Hand & Wrist Trauma Management

✋ Hand & Wrist Trauma Management

Hand and wrist trauma is common and can involve bones, joints, tendons, ligaments, nerves, blood vessels, and skin. Due to the complexity and functional importance of the hand, prompt and precise treatment is essential to restore full function and prevent long-term disability.

🚨 Types of Hand & Wrist Trauma

🦴 Bone Injuries

Fractures:

Distal radius: Most common wrist fracture.

Scaphoid: High risk of nonunion due to poor blood supply.

Metacarpals & phalanges: Can cause rotational deformities if not aligned.

Dislocations:

Often involve PIP joints, carpometacarpal joints (especially thumb).

Crush Injuries:

May involve multiple structures—bone, soft tissue, and nerves.

🧵 Tendon Injuries

Extensor tendons: More superficial, easily lacerated.

Mallet finger, Boutonnière deformity if not treated properly.

Flexor tendons: More complex due to multiple pulleys in the fingers.

Require precise surgical repair and structured rehab.

🧠 Nerve Injuries

Often accompany lacerations or crush injuries.

Median, ulnar, and radial nerves commonly involved.

Symptoms: Weakness, numbness, paresthesia.

Early microsurgical repair or grafting if needed.

🩸 Vascular Injuries

Involve digital arteries or radial/ulnar arteries.

May cause ischemia or compromise replantation.

Require microsurgical repair in severe cases.

🧬 Soft Tissue & Skin Loss

Lacerations, degloving injuries, or burns.

May need skin grafts, local flaps, or free tissue transfer for coverage.

🩺 Initial Assessment & Management

Primary Survey (Trauma Protocols)

Follow ATLS principles for polytrauma.

Ensure life-threatening injuries are addressed first.

Focused Hand Evaluation

Inspect for deformity, wounds, swelling.

Neurovascular status: Check sensation and capillary refill.

Tendon testing: Active flexion/extension of joints.

Imaging:

X-rays (AP, lateral, oblique)

CT or MRI for complex cases (e.g., scaphoid, ligamentous injuries)

🧰 Definitive Management

🔹 Fractures & Dislocations

Closed reduction and splinting for simple injuries

ORIF (Open Reduction Internal Fixation) for displaced or unstable fractures

External fixation for complex or contaminated injuries

🔹 Tendon & Nerve Repair

Timing is critical—early repair within 1–2 weeks preferred

Microsurgical techniques for nerves and flexor tendons

Tendon grafting or transfers for delayed repairs

🔹 Soft Tissue Coverage

Use skin grafts, local flaps (e.g., thenar flap), or free flaps

Vacuum-assisted closure (VAC) may help in wound management

🔹 Infection Control

Debridement of open wounds

Broad-spectrum antibiotics for contaminated or bite injuries

Tetanus prophylaxis as needed

🧠 Rehabilitation & Recovery

Early Hand Therapy

Supervised by certified hand therapists (CHTs)

Focus on range of motion, strengthening, and function

Splinting: Static or dynamic splints based on injury

Complications to Avoid

Stiffness or contracture

Malunion or nonunion

Chronic pain (CRPS)

Loss of fine motor skills

🧑‍⚕️ Specialist Involvement

Hand surgeons (orthopedic or plastic)

Occupational/physical therapists

Reconstructive microsurgeons (for complex or avulsion injuries)

🧭 Key Goals of Trauma Management

Restore form, function, and sensation

Minimize pain, infection, and stiffness

Return to daily activity, work, and recreation safely