Form follows function in the hand; therefore, any injury to the underlying structures of the hand carries the potential for serious handicap. To reduce this risk, even the smallest hand injuries require a good medical evaluation and treatment. Hand injuries can be divided into 5 general categories, which are listed below. If you are suffering from a hand trauma, you should immediately seek an appointment with one of our hand and arm surgeons, who will help diagnose the type and severity of your injury as well as the best course of treatment.
Upon presentation, our doctors check laceration wounds to evaluate the depth or involvement of nerves, arteries, muscles and tendons. Simple lacerations are dealt with by numbing, cleansing and then repairing the wound. Dressings are added if needed, as well as pain medication, antibiotics or tetanus shots. Our surgeons can also treat more serious injuries such deep cuts, animal bites, and human bites (or “fight bites”). Some of these wounds may initially appear to be minimal, but because they carry a high risk of infection, they should be treated with care by an experienced physician.
Dislocations and Fractures
Dislocations are the result of injuries to the ligaments around joints. In a dislocation a bone is displaced out of normal position resulting in obvious deformity, pain, and decrease in mobility. When a dislocation occurs, the doctor will evaluate the injury to ensure there are no fractures or bone breaks. Dislocated bones must be put back in place. This process is called reduction, and it can be accomplished by external manipulation of the injured area (closed reduction) or by surgery (open reduction). All require follow-up care after a period of immobilization, usually with a splint or cast. The goal of treatment is to preserve the function and stability of the joint. Fractures of the hand and wrist are fairly common. Most fractures heal well if treated in a timely and appropriate manner. Some injuries may require a series of X-rays over a couple of weeks. The small bones and complex structure of the hand make some fractures difficult to detect. The treatment of fractures depends a number of factors including the severity of the crack or break, whether joints are involved, the location of the specific bone injured, the amount of deformity (displacement), and if there is a laceration associated with the fracture. Children’s bones are still growing and so are susceptible to fractures involving the soft areas where the bone growth is actually occurring (growth plate). Some of these growth plate injuries are difficult to diagnose because they do not show up on X-rays. Injuries near the growth plate areas of a child’s hand therefore may need to be treated as fractures (even with normal X-rays. Treatment of a recent fracture rarely includes an enclosed cast. Fractures and other injuries that require immobilization are often splinted on one side to prevent compression injuries from a cast that goes around the whole hand. A splint allows room for the swelling associated with acute injuries, which may prevent the loss of adequate circulation or nerve injury.
Soft Tissue Injuries and Amputations
These injuries can be devastating to the hand. Reattaching (replantation) is difficult and even if successful may cause long-term problems with pain and infection. Replantation is most successful in thumb amputation, amputation of multiple fingers or the entire hand, or amputations involving a child. Crush or tear injuries and prolonged delay before evaluation may make successful replantation impossible. Each injury requires an immediate evaluation because each person’s circumstances warrant all possibilities to be considered. The type, location, extent, person’s wishes, and time of injury all contribute to the treatment plan. Some injuries will require immediate surgery for replantation. Others will require little medical intervention beyond cleansing, bandaging, and giving the injury time to heal.
Fingertip and nail infections may be treated with incision and drainage (if indicated), antibiotics and close follow-up. A major consideration for an infection in the hand is the presence of a fluid collection or an abscess. If the infection is isolated to the skin, known as cellulitis, treatment involves antibiotics and close follow-up. However, an abscess requires drainage (sometimes known as “lancing”). If the abscess is large or near nerves, arteries, ligaments or tendons, it may need to be treated in the operating room. Hand infections have the potential for rapid progression leading to severe loss of function and should be dealt with at the first sign of infection.
Serious burn injuries to the hand require an evaluation by a hand or burn surgeon. Our hand and arm surgeons will evaluate your injury and decide whether hospital admission is required for treatment. Multiple operations including skin grafting may be needed in order to ensure the best outcome. There are degrees of burns from 1st to 3rd degree, which are each treated with a different level of care. In addition, there are different types of burns such as chemical burns, electrical burns, and cold injuries that require different types of care from a traditional fire burn. Our hand and arm surgeons will evaluate and treat your specific injury and monitor you to ensure the best outcome. The surgeons and staff at The Face & Body Center are available to discuss any questions you may have by calling 866-939-4999 or 939-9999 in the Jackson Metro Area.