonhand,.com

Motor Evaluation • • • • Posture/Attitude- not always reliable Have patient move a part (useful but less specific) Have patient hold a position Intrinsic vs. Extrinsic Muscles ???

Evaluation of the Tendons • Hand Posture/Tenodesis Effect o normal cascade when a relaxed hand is supinated/pronated o Not always accurate

Evaluation of the Tendons • Individual testing (if patient can tolerate)

Management Principles

Management Algorithm Life NO NO Limb Limb Threatened? YES Limb Limb Stable?? Stable NO NO Threatened? Threatened? Resuscitate YES YES Amputate! Amputate! Reconstruct Reconstruct Revascularize Revascularize NO NO YES YES Limb Limb Function?? Function YES YES NO NO Fix Bone/Muscle Fix Bone/Muscle

Life vs. Limb • Vascular injury o May be life threatening in the acute stage o Incomplete injury to large arteries/veins • Injuries to vital organs • Medical co-morbidities

Stable NO Limb Limb Stable? NO Threatened? YES Amputate! Reconstruct Revascularize NO YES Limb Function? YES NO Fix Bone/Muscle

Prob #1: Limb Survival

Prob #2: Limb Stability

Prob #3: Function

Treatment Modalities

Treatment Modalities • Combination

Treatment Modalities • Antibiotics – preventing infection in open injuries • Analgesics – comfort while awaiting further management/healing* • Steroids • Vitamins/Supplements

Treatment Modalities • Immobilizers

Treatment Modalities Fixators/Implants

Treatment Modalities Fixators/Implants

Treatment Modalities • Gadgets

Treatment Modalities • Special Techniques

Treatment Modalities • Aftercare/Rehabilitation o Often underappreciated phase of treatment o Any method of surgical or non-surgical intervention is only half the battle o Timely rehabilitation is essential

Consequences of Improper or Inadequate Management

Delayed Treatment

Inadeqaute Evaluation • Assumed closed injuries

Neglected Open Fracture • Progressive infection • Amputation • Death

Wound at the ER • OPEN ALL DRESSINGS/SPLINTS! • No harmful solutions • Copious irrigation o Ongoing study in open fractrures is promising

Wound Dressing

Iatrogenic Ischemia

Wound Dressing • Dressing o Well padded, fluffy o Avoid circumferential o Interdigit dressing • prevent maceration o Minimize adhesives

Inadequate Planning • Wrong incisions

Planned Incisions • according to principles

Improper Aftercare • Comfortable Position

Anticipatory Immobilization • Safe Immobilization


Add a comment

Related presentations

Related pages

GABuyer Europe March 2014 by AvBuyer Ltd. - issuu

GABuyer Europe Magazine, ... FC March2014_FC December 06 06/02/2014 15:41 Page 1. ... "Think of the combined experiences and wisdom of these men and women, ...
Read more

Shapes - Магазин кальянов КАЛЬЯНЫ.ру

... recovering from a broken hand. Имя: Angelina (07.02.2015 20:01:34) ... GTA: San Andreas and Red Dead Redemption combined. ...
Read more

Charlotte sun herald - UFDC Home

Charlotte sun herald ... the Sarasota and Charlotte county sheriffs ofces and the Punta Gorda Police Department have combined ... W itness my hand ...
Read more