Hand injuries are always serious problems and should be seen by a specialist hand surgeon. This is not because surgery is frequently necessary, in fact the opposite holds true, the reason is that all hand injuries require multi-disciplinary rehabilitation from day one in order to prevent disasterous complications such as stiffness.
Finger dislocations are injuries which are often underestimated in their severity.
Fractures of any of the 27 hand bones can potentially be treated without surgery if the bone pieces are undisplaced. This involves frequent X-ray surveillance, based on the fact that all hands with fractures should be moved early with hand physiotherapy, often in combination with judicious splint use, provided by hand occupational therapists. This results in excellent functional outcomes in truly stable fractures, but it may lead to displacement of potentially unstable fractures. If this is not actively looked for and acted on, a deformed, stiff hand with joint arthritis will inevitably result. The fine line between surgical and non-surgical treatment must be negotiated with care because unnecessary surgery may worsen the situation. Required surgical procedures should be carried out by specialist surgeons with meticulous soft tissue management and training in microsurgery. Rehabilitation requirements post surgery remain similar to those for non-surgical management and early movement and physiotherapy is of paramount importance.
Hand trauma may often result in soft tissue (tendons, ligaments, muscles, nerves and blood vessels) injury only, with no associated fractures. This is always the case with open wounds, but may often occur with closed injuries as well. These are by no means lesser problems and the idea that there is nothing serious wrong because the X-ray is normal could not be further from the truth. Unfortunately, these injuries are often under diagnosed, not least due to the difficulty examining the acutely injured hand. The early management of open hand wounds in order to prevent wound infection and to allow for early diagnosis, special imaging investigations (ultrasound scan, MRI) if required and possibly early surgical intervention or conservative treatment with appropriate splintage and physiotherapy is imperative.
Due to the intricate tendon and ligament balance that exists in the uninjured hand, injuries of one- or a few of these structures can result in imbalances, which my be difficult or impossible to treat if diagnosed late and may lead to disabling deformities and/or stiffness. Because ligaments and tendons are mobile structures which move relative to the other soft tissue structures, microsurgical repair with immaculate soft tissue management as well as specialised physiotherapy and occupational therapy input is imperative so that adhesions may be avoided.
Specific fractures which are frequently managed by us are scaphoid fractures, wrist fract fractures and the various finger fractures.
The scaphoid Is one of the intricately interlinked carpal bones and may be broken from a fall onto the outstretched hand. These fractures are often not visible on the first X-ray after the accident and this may lead to the injury being mismanaged, often resulting in rapid onset wrist arthritis. While most scaphoid fractures may be treated in a plaster cast or brace, displaced fractures require surgery. With the advent of minimally invasive surgical procedures, more and more patients are opting for fixation of minimally displaced fractures in order to forego lengthy periods in plaster casts.
Carpal ligament tears, most frequently between the scaphoid and the lunate bone may occur with a similar mechanism of injury instead of a fracture. Dislocation of the carpal bones may also occur. These injuries are also frequently missed because there are no fractures on the X-ray. Surgery is always required.
Wrist fractures range from mild to severe and may be associated with dislocations and/or carpal injuries. They are one of the most common osteoporotic fractures and growth plate injuries of the wrist are amongst the most frequent injuries in children. Treatment again depends on fracture type, patient age as well as expectation. While surgery is in some cases inevitable, mostly treatment may be individually tailored to patient needs.
Finger fractures are again examples of injuries that require individual assessment in order to plan treatment. Sometimes surgery is inevitable, in all other cases, early movement is initiated and if this leads to fracture displacement, surgical reduction and stabilisation becomes necessary.
