25. Treatment
• Closed manipulation and
Plaster cast
• Closed manipulation &
percutaneous fixation
• Open reduction and
internal fixation
26. Fracture metacarpals
• All ages
– Fracture through the base
– Fracture to the shaft
– Fracture to the neck
• Boxer’s fracture
• Auto immobilisation
• Dorsal slab
27. Fracture phalanges
• Fall of heavy object or crush injury
• Undisplaced
Displaced
• Strapping
• Open reduction
31. Paronychia
• infection of the finger that involves the tissue
at the edges of the fingernail
• superficial and localized to the soft tissue and
skin
• most common bacterial infection seen in the
hand ( staph; strep).
32. Paronychia treatment
• wound care alone.
• collection of pus - drain.
– a simple incision over the collection of pus to allow
drainage.
– scalpel may be inserted along the edge of the nail to
allow drainage.
– If the infection is large, a part of the nail may be
removed.
• oral antibiotic.
• wound care at home.
33. Felon
• infection of the fingertip.
• This infection is located in the fingertip pad
and soft tissue associated with it.
34. Felon treatment
• incision and drainage
» incision will be
made on one or
both sides of the
fingertip.
» break up the
compartments
» gauze will be
placed into the
wound to aid
the initial
drainage.
» flush out with a
sterile solution
• antibiotics.
35. Herpetic whitlow
• infection of the fingertip area caused by
herpes simplex virus type I or II
• This is the most common viral infection of the
hand.
• This infection is often misdiagnosed as a
paronychia or felon.
36. Herpetic whitlow treatment
• Antiviral drugs
• Pain medication.
• wound must be properly protected to prevent
a secondary bacterial infection
• Incision and drainage is not recommended.
37. Cellulitis
• superficial infection of the skin and underlying
tissue.
• usually on the surface and does not involve
deeper structures of the hand or finger.
• Staph and strep.
39. Infectious flexor tenosynovitis &
Deep space infection
• infection involves the tendon sheaths and
deep spaces
• penetrating trauma that introduces bacteria
• surgical emergency and will require rapid
treatment with IV antibiotics.
40. Kanavel’s cardinal signs
• intense pain
– along the course of tendon with extension
– this is the earliest and most important sign
• flexion posture
• uniform swelling
• percussion tenderness along the course of the
tendon sheath
47. • Wrap the dental floss around your finger, up
to your knuckle
48. • Unwind the dental floss, beginning at the
bottom of the finger
49. Do’s & Don’ts
Do’s
Don’ts
Examine hand carefully
Do not incise every infected digit
Think of other diagnosis
Do not make puncture incisions
Wait for abcess to localize
Do not injure digital vessels or nerves
Place adequate depth and length of
incisions
Do not place incisions crossing the
creases
Immobilise, elevate the hand
Do not close bite wounds
Antibiotics & proper dressings
Do not forget pus culture and
sensitivity
Notas del editor
Edward Hallaran Bennett (9 April 1837, Charlotte Quay, Cork – 21 June 1907, Dublin) was an Irish surgeon remembered for describing Bennett's fracture. He studied at Trinity College, Dublin of theUniversity of Dublin, graduating M.Ch. in 1859 and M.D. in 1864. He was professor of anatomy and surgery at Trinity College from 1873-1906. He studied fractures, dislocations and bone diseases, recording them at the Pathology Museum at Trinity College. He described his eponymous fracture at the British Medical Association meeting in Cork in 1880.[1] He is said to have introduced antiseptictechnique to Dublin, and became president of the Royal College of Surgeons in Ireland.[2]