Injury and trauma to the hand can result in damage to the 27 bones (including the 8 bones of the wrist) or associated structures - muscles, skin, nerves, tendons, ligaments, joint cartilage, arteries, veins, and fingernails.
Injuries can be the result of a blunt force - such as falls and crushing injuries – or from sharp lacerations causing damage to skin, nerves, arteries and tendons.
Common hand injuries by age group
Adults - workplace, sport or home accident
Elderly - falls
Older Children – sport-related.
Toddlers – fractures and lacerations (common because they use their hands to explore)
Infants – Fingertip injuries
Common hand injuries explained
Fracture – this is just another word that means “broken bone”. The word fracture on its own does not describe how bad the broken bone is.
A fracture can be;
undisplaced – this can look like a crack in the bone.
displaced – this means that the fracture pieces have moved apart from each other. This can be minimally displaced (only moved by a little bit) or significantly displaced (where the pieces have either separated from each other or slipped along from each other).
This displacement can be in several directions.
The bones can be;
* “bent” - called angulation of the fracture.
* “twisted” – called rotation deformity.
* “separated” - leaving a gap between the bones.
Other types of fractures are -
* comminuted fractures - where the bones are broken into several pieces.
* open fractures (compound fractures) – where there is a laceration directly over the fracture, or the bones are coming through the skin.
* intra articular fractures - where the fracture goes into a joint.
* growth plate fractures – only occurring in younger patients with growing bones, this is where the fracture goes into or through the growth plate of the bone.
Treatment of fractures depends on multiple factors. Different types of fractures need different treatment. Sometimes no treatment of a fracture is required other than a splint/plaster and rest. Sometimes major surgery is required for a fracture if it needs to be reconstructed.
Dislocation – this occurs when two bones which are joined together at a joint become separated forcefully.
Tendon injuries – A tendon is a structure which moves a bone or joint, being pulled by a muscle. Sometimes these can be torn or cut. Tears of tendons tend to occur at the joint where they attach to bone, rather than in the middle of the tendon.
Ligament injuries – A ligament is a structure that holds two bones together at a joint. It stops the joint from becoming dislocated and it holds the joint steady when it is bending or moving. A forceful motion against a bone can tear a ligament, resulting in either an unstable joint or a dislocated joint.
What are the common causes of hand injuries?
Common sporting hand injuries – Fingers, hands and wrists are often injured in sporting activities, resulting in many different damage patterns. Fractures, sprains, dislocations, tendon injuries and ligament injuries are common. Some sports even have their own characteristic injuries that are named after the sport – e.g. skier’s thumb and football jumper tendon avulsion.
Fingers – although fingers are commonly injured in ball sports and the injury is often minor, sometimes they can be much more significant and require further treatment. A careful examination of the injured part is required, and in many cases additional investigations such as x-rays, CT scan, MRI scan or ultrasound may be required.
Tendon injuries, ligament injuries and dislocations all require specialist hand surgeon assessment. Not all of these will require surgery, but some will. The decision is made after the assessment of the patient and the results of the investigations. In many cases, the additional input of a qualified hand therapist is required.
Common home hand injuries;
sharp injuries - with knives, glass and exposed metal surfaces such as opened tins, roof materials and fences. A small cut to the skin can sometimes be deceptive and there may be underlying damage to important structures such as injury to nerves and tendons, which will need repair. A careful examination by a hand surgeon is needed to exclude this, as well as scans and x-rays. Sometimes exploratory surgery is required to exclude damage to these structures.
*blunt or crushing injury – due to fingers being caught between two hard or heavy surfaces and can lead to skin, bone or joint damage. Nail and nail bed injuries caused in this manner are common.
*burns to finger and hands occur from splashes of hot oil or fat or from inadvertent contact with hot surfaces.
*falls – often occurring in the elderly, resulting in fractures and dislocation of joints
Common workplace hand injuries – crushing-type injuries from heavy objects, power tool accidents causing multiple layer injury.
Common childhood hand injuries – fingers trapped in doors, fingers caught in moving objects such as bicycle chains. Cuts from glass and other sharp objects such as lid of a can.
Hand injuries surgery care
Perth hand injuries surgeon Dr Lewis Blennerhassett personally oversees your care from your first consultation through to full recovery. At your first visit, he will listen to your needs, discuss your requirements, concerns and risks, and an operative plan will be formulated specifically for you.
Next you will chat with our friendly practice manager – she will help you find a suitable date for your surgery and advise on necessary individual preparations.
If you are a smoker, it's highly recommended that you stop because smoking can impair the blood circulation in your hand and delay your recovery time.
Does hand injuries surgery require anaesthesia?
Some minor injuries can be repaired under local anaesthesia (patient is awake), with the injured area numbed with injections. However, many injuries will require general anaesthesia (patient is asleep) to allow thorough exploration and repair. This will be discussed with each patient individually, since there are many factors involved in making this decision.
Hand injuries surgeon Dr Lewis Blennerhassett ensures his hand surgery is performed only in fully accredited, fully equipped hospitals, with skilled anaesthetists, with the highest qualifications.
He only works in reputable hospitals and clinics that comply with the highest Australian standards of safety, cleanliness, infection control, staffing and equipment.
*This is general advice for general education and information purposes. Contact a qualified healthcare professional for any medical advice needed. Dr Blennerhassett will discuss your individual expectations, risks and recovery management with you. This does not contain all the known facts about this procedure or every possible side effect of surgery. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
Consultations with Dr Lewis Blennerhassett
During the pandemic, we have recently been conducting most of our consultations either over the phone or as a videoconference. This has been quite good for certain types of consultations, such as skin cancer reviews, and follow-up reviews of patients. However, many consultations really need to be performed face-to-face, such as certain cosmetic consultations, as well as hand examinations that require a physical examination.
At this time, seeing patients face-to-face for non-urgent conditions, such as many cosmetic conditions, is still not permitted or recommended across the board. However, we will be commencing limited consultations face-to-face for hand examinations as of 14/5/20, as well as some other certain situations, such as a condition where there is pain or disability.
Surgical procedures being performed now due to COVID-19 restriction changes
Dr Lewis Blennerhassett is continuing to perform emergency procedures, and some elective procedures at this time.
According to the Government Guidelines, elective surgery can take place if it is Category 1 (Surgery which needs to take place within 30 days to avoid an adverse outcome) or Category 2 (surgery which should take place within 90 days to avoid an adverse outcome).
Some Category 3 surgical procedures are also allowed at this time, such as IVF, procedures for patients under 18 years of age, joint replacements, cataracts and a few others.
From a Plastic Surgery perspective, this means that there has been a slight loosening of the restrictions on which procedures can be performed.
At the moment, as well as continuing with emergency surgery and cancer surgery, we are also starting to perform hand surgical procedures such as Carpal Tunnel Surgery and Dupuytren’s Surgery.
While my Subiaco Plastic Surgery rooms are still OPEN, to protect you and my staff and anaesthetist;
Join us on our Instagram and Facebook @DrLewisB and we will keep you up to date on how we are helping with the fight against the virus and when operating theatres will be open again.
Stay healthy and stay home and support healthcare workers going to work for you
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Shout out to my patients with post operative wounds who won’t be able to go into the water for a bit. I too love swimming and surfing but you need to know that it’s important for you to keep your wound dry and stay out of the water.
Read the Australian Society of Plastic Surgeons official statement and research into the risks of breast implant surgery.
Over the past few years Medicare has been assessing its schedule extensively and, as a result, many procedures in the plastic and reconstructive area, which had previously been partially claimable from Medicare, have been deleted or their criteria has been altered.