Disease Description (Causes and Symptoms)
- Definition: Hand trauma refers to trauma occurring in the hand, in which the skin and soft tissue, tendons, nerves, blood vessels, bones, and joints may be injured individually or in combination.
- Major causes: Occupational accidents, household and kitchen accidents (glass, knives), sports injuries, traffic accidents, falls, crush injuries, and more.
- Summary of pathophysiology: Depending on the mechanism of injury (amputation, abrasion, crushing, ligament or tendon rupture, fracture, etc.), soft tissue, vascular, and nerve damage may occur. This can lead to tissue necrosis, bleeding, infection, abnormal joint fusion, and fibrosis (adhesion), potentially resulting in loss of function.
- Typical symptoms: Local pain, swelling, deformity (in cases of fracture or dislocation), impaired movement (inability to bend or extend), loss of sensation (nerve injury), bleeding, and visible foreign bodies or exposed bones or tendons in the wound.
Treatment Methods
- First aid (initial treatment)
- Control bleeding (apply pressure). If bleeding cannot be stopped, provide first aid and immediately transfer the person to a medical institution.
- Clean contaminated wounds with saline or a similar solution. Professional treatment is recommended when removing foreign bodies.
- If a fracture is suspected, avoid unnecessary manipulation, immobilize the injured area, and transfer the person to a medical institution.
- In cases of rupture or amputation, if possible, wrap the amputated tissue in sterile gauze, cool it, and transport it together with the patient (significant arterial injury is time-sensitive).
- Diagnostic approach
- Assess nerves (sensation), muscle strength (movement), and vascular perfusion (color and capillary refill time).
- Use radiographic examination (X-ray) to identify fractures and joint dislocations; CT or ultrasonography may be performed when necessary (for tendon and vascular assessment), and CTA or angiography may be performed when vascular injury is suspected.
- Non-surgical treatment
- For simple abrasions, closed fractures, and partial tendon injuries, treatment may include disinfection, suturing, cast or splint immobilization, antibiotics (for contaminated wounds), analgesics, and tetanus prevention.
- Early physical therapy (to prevent joint stiffness) and use of an orthosis.
- Surgical treatment
- Surgical repair (reduction and fixation, tendon repair, microsurgical nerve and vascular anastomosis, skin reconstruction, and flap surgery) is performed for open fractures, complete tendon transection, nerve transection, arterial injury, severe soft-tissue defects, and distal amputation (when replantation is required).
- Microsurgery (microsurgical replantation) may be necessary to preserve function in cases of amputation or severe crush injury.
- Medications and other treatments
- Consider broad-spectrum antibiotics when wounds are contaminated (open wounds, water, rust, contaminants, etc.), as well as analgesics and anti-inflammatory medications when necessary.
- Check preventive tetanus vaccination status and provide a booster vaccination when necessary.
- Rehabilitation and follow-up care
- Early rehabilitation after surgery or conservative treatment is important (to restore joint range of motion, prevent tendon adhesions, and recover muscle strength).
- Monitor for complications such as wound infection, adhesions, joint stiffness, and chronic pain.
- Precautions (points to note during treatment)
- Emergency transfer is necessary when vascular or nerve injury is suspected (delays may lead to poor recovery).
- Contaminated wounds have a high risk of infection and require appropriate cleaning, antibiotics, and surgical debridement.
- Even small bone fractures can significantly affect function, so a detailed evaluation is necessary.
Checklist Before an Outpatient Visit (Including Preparation and Example Questions)
- Items to bring (recommended)
- A list of current medications (including anticoagulants and antithrombotic agents), allergy history (especially medication and latex allergies), history of previous surgeries and trauma, results of previous imaging examinations (CD or photographs, if available), tetanus vaccination status, photographs of the wound (initial appearance, if possible), and the time, cause, and course of the injury (a detailed record of how it happened).
- Symptom records (useful during the consultation)
- Severity of pain (onset, continuous or intermittent), sensory changes (numbness or tingling), movement limitations (which movements are impossible), presence and amount of bleeding, and signs suggestive of infection (fever, pus, or redness).
- Self-care instructions before visiting a medical institution
- Visit the emergency department if bleeding does not stop. Seek emergency care immediately in cases of severe deformity, amputation, persistent pain, loss of sensation, or loss of blood flow (paleness or coldness).
- Cover the wound with clean gauze and minimize movement. Do not remove contaminated materials with your hands.
- Example questions (to submit to or use as a reference for the doctor during the consultation)
- Could my current medications cause problems with surgery or anesthesia?
- Do I need antibiotics or additional diagnostic tests (CT or ultrasonography) for this wound?
- What is the recovery period, and when can I expect to return to my daily activities?
Examples of General Questions to Ask the Doctor
- Is surgery absolutely necessary for this injury, or is conservative treatment possible?
- What is the expected recovery period and rehabilitation plan (number and duration of physical therapy sessions)?
- What are the major complications of the surgery or treatment, and how can they be prevented?
- If I am currently taking medication (for example, an anticoagulant), will the treatment plan change?
Examples of Questions Tailored to the Disease
- Nerve or tendon damage is suspected. If nerve or tendon repair is necessary, to what extent can sensation and motor function be expected to recover? (Please explain the expected timeline and prognosis.)
- How is the possibility of replantation (microsurgical replantation) of the amputated part determined? I would like to know the success rate of replantation and the limitations of subsequent functional recovery.
Emergency signs (immediate emergency department or hospital visit recommended): Uncontrolled bleeding; the hand or finger is pale, cold, numb, or has no pulse; severe deformity (exposed bone or tendon); amputated or severely ruptured tissue; or a wound accompanied by a high fever and thick pus (purulent discharge).