| INJURY SITE |
TYPICAL MECHANISM |
PITFALLS / COMPLICATIONS |
ED / MIU / UCC TREATMENT |
FOLLOW-UP |
| 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 |
