Episode 9: Hand Review with Dr. Vincent Ruggiero
Learning points:
Always Start with a good exam. Don’t forget to always inspect, palpate, test range of motion, test strength, and test sensation.
A boxers fractures is a 5th metacarpal neck fracture. Always remember to look for an overlying laceration. They are commonly associated with human bites and explore any open wounds for tendon injury. Tendon injuries are very time sensitive, and it’s helpful to use a tourniquet when exploring for tendon injury. Never repair a tendon in the ED! And always reduce and place into an ulnar gutter splint before giving the proper follow up.
For flexor tendon synovitis, know your Kanavel’s signs:
Finger is held in slight flexion.
Fusiform swelling over the affected tendon
Tenderness over the affected tendon.
Pain on passive extension of the affected finger.
And make sure you admit these patients for observation, IV antibiotic treatment, and debridement.
Fracture and Joint Reduction tips:
Over reduction injuries are very rare. Dont be afraid to push!
Make splints the correct size with the right indentations to ensure proper alignment
Always admit high pressure injuries if there is a solvent involved that isn’t water, these patients need to be observed and de-brided, and also admit ring avulsion injuries for hand surgery evaluation.
