Makindo Medical Notes"One small step for man, one large step for Makindo" |
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INJURY SITE | TYPICAL MECHANISM | PITFALLS / COMPLICATIONS | ED / MIU / UCC TREATMENT | FOLLOW-UP |
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Triquetral # (small flake, best seen lateral) | 🤕 Hyperextension of wrist | ✅ Full function usually restored | 🩹 Futura splint or POP for pain relief | 📄 Discharge with leaflet or 📅 fracture clinic if POP given |
Lunate dislocation | 🤕 FOOSH, 🚗 high-speed RTC | ⚠️ May be missed – suspect if severe swelling but no obvious fracture | 🩹 Splint or POP for pain | 🚨 Immediate ortho referral → reduction & fixation |
1st Metacarpal Base – Bennett’s # (may extend into joint) | 👊 Longitudinal blow (boxing) or forced abduction | ⚠️ Often unstable if intra-articular → fixation needed | 🩹 POP if no joint extension. 📸 Check X-ray in cast | 📅 Hand clinic. 🚨 Immediate ortho if intra-articular or displaced |
Ulnar Collateral Ligament (Gamekeeper’s / Skier’s thumb) | 🤕 Forcible abduction | ⚠️ Missed injuries → permanent disability. Test laxity (‘give’). | 🩹 Scaphoid backslab (❌ not Elastoplast spica) | 🚨 Immediate referral if avulsion / obvious laxity. 📅 Hand clinic if uncertain |
5th Metacarpal Neck (Boxer’s #) | 👊 Punch injury | ⚠️ “Fight bite” infection risk | 1️⃣ Closed: Angulation ≤40° → Buddy strap + analgesia. 2️⃣ Open/bite: Washout + antibiotics + buddy strap | 1️⃣ 📄 Discharge leaflet. 2️⃣ 🚨 Immediate ortho referral |
5th MC Shaft | 🤕 Blow / trauma | ⚠️ Check rotation | 🩹 POP | 📅 Hand clinic |
Other Metacarpals | 🤕 Blow to hand (common all ages) | ⚠️ Shortening / rotation. 📸 Lateral XR to assess base displacement | 1️⃣ Acceptable → Buddy strap + early mobilisation. 2️⃣ Some displacement → POP (ulnar gutter, MCP 90° flex). 3️⃣ Severe → Ortho referral | 1️⃣ 📅 Fracture clinic. 2️⃣ 📅 Hand clinic. 3️⃣ 🚨 Ortho referral |
Phalanges (proximal & middle) | 🤕 Usually simple, undisplaced | ⚠️ May angulate (intrinsic muscle pull). Beware rotation | >10° angulation → correct under ring block. 🩹 Buddy strap over roll bandage | 📅 Hand clinic |
Terminal phalanx | 🤕 Direct blow or laceration | ⚠️ Open #, displaced, nailbed injury | 1️⃣ No bony injury → Clean + strap. 2️⃣ Open # → Washout + antibiotics (❌ don’t close wound). 3️⃣ Closed # → Buddy strap. 4️⃣ Nail bed/fold injury → Clean + replace nail | 1️⃣ 📄 Discharge. 2️⃣ 🚨 Immediate hand surgeon. 3️⃣ 📄 Discharge. 4️⃣ 🚨 Immediate referral |
Mallet finger (soft tissue) | 🤕 Forced flexion of extended finger | ⚠️ Dropped fingertip | 🩹 Mallet splint × 6 weeks | 📄 Discharge with leaflet + GP/hand physio FU |
Mallet finger (with avulsion #) | 🤕 Forced flexion | ⚠️ Risk of non-union | 🩹 Mallet splint | 📅 Hand clinic in 1 week + leaflet |
MCP & IP Joint Dislocations | 🤕 Usually hyperextension | ⚠️ Look for associated head/neck #s | 🔧 Reduce under LA/entonox. 🩹 Buddy strap + post-reduction XR | 📅 Hand clinic. 🚨 Ortho referral if irreducible |
Cuts / Wounds | ✂️ Various | ⚠️ Nerve, tendon, artery injury. ⚠️ Palm lacerations → contracture risk | ✍️ Document neurology before LA. 1️⃣ <1/3 tendon width + normal power → Washout + close + buddy strap. 2️⃣ >2/3 tendon width / weak → Washout + non-adherent dressing. ⚠️ Artery: if bleeding >5 mins despite pressure, suspect partial arterial injury | 🚨 Nerve injury → Immediate referral. 1️⃣ 📅 Hand clinic. 2️⃣ 🚨 Ortho referral. ⚠️ If distal ischaemia: < elbow → Ortho. > elbow → Vascular team |
🐶 Bites | ⚠️ Infection of deep structures | 🧼 Clean + irrigate thoroughly | 📞 Discuss all bites below elbow with ortho team | 📅 Hand clinic or 🚨 ortho depending on depth |
📌 Exam Pearls: – Boxer’s # → always check for “fight bite”. – Bennett’s # → unstable, intra-articular → ortho referral. – Mallet finger → splint 6 weeks, even small bony flakes. – Lunate dislocation → often missed, look for “spilled teacup” sign on XR. – UCL injury (Skier’s thumb) → test laxity carefully → missed cases → permanent disability.