Hands being the most used part of the body are prone to injuries that can be simple or complex. The complex injuries may result from fall, accidents, fights, crush injuries or twisting injuries. They may include hand fractures, tendon and ligament injuries, loss of tissue that can be either soft or bony or both, joint dislocations or amputations etc.

SYMPTOMS

• Bleeding
• Wound
• Pain and tenderness
• Swelling
• Obvious deformity
• Loss of hand movements
• Numbness 

DEFECTS

The resulting defects range from soft tissue loss to deformity of hand due to fractures, inability to move fingers or hand due to tendon or nerve injuries, loss of sensations and bony defects or a combination of these.

PROCEDURE REQUIRED

Depends upon the components involved:

Lacerations or wounds that can be closed primarily are treated with stitches. Those with tissue loss are treated by either grafting (borrowing skin) or flaps (borrowing missing tissues) from some other site.

Fractures can be managed either conservatively or by fixation. If bone is missing, either it needs to be borrowed from some other site or repaired by means of synthetic substitutes. 

The damaged structures like tendons, nerves and vessels need to be repaired primarily or by borrowing similar tissue from some other part of the body.

Amputations either require replantation (attaching the amputee back) or stump formation. 

HOSPITAL STAY AND ACCOMODATION

It varies and is usually one day or sometimes a week in cases of extensive procedures. The simpler injuries like fractures, minor lacerations and tendon nerve repair can be dealt as Day care procedures or Inpatient. But the complex ones need inpatient stay.

COMPLICATIONS

• Stiff hand
• Infection
• Loss of tissue (graft/ flap failure)
• Loss of range of motion
• Malunion, delayed or non union in case of fractures

EXPECTED OUTCOMES

The return of hand function depends on many factors including the time of injury, the type of injury, management plan and hand therapy. The hand therapy plays an important role in return of the function and with proper exercises even hands with complex injuries can perform daily tasks. 

LONG TERM EFFECTS

• Psychological effect
• Long term hand therapy
• Arthritis
• Loss of partial function
• Need of other procedures for improvement of function

 

Written by :  Dr. Batool Urooj

Copyrights: Pakistan association of Plastic Surgeons