• Mutilating Hand Injuries

    (Hand Trauma; Hand Injury)

    Definition

    A mutilating hand injury is severe damage to the hand. The injury may include damage to bones, tendons, soft tissues, nerves, and skin. It can become a life-threatening condition.
    If you have this type of injury, call 911. Untreated, this can lead to a serious infection. Immediate care will also decrease the chance of further damage.

    Causes

    Mutilating hand injuries can be caused by a variety of factors, including:
      Industrial accidents
      • Machine injuries
      • Power tool injuries
    • Crushing accidents
    • Burns
    • Chemical exposure
    • Car accidents
    • Farming injuries

    Risk Factors

    This type of hand injury is the result of an accident. There are no known risk factors that increase your chance of this injury.

    Symptoms

    This injury is obvious. Bone, tendons, skin, nerves, and soft tissue may all be damaged. Common symptoms include:
    • Excessive bleeding
    • Amputation of hand or fingers
    • Ripped skin
    • Skin loss
    • Open wound
    • Exposed bone or tendons
    • Pain
    Severe Hand Trauma
    hand trauma
    Copyright © Nucleus Medical Media, Inc.

    Diagnosis

    When you are brought to the emergency room, a doctor will quickly assess your injury. Your wound will be inspected and your hand’s nerves and tendons will be tested. You will be asked to explain how the injury happened. You will also be asked which of your hands is dominant.
    Tests may include the following:
    • X-rays —test that uses radiation to form an image; used to assess damage to the hand bones
    • CT scan —a type of x-ray that uses a computer to form an image; used to assess damage to the hand bones
    • MRI scan —test that uses magnetic waves to form an image; used to assess damage to the hand bones and nerves
    • Examination of injury under anesthesia
      • Anesthesia is given so the doctor can closely examine your wound
      • Debris or dirt will be removed

    Treatment

    Immediate treatment is focused on stopping any bleeding. The doctor will make sure your vital signs are stable. An IV will be started to give you fluids and medicines. You may be referred to a hand specialist for surgery. Depending on your injury, you may receive the following treatment:

    Tetanus Shot

    This will protect you from a tetanus infection.

    Medications

    The following types of medication may be given:
    • Pain medications
    • Anesthesia to examine the wound closely
    • Antibiotics to prevent a wound infection

    Wound Irrigation

    Sterile saline is used to clean the wound. This will help prevent infection and further injury.

    Hand Surgery

    You may need to have immediate surgery. If your injury is less severe, your hand will be dressed and splinted. You will have a follow-up visit with a hand surgeon.
    The type of surgery necessary depends upon the injury. Examples include fusing damaged joints and reattaching fingers. Often, several surgeries are necessary for this type of injury.

    Rehabilitation

    You will likely need physical therapy to regain strength and movement in your hand. You may also work with an occupational therapist to learn how to function with your injured hand.

    Prevention

    To help reduce your chance of injuring your hands, take the following steps:
    • Do not operate machinery that you are unfamiliar with.
    • Follow all safety instructions when operating tools or machinery. Be especially careful when using snow blowers and lawn mowers. These commonly used tools result in many hand injuries each year.
    • Do not put fingers or hands near moving parts of machinery.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org

    American Society for Surgery of the Hands http://www.assh.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Foundation http://www.canorth.org/

    The Canadian Society of Plastic Surgeons http://www.plasticsurgery.ca/

    References

    Fingertips Injuries/Amputations. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00014&return%5Flink=0 . Updated August 2011. Accessed October 15, 2012.

    Hammig B, Jones C. Injuries related to snow blowers in the United States: 2002 through 2008. Acad Emerg Med. 2010;17(5):566-569.

    Kamrani RS, Mehrpour SR, Aghamirsalim MR. High-pressure plastic injection injury of the hand: case report. Occup Med (Lond). 2011 Aug 8.

    Snowblower and lawnmower Injuries. American Society for Surgery of the Hands website. Available at: http://www.assh.org/Public/HandConditions/Pages/SnowblowerandLawnmowerInjuries.aspx . Accessed October 15, 2012.

    Neumeister MW, Brown RE. Mutilating hand injuries: principles and management. Hand Clinics . 2003;19:1-15.

    Tintinalli JE, Kelen GD, Stapczynski JS. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide . 6th Ed. United States: The McGraw-Hill Companies; 2004; Chapter 268, Injuries to the Hand and Digits.

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