Figure 12.1
Radiographs of a fifth metacarpal fracture
Figure 12.2
A proximal interphalangeal joint dislocation
What to Ask
- 1.
What is the neurovascular exam?
- 2.
Has the patient been given any numbing agent, and where? Local/digital/peripheral block?
- 3.
Is this an open injury? If so, immediate tetanus prophylaxis and antibiosis should be given.
- 4.
What is the mechanism of injury?
- 1.
Crush and avulsion injuries portend worse outcomes if salvage is performed.
- 2.
High-pressure injection injuries have a wide zone of injury and necrosis.
- 3.
Metacarpal neck fractures caused by self-inflicted trauma (i.e., punching) may indicate poor compliance.
- 4.
“Ring avulsion” injuries may have proximal neurovascular traction injury.
- 1.
- 5.
Is there a subungual hematoma? Treatment for distal phalanx fractures and subungual lacerations varies based on the presence and extent of nail plate injuries with concomitant hematoma.
- 6.
Does the patient smoke? Patent vascularity is important for tissue survival and treatment decision-making.
- 7.
Has anyone attempted reduction of the interphalangeal dislocation? Repeated reductions may increase swelling or cause entrapment of tissue in the joint preventing closed reduction. Failure of appropriate closed reduction may also indicate tissue incarceration necessitating open treatment.
What to Request
- 1.
Patient should be immobilized until you arrive.
- 2.
Open soft tissue injuries should be dressed in wet gauze.
- 3.
Analgesia for comfort.
- 4.
Local anesthetic (e.g., lidocaine) for local or peripheral nerve block that you will perform.
- 5.
Ensure that no one has locally or digitally blocked the digit prior to your arrival.
- 6.
If an amputation has occurred, ask that the amputated tissue be wrapped in moist gauze and placed on ice.Related posts:
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