Traumatic Hand Injuries
The structures of our musculoskeletal system – the bones, joints, ligaments, tendons and other tissues – are highly susceptible to damage caused by trauma from accidents, injuries and other events. These traumatic events may include a fall, automobile accident or sports injury, and one or both hands are often involved. The trauma can cause pain, swelling, inflammation and other sometimes serious complications. Any bones that have been fractured need to be healed and joints may need to be realigned in order to maintain proper function and optimize their use.
The hands are a particularly common site for traumatic injury because they are so often in use. For that same reason, it is essential to treat any injury to the hands promptly and completely to ensure that maximum mobility and functionality are restored.
Treatment for accidents or injuries can vary depending on the type and severity of the trauma to the hand. Most treatment courses usually begin with conservative methods and only consider surgery as a last resort. Physical rehabilitation may be needed in order to restore movement and function to the affected hand as it heals.
A fracture is defined as any type of break or crack in the bone. This can range from a small crack to a complete separation when it results from a traumatic event. Fractures cause pain, swelling and bruising in the affected hand, which often worsens when pressure is applied. Your doctor can diagnose a fracture often just with a physical examination, although an X-ray or CT scan may be performed to confirm the diagnosis and determine the severity of the fracture.
A laceration is a certain type of skin wound with jagged, irregular edges. Lacerations are common injuries that often occur from the skin coming into contact with a sharp object. Lacerations typically involve bleeding, redness, swelling, pain, tenderness and other symptoms. The hands are a frequent location for lacerations caused by accidents or falls.
The main goal of laceration repair is to stop the bleeding and stabilize the patient if he or she is feeling faint. Laceration repair usually includes cleaning and preparing the wound, before closing it with stitches, staples, special surgical glue or adhesive strips. Follow up care may be required to remove the closure material and monitor the healing process. Most lacerations heal successfully with no complications.
For hand lacerations, your physician will check to determine whether a tendon was affected. A tendon laceration involves an injury to the flexor tendon, the long tissues that stretch the length of the fingers and connect the muscles to the bone, allowing the finger to move. Tendon lacerations are most often caused by a cut on the finger that damages the tendon, which is located just under the surface of the skin.
Surgical Repair of Traumatic Hand Injuries
While some traumatic injuries can be cared for nonsurgically with a splint, cast or another stabilizing device, many require a surgical procedure to ensure that complete healing can occur. This may involve traditional or minimally invasive surgery, reconstruction of the soft tissue, transplantation of a muscle or joint, bone grafting or several other types of treatment methods.
Surgical care is often necessary for treating acute fractures and serious musculoskeletal injuries. In addition, deformities can result from a nonunion, which is the failure of a fracture to correctly unite, or a malunion, which is when a bone is not aligned correctly, and these conditions will usually necessitate trauma surgery. Open fractures with wounds also require surgery to repair the damage and close the wound properly. Treatment for fractures aims to heal the bone so that it is properly aligned and able to function once again.
In cases of soft tissue injury, the surgeon will focus on reconstruction of the damaged area of the hand. A grafting procedure may be performed, in which bones, nerves or other tissue from healthy areas of the body are transferred to the injured hand and carefully attached. Other traumas require a flap surgery in which blood vessels, muscle, fat and skin tissue are taken from a healthy area of the body and placed in flaps created in the hand for support and to enable reconstruction. Microvascular reconstruction can restore the blood flow to the injured tissue and maintain its health.