Hand Trauma, Dislocations and Fractures, Infections

Summary

The goal in the treatment of a hand trauma or a hand infection is full and rapid restoration of hand function. The main complication is stiffness, which may be of articular origin, or result from ligament shortening, from adhesions within the gliding planes or along the tendons or the consequence of intrinsic tightness or algodystrophy. Understanding the precise cause of stiffness in a particular case allows the instauration of an efficient prevention. Most ligament injuries result from sporting accidents, and the proximal interphalangeal joints of the long fingers and the metacarpophalangeal joint of the thumb are particularly at risk. The principles of treatment of hand fractures are anatomical reduction, followed, when possible, by immediate mobilization and, if necessary, by immobilization of the injured finger in the “protective” position, minimizing that support period as much as possible, and remobilization when the fracture is clinically stable. The indications of replantation include amputation of the thumb, amputation of multiple digits, single-digit amputation distal to the insertion of the flexor digitorum superficialis, amputation in a child, and amputation through the palm, the wrist, or the forearm. Most hand infections result from direct contamination from a penetrating injury or a laceration.